BACKGROUND:Gender disparities in rheumatology persist despite increasing female representation. This comprehensive global survey, conducted by the Coalition for Health and Gender Equity (CHANGE) group, examined preferences for gender equity interventions among rheumatology professionals. METHODS:A cross-sectional online survey of rheumatologists and allied health professionals was conducted across 105 countries (January 2023-May 2024). Intervention preferences spanned four domains: conference-based, organizational, skills training, and work-based strategies. Gender differences were evaluated using logistic regression adjusted for years of work experience, with subgroup analyses by Human Development Index (HDI), Gender Inequality Index (GII), professional role, and caregiving responsibilities. Multiple comparisons were adjusted using Benjamini- Hochberg correction for false discovery rate. RESULTS:Among 1945 respondents (66.4% female), the most widely endorsed interventions overall were family- and child-friendly conference policies (71.4%), communication and scientific writing training (52.6%), and engagement of national rheumatology groups (46.9%). Women demonstrated significantly stronger support for increasing the visibility of female role models (11.89% vs 5.81%, OR = 3.29, p < 0.01), establishing gender-balanced committees (17.66% vs 16.01%, OR = 1.76, p < 0.01), and gender-sensitive editorial board policies (12.70% vs 10.66%, OR = 1.77, p < 0.01). Respondents from higher-GII countries prioritised scientific writing masterclasses (OR = 4.58, p < 0.05) and career planning training (OR = 3.90, p < 0.05) but showed lower endorsement of unconscious bias training (OR = 0.48, p < 0.05) and male allyship programmes (OR = 0.42, p < 0.05). Women in low/middle-HDI countries more frequently selected grant writing support (40.3% vs 26.4%, p < 0.01). CONCLUSION:Gender equity intervention preferences vary systematically across contexts. These findings provide empirical foundations for developing culturally responsive, evidence-informed intervention frameworks to advance gender equity in rheumatology.

Purpose:To seek recommendations from a panel of experts in psoriatic arthritis (PsA) on the current management challenges, local practices, and role of interleukin (IL)-17 inhibitors in the United Arab Emirates (UAE) using evidence from phase III trials as background. Methods:Nine rheumatologists who treat PsA in the UAE completed a structured survey and attended a meeting to discuss topics/issues identified in the survey. A literature search was performed to identify phase III randomized trials of IL-17 inhibitors available in the UAE for PsA. Results:There was general agreement among the panel on the most common PsA domains presenting in patients (most commonly psoriasis [75-95% of patients], peripheral arthritis [50-90%], and enthesitis [40-90%]). In general, IL-17 inhibitors were among the preferred treatment options for managing PsA, particularly for patients with axial-, enthesitis-, or psoriasis-related symptoms. Current unmet needs and challenges included a lack of disease awareness among the general population and other healthcare professionals; the lack of a single medication to cover all domains/comorbidities; and lack of universal insurance coverage. The panel had experienced success with the IL-17 inhibitors ixekizumab and secukinumab, with many citing no preference for either agent. The literature search identified publications relating to 10 key phase III clinical trials of IL-17 inhibitors. Conclusion:The panel advocates for the use of the domain-based Group for Research and Assessment of Psoriasis and Psoriatic Arthritis treatment recommendations and generally considers IL-17 inhibitors (ixekizumab or secukinumab) as the preferred treatment options for managing PsA.

Background: Shortage of Rheumatologists worldwide results in long delays in diagnosis and poor outcomes for patients. At the same time the world is seeing an unprecedented rise in Artificial intelligence language models which have been able to diagnose complex medical cases outperforming human readers [1]. Objectives: To evaluate consecutive new referrals to a Rheumatology clinic both by Rheumatologists and by Proprietary Rule Engine and AI GPT4. Methods: Symptoms and available lab tests of consecutive new patients were fed into the engine developed by Algorithm Health Ltd (AHL) who have developed a proprietary medical rule engine that combines pattern recognition and algorithmic assessment of the parameters used for the classification.The rule engine has included symptoms and lab test results and each were given specific weightages linked to individual diseases. The model also looks at the input data to assess from the overall pattern of the parameters, the appropriate diagnosis which the data would best fit. The system is capable of handling large volumes of data near instantly and providing the required output. In addition the data was fed into Chat GPT4 AI models to generate a diagnosis.Patient data was anonymized and the data scientists were blinded to the Rheumatologists diagnosis. We also obtained diagnosis from a second Rheumatologist who was similarly blinded to initial diagnosis. Results: Results A total of 100 new patients presented to the clinic between November 20th 2023 to January 5, 2024.The AHL Rule Engine and AI Chat GPT 4 presented 3 differential diagnosis based on the symptoms and lab tests fed into the engine. The Rule engine and AI correlated with the first diagnosis of Rheumatologist 80 % of the time and in the top 2 differential diagnosis 17 percent of the time. The Rule engine and AI GPT4 missed the diagnosis in one cases (inflammatory mono arthritis of shoulder although an appropriate differential diagnosis was given). In a second case of knee bursitis the Rule engine was unable to diagnose but GPT4 was able to provide an appropriate differential. The Rule Engine also presented an inappropriate differential diagnosis of Addison’s disease although the Primary diagnosis of Sarcoidosis was correct. In 1 case GPT4 missed diagnosis of Reactive arthritis although AHL Rule was able to pick it up. AHL engine appropriately prioritized Rheumatoid arthritis over other diagnosis in 2 cases which GPT4 could not. Conclusion: AI powered engines were 98% accurate in initial diagnosis or differential diagnosis of new cases presenting to a Rheumatology clinic. The Proprietary AHL rule engine has the potential to be more accurate than GPT4 as minor symptoms can be tailor made for subtle symptoms and complex scenarios. These technologies can be powerful tools for initial differential diagnosis and prompt triage for Rheumatology referrals. We see a near future were most preliminary assessments and early treatment can be commenced at a Primary care level while awaiting Rheumatology appointments. In addition, in countries where access to Specialists is through self referral it can be used as a self screening tool by patients. REFERENCES: [1] Use of GPT-4 to Diagnose Complex Clinical Cases Alexander V. Eriksen, M.D. et al November 9, 2023 NEJM AI 2023;1(1) DOI: 10.1056/AIp2300031 VOL. 1 NO. 1.PRIMARY DIAGNOSIS BY RHEUMATOLOGIST Acknowledgements: NIL. Disclosure of Interests: None declared.RHEUMATOID ARTHRITIS18SPONDYLOARTHRITIS12SYSTEMIC LUPUS6SJOGREN6PSORIATIC ARTHRITIS5INFLAMMATORY ARTHRITIS4ANTIPHOSPHOLIPID SYNDROME1UVEITIS1REACTIVE ARTHRITS2TEMPORAL ARTERITIS1SARCOID1DERMATOMYOSITIS1WEGENERS1ADULT STILLS1GOUT5FIBROMYALGIA5OSTEOARTHRITIS11SOFT TISSUE, OTHER DX19

Aim: This study aims to (1) Describe a multi-ethnic cohort of PsA patients seen in rheumatology centers in UAE, in terms of socio-demographic features, clinical and disease characteristics, and treatment trends (2) Explore relationship between active combination (biologics and methotrexate (MTX)) or MTX users and achieving minimal disease activity (MDA). Methods: Patients ≥ 18 years with PsA from a database of two rheumatology centers in the UAE were included. Continuous data were presented as mean and standard deviation (SD); dichotomous data were presented as percentages. To estimate the treatment effect on MDA the odds ratio and 95% confidence interval (CI) were calculated. Results: 143 patients were included (mean age 43.5 (SD: 10.2), 60% male; ethnicity: South Asian (45%), Arab (16%) and Caucasian (33%)). Using Disease Activity in Psoriatic Arthritis (DAPSA) scores, 29 (18%) were in remission, 65 (45%) in low disease activity (LDA), 32 (22%) moderate disease activity and 17 (11%) in high disease activity (HDA). Using the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) scores, MDA was achieved in 88/143 (62%). Active users of combination therapy (OR 4.8, 95% CI [1.29, 17.8]; p = 0.02) or biologics alone (OR 5.36, 95% CI [2.10, 13.70]; p=0.0004) were at increased odds of achieving MDA. Conclusion: this study provides insight on the epidemiology, disease and treatment trends in PsA in UAE where by majority of our PsA patients that were largely on biologics or combination therapy, had well controlled disease. This supports the early use of biologics in treatment of PsA.

Systemic sclerosis is an autoimmune condition characterized by a wide range of clinical presentations. Registries may serve to expand understanding about systemic sclerosis and aid in patient care and follow-up. The objective of this study was to analyze the prevalence of systemic sclerosis in a large cohort from the United Arab Emirates Systemic Sclerosis Registry and find the significant similarities and differences between the different subsets. All scleroderma patients in the United Arab Emirates were included in this multicenter national retrospective analysis. Data on demographics, comorbidities, serological characteristics, clinical aspects, and treatment were collected and analyzed, highlighting the most common traits identified. A total of 167 systemic scleroderma patients from diverse ethnic backgrounds were enrolled. Overall, 54.5% (91/167) of the patients were diagnosed with diffuse cutaneous systemic sclerosis, and 45.5% (76/167) with limited cutaneous systemic sclerosis. The prevalence of systemic sclerosis was 1.66 per 100,000 for the total registry and 7.78 per 100,000 for United Arab Emirates patients. Almost all patients in the diffuse cutaneous systemic sclerosis and limited cutaneous systemic sclerosis groups tested positive for the immunofluorescence antinuclear antibody. Antibodies against Scl-70 were significantly more associated with diffuse cutaneous systemic sclerosis, whereas anticentromere antibodies were significantly more associated with the limited cutaneous systemic sclerosis group (p < 0.001). Sclerodactyly, shortness of breath, and digital ulcers were more common in diffuse cutaneous systemic sclerosis patients compared with the limited cutaneous systemic sclerosis subtype in terms of clinical symptoms and organ involvement. Telangiectasia was much more common in the limited cutaneous systemic sclerosis group. Furthermore, diffuse cutaneous systemic sclerosis patients had more lung fibrosis (interstitial lung disease) than limited cutaneous systemic sclerosis patients (70.5% vs 45.7%), and pulmonary arterial hypertension was twice as common in limited cutaneous systemic sclerosis patients as it was in diffuse cutaneous systemic sclerosis patients. Local registries are paramount to understanding the clinical/serological characteristics of scleroderma. This study emphasizes the importance of raising disease awareness and distinguishing between the various systemic sclerosis subsets to implement patient-tailored strategies for early detection, better management, and higher quality of care.

Dear Editor, While the rheumatology workforce in many countries is increasingly becoming gender-balanced [1], advancing equity in academic recognition is still an unmet need. A report from 2015 estimated that 66% of fellows and 41% of rheumatologists in the USA are women. The same report predicted that by 2025 women will comprise the predominant majority of the rheumatology workforce [2]. Similarly, in many European countries, including Belgium, Hungary, Italy, Lithuania, the Netherlands and the UK, women comprise >50% of the rheumatology workforce [3]. Despite being in the majority, women in rheumatology are underrepresented in leadership positions [2–4]. The gender equity in academic rheumatology initiative has sparked discussions on the effect of inequity in academia on assignment to leadership roles [3–5]. To explore whether a gender gap exists in the global rheumatology leadership, we undertook a cross-sectional review of gender representation among the presidents of regional rheumatology leagues, namely the ACR, African League Against Rheumatism (AFLAR), Asia-Pacific League of Associations for Rheumatology (APLAR), the EULAR and the Pan-American League of Associations for Rheumatology (PANLAR).

Objective Psoriatic arthritis (PsA), a chronic inflammatory disease characterized by heterogeneous clinical manifestations, substantially impacts the quality of life of affected individuals. This article aims at developing consensus recommendations for the management of PsA and associated comorbidities and screening and monitoring requirements of PsA therapies in the United Arab Emirates (UAE) population. Methods An extensive review of present international and regional guidelines and publications on the pharmacological management, monitoring of therapies in the context of PsA was performed. Key findings from guidelines and literature were reviewed by a panel of experts from the UAE at several meetings to align with current clinical practices. Consensus statements were formulated based on collective agreement of the experts and members of Emirates Society for Rheumatology. Results The consensus recommendations were developed to aid practitioners in clinical decision-making with respect to dosage recommendations for pharmacological therapies for PsA, including conventional drugs, non-biologic, and biologic therapies. Consensus recommendations for therapeutic options for the treatment of PsA domains, including peripheral arthritis, axial disease, enthesitis, dactylitis, psoriasis, and nail disease, were developed. The panel emphasized the importance of monitoring PsA therapies and arrived at a consensus on monitoring requirements for PsