OBJECTIVES:To describe local adaptations of materials derived from evidence-based recommendations in a training programme in rheumatoid arthritis (RA).METHODS:The eRA (evolving the management of rheumatoid arthritis) programme generated shared decision-making practises and a checklist for managing comorbidity in RA, among others, at the international level. Unmet needs in RA management were first identified and prioritised. Then educational materials were designed and developed to address these gaps. These materials were evaluated in detailed and discussed in small regional groups by practicing rheumatologists. Voting, open discussions and recommendations were extracted from the meetings.RESULTS:Thirty-five Spanish rheumatologists discussed a comorbidity checklist and a shared decision-making tool. The results of the local meetings were synthesised as (1) a judicious commitment to check agreed comorbidities, and (2) a list of barriers and facilitators for the implementation of shared decision making in the local settings. With regards to ways to implement the agreed list and periodicity, two issues stand-out: (1) patient education and (2) the need of easy access to information and the use of local organisational systems in place. With respect to shared decision-making, issues raised included messages for self-awareness, challenges, and practical facilitators.CONCLUSIONS:Discussion, adaptation, and planning are needed before implementing any evidence-based recommendation and materials if we want to achieve a successful implementation. Further studies should demonstrate whether this initiative was successful in achieving the goals of improved patient care. Our experience could be used as a guidance or example for implementation elsewhere.

There are few published data regarding physician’ and patient’ perception of the disease control for ankylosing spondylitis (AS) and psoriatic arthritis (PsA).To evaluate the relationship between physician’ and patient’ disease control perception compared to clinical outcomes for controlled disease (BASDAI<4 in AS or DAPSA≤14 in PsA).MIDAS is an observational, non-interventional, cross-sectional, multicenter study. Patients ≥18 years with ≥6 months AS or PsA diagnosis according to ASAS and modified New York criteria or CASPAR criteria, respectively, undergoing treatment ≥3 months before inclusion. The endpoint of this analysis was the relationship between disease control perception by physicians and patients and disease control (BASDAI<4 in AS or DAPSA≤14 in PsA).313 AS patients included: 75.7% male, 78.5% HLA-B*27+, a mean (SD) age of 50.4 (12.0) years, a mean (SD) disease duration of 15.5 (11.6) years and a mean (SD) CRP of 5.1 (8.2) mg/l. 313 PsA patients included: 54.3% male, 17.95% HLA-B*27+, a mean (SD) age of 54.1 (12.2) years, a mean (SD) disease duration of 10.5 (9.0) years and a mean (SD) CRP of 4.91 (7.3) mg/l. AS group: in 95.5% of AS patients with BASDAI<4, physician’s perception matched the clinical evaluation, while only 42.3% of the patients with BASDAI≥4 matched physician’s perception. Positive Predictive Value (PPV) was 75.1%, Negative Predictive Value (NPV) was 83.9% and precision was 76.7%. Patients perceived their own disease as controlled in 95.0% of cases with BASDAI scores <4 and as not controlled in 29.7% of cases with BASDAI score ≥4. PPV was 71.1%, NPV was 76.7% and precision was 71.9%. The same trend was observed when assessing disease control through ASDAS-CRP index. PsA group: in 96.2% of patients with DAPSA≤14, physician’s perception matched the clinical evaluation, while only 47.6% of patients with DAPSA>14 matched the physician’s perception. PPV was 73.1%, NPV was 89.6% and precision was 76.4%. Patients perceived their own disease as controlled in 93.5% of the cases with DAPSA scores ≤14 and as not controlled in 32.3% of the cases with DAPSA>14. PPV was 66.8%, NPV was 77.4% and precision was 68.4%. The same trend was observed when assessing disease control through the MDA criteria (Table 1).Table 1.Physician’s and patient’s perception of the disease control related to disease control variables in AS and PsAControlled disease by physician’s perception?Controlled disease by patient’s perception?Valid NYesN (%)NoN (%)Valid NYesN (%)NoN (%)ASDisease control(BASDAI)Controlled(BASDAI<4)202 (100%)193 (95.5%)9 (4.5%)202 (100%)192 (95.0%)10 (5.0%)Not controlled(BASDAI≥4)111 (100%)64 (57.7%)47 (42.3%)111 (100%)78 (70.3%)33 (29.7%)Disease activity(ASDAS-CRP)Inactive(ASDAS-CRP<1.3)92 (100%)90 (97.8%)2 (2.2%)92 (100%)91 (98.9%)1 (1.1%)Active(ASDAS-CRP≥1.3)221 (100%)167 (75.6%)54 (24.4%)221 (100%)179 (81.0%)42 (19.0%)PsADisease control(DAPSA)Controlled(DAPSA≤14)186 (100%)179 (96.2%)7 (3.8%)185 (100%)173 (93.5%)12 (6.5%)Not controlled(DAPSA>14)126 (100%)66 (52.4%)60 (47.6%)127 (100%)86 (67.7%)41 (32.3%)Active disease (MDA)Inactive(MDA criteria ≥5)161 (100%)154 (95.7%)7 (4.3%)160 (100%)152 (95.0%)8 (5.0%)Active(MDA criteria<5)151 (100%)91 (60.3%)60 (39.7%)152 (100%)107 (70.4%)45 (29.6%)AS, ankylosing spondylitis; ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score- C-reactive protein; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; DAPSA, Disease Activity in Psoriatic Arthritis; MDA, Minimal Disease Activity; PsA, psoriatic arthritis.A higher agreement between physician’s and patient’ perception with the current clinical evaluation was observed when patients were controlled. MiDAS study showed that in real clinical practice in Spain, physicians perceived more disease control than the patientsWe thank to MIDAS group investigators and patients included in the study.José Luis Pablos Speakers bureau: Janssen, Pfizer, Lilly, Novartis, Roche, Celgene, Bristol, Abbvie, Sanofi, Consultant of: Janssen, Pfizer, Lilly, Novartis, Roche, Celgene, Bristol, Abbvie, Sanofi, Gilead, Galápagos, Xavier Juanola Speakers bureau: Novartis, Abbvie, Pfizer, Lilly, Consultant of: Novartis, Lilly, Abbvie, Ceferino Barbazán Speakers bureau: Sanofi, Pfizer, Novartis, Amgen, Abbvie, Roche, Galápagos, Lilly, BMS, Biogen, UCB, Consultant of: Sanofi, Pfizer, Novartis, Amgen, Abbvie, Roche, Galápagos, Lilly, BMS, Biogen, UCB, María L. García Vivar Speakers bureau: Lilly, Novartis, Pfizer, Amgen, Bristol, Abbvie, Sanofi, Janssen and UCB, Consultant of: Lilly, Novartis, Pfizer, Amgen, Bristol, Abbvie, Sanofi, Janssen and UCB, Ana Cruz Valenciano Speakers bureau: Novartis, Consultant of: Novartis, Carlos Rodriguez-Lozano: None declared, Maria Estadella Employee of: I’m employed at Syneos Health providing services for Novartis., Ana Venegas Employee of: employee at Novartis, Cristina Sanabra Employee of: Novartis employee, Carlos Sastré Employee of: Novartis employee.

Background Giant cell arteritis (GCA) is a large vessel vasculitis that has a special predilection for extracranial branches of the external carotid artery. Among its most fearsome complications is visual affectation. Tocilizumab (TCZ) is a monoclonal antibody directed against the interleukin 6 receptor that has shown utility in the treatment of GCA. Objectives Our aim was to assess the evolution of visual clinic in patients with GCA treated TCZ. Methods Retrospective multicentre study of 20 GCA patients with visual involvement treated with TCZ. The efficacy of this drug on visual symptoms was evaluated. Results We evaluated 20 patients (14 women and 6 men) with a mean age ±SD of 73.7±10.1 years with GCA and visual symptoms. In total there were 23 affected eyes. The symptoms reported were: unilateral blindness (n=6), unilateral blurred vision (n=6), unilateral amaurosis fugax (n=3), unilateral hemianopsia (n=2), bilateral blindness (n=1), bilateral blurred vision (n=1), bilateral hemianopsia (n=1). Before starting treatment with TCZ all patients had received high doses of prednisone, with a mean ±SD of 54.2±13.8 mg/day (range of doses: 40–80 mg/day). In addition, 9 of them also received intravenous corticosteroid boluses. In addition, 13 patients received traditional immunosuppressants: methotrexate (MTX) (n=12), cyclophosphamide (n=2), leflunomide (n=1) and azathioprine (n=1). Regardless of corticosteroids, TCZ was administered as monotherapy in 14 patients, while in 6 it was administered in combination with MTX. The TABLE shows the evolution of the visual affectation of these patients. Throughout a median follow-up [RIC] of 94–18 months, none of the 7 patients who had a blindness regained vision. The 2 patients who presented unilateral hemianopsia recovered vision. The patient with bilateral hemianopsia and the patient with bilateral blurred vision experienced a partial improvement. The rest of the patients achieved a complete recovery. Conclusions Although TCZ seems to be also useful in the treatment of visual manifestations of ACG, once blindness is established, it does not seem to be effective. Disclosure of Interest None declared

Background Chronic inflammatory arthropaties-CIA (RA-rheumatoid arthritis, PA-psoriatic arthritis, and AS-ankylosing spondylitis) cause functional disability and reduces health-related quality of life (HRQoL) of patients1 Objectives To evaluate HRQoL in patients with CIA and biologic therapy (BT), as a measure of patient reported outcome. Methods Descriptive cross-sectional study (August 2014) in a tertiary hospital. Inclusion criteria:a)adult patients with RA, PA, SA and other CIA (O) attended at the Rheumatology Service and b)≥2 months of treatment with BT (sc/iv adalimumab-ADA, sc/iv etanercept-ETA, iv infliximab, sc golimumab, sc certolizumab, sc/iv abatacept, sc/iv tocilizumab or iv rituximab). Sociodemographic and clinical variables were obtained by structured interview and review of medical record.Degree of disease activity measures: DAS28 index (≤3.2:low activity; >3.2-≤5.1:moderate; >5.1:high) for RA and PA peripheral; BASDAI (<4:low activity ≥4:high activity) for AS and PA with predominant axial involvement. HRQoL was mesured by a self-administered questionnaire:EQ5D-5L2. It evaluates 5 dimensions:mobility (M), self-care, usual activities (UA)pain/discomfort (PD) and anxiety/depression. Each dimension has 5 levels of severity. A HRQoL score is obtained (EQ-index) from 0 (death) to 1 (full health). It also has a visual scale (EQ-VAS) of global health from 0 (the worst health) to 100 (the best health). Descriptive and multiple linear regression analysis (LRA) were performed to determine which variables contributed on HRQoL. Results A total of 382 patients were eligible for the study.314 patients agreed to answer the questionnaire (women:55.7%, average age (±SD): 55.2±13.9 years, average disease duration (±SD):13.05±8.1 years). Pathologies distribution: 44.3% RA, PA 26.1%, 21.3% AS, 8.3% O. BT: 51.9% ADA, 28.7% ETA and 19.4% others. 65.9% of patients had a first line of TB. 50% of patients had concomitant drug (corticosteroid/methotrexate/leflunomide). 71.7% of patients had low activity, with standard drug regimen (61.8%) and optimized regimen (37.6%). The EQ-index perceived was:0.73±0.22 and a global health EQ-VAS: 64.2±21.0 points. The worst rated questionnaire dimensions (severities 3–4-5) were P (33.7%), UA (29.9%) and M (26.7%). LRA showed significance differences (p<0.001) for disease activity, disease duration and education. 0.4 and 9.05 EQ-VAS points were reduced for each year of evolution and each DAS28 point increase, respectively. Differences were not significant for age, sex, pathology, drug or line number. Conclusions Generally, patients evaluated have a good control of disease activity and an acceptable HRQoL perceived. Chronic P and loss of autonomy to perform UA are the worst rated dimensions References Gerhold K, Richter A, Schneider M, Bergerhausen HJ, Demary W, Liebhaber A, et al. Heailth-related quality of life in patients with long-standing rheumatoid arthritis in the era of biologics: data from the German biologics register RABBIT. Rheumatology.2015; 54:1858–66. Rabin R, de Charro F. EQ-5D:a measure of health status from the EuroQol Group. Annals of Medicine. 2001; 33:337–43 Disclosure of Interest M. Άlvarez-Payero: None declared, F. Maceiras: None declared, R. Melero: None declared, C. Mouriño: None declared, A. Martin: None declared, M. Rodríguez-Rodríguez: None declared, M. Ucha: None declared, N. Martínez: None declared, I. Hernandez: None declared, C. Barbazán: None declared, M. Rodríguez: None declared, V. Balboa: None declared, J. Uña: None declared, G. Piñeiro Grant/research support from: Pfizer, J. Pego Grant/research support from: Pfizer

Objectives Analyze the potential relationship between the risk of hip fracture and the results of the scales Elderly Patient Global Rating geriatric patients. Methods Retrospective and descriptive study of a random series of 120 patients over 75 years attending emergencies in the University Hospital of Vigo in the year 2013 with a diagnosis of hip fracture. Data collected from medical records that refer to the functional, mental and social value at the time of the event are analyzed. Results Of the 120 patients analyzed in the study, 92 were women (76.6%) and 28 males (23.3%) with a mean age of 84.53 years. Considering the Elderly Patient Global Assessment in the functional area, according to the scale of disability of the Red Cross in terms of ambulation is concerned, we classified our patients in 6 degrees: grade 0 (normal walking) on 30.83% of patients; Group 1 (wanders with some difficulty) 27.5%; Grade 2 (roams using cane or similar) 17.5%; Grade 3 (roams helped at least one person) 10.83%; Grade 4 (roams helped with extreme difficulty, two people) 6.67%; and grade 5 (immobilization in bed or chair) 6.67%). Regarding the mental sphere in 75% of our patients any cognitive decline is not evidence. Only 10% of them were institutionalized at the time of the fracture. Conclusions In this series of 120 elderly patients a direct relationship between hip fracture by low-impact crash, and functional, mental and social situation is evident; being at greatest percentage of fractures, those elderly who have difficulty walking or in need of a single support, without any cognitive impairment and who live in residence. Disclosure of Interest None declared

Background Daily clinical practice not always corresponds with the standard use of biologic therapies (BT) in rheumatic patients.st Objectives To determine the real vs. theoretical annual cost of BT per patient with chronic arthritis at a University tertiary Hospital. Methods Descriptive, observational, retrospective and cross-sectional study. Information over a 5-year period (2009-2014) is collected. Inclusion criteria: a) adult patients with RA (ACR), AE (New York modified/ASAS) or PsA (CASPAR) attended at the Rheumatology Service of the University Hospital of Vigo and b) >6 months of treatment with BT. Variables: a)demographics, b)clinical, c)pharmacotherapeutic history and d)per each BT: number of dispensations, adverse events, therapeutic failures, transitory or definitive discontinuation, survival of each BT line, real and theoretical (price to retailer) annual cost/patient of each BT line. Variables are described per disease and BT. Results 484 patients were studied (total: 755 BT lines). Mean age (years): 53.8±14.8; females: 263 (54.3%). The diseases treated were RA 226 (46.8%), AE 107 (22.2%), PsA 117 (24.2%) and other spondyloartrhopaties 33 (6.8%). Mean disease duration (years): 13.1±8.2. Mean global BT duration (months) from the beginning of the evaluation (January 2009) was: 40.9±58.9. The table shows the different BT lines used and their mean duration (months) from that date. There were 359 (47.4%) definitive withdrawals of BT, being secondary failure 156 (43.4%) and adverse events 82 (22.8%) the most frequent reasons. There were 94 (12.4%) temporal discontinuations of doses of BT. The most frequent reasons of temporal discontinuations were surgery 13 (13.8%) and non-infectious adverse events 12 (12.8%). There was modification of BT doses by optimization in 236 (31.2%) BT lines. The number (%) of patients optimized per disease was: RA 77 (34.1%), AE 35 (32.7%) and PsA 44 (37.6%). The mean duration (months) of optimization was: RA 42.0±12.7; AE 22.9±20.0 and PsA 21.9±18.2. There was modification of BT doses by intensification regimes in 24 (3.2%) of the BT lines. The number (%) of optimizations and intensifications of each BT and the mean duration (months) of optimization of the 3 more used BT are shown in the table. The mean theoretical global BT cost per year of treatment was 12,569€ ±1,707. The mean real global cost per year was 11,167€ ±3,266. The mean real and theoretical annual cost and its ratio, for the 3 more used BT are shown in the table. The mean theoretical annual cost per the 3 main diseases was: RA 12,538€ ±1,509; EA 12,703€ ±1,536 y APs 12,647€ ±1,165. The mean real annual cost per disease was: RA 11,400€ ±2,988; AE 10,993€ ±3,024 and PsA 10,870€ ±2,797. The annual real/theoretical cost ratios per disease were: 91.4, 87.6 and 86.5%, respectively. Conclusions In daily practice there are different reasons that make that BT use differs from the standard recommendations. This makes that the real cost usually is less than the theoretical one. The detailed analysis of our data will give us relevant information about the factors that determine these variations and their involvement on the pharmaceutical cost. Disclosure of Interest J. M. Pego-Reigosa Grant/research support from: Pfizer, M. Ucha: None declared, F. Maceiras: None declared, R. Melero: None declared, M. Άlvarez: None declared, C. Mouriño: None declared, A. Martín: None declared, M. Rodríguez: None declared, M. Rodríguez: None declared, V. Balboa: None declared, J. Uña: None declared, I. Hernández: None declared, C. Barbazán: None declared, G. Piñeiro Grant/research support from: Pfizer, N. Martínez: None declared

Four patients with a previous inflammatory rheumatic disease developed a peripheral tuberculous (TB) arthritis in a joint apparently affected by a rheumatic disease. The single most important factor in the diagnosis of TB was the presence of past or present pulmonary TB or a family history on a background of steroid use. Clinical presentation, disease evolution, and routine laboratory tests were unhelpful. The most effective method of diagnosis was synovial biopsy.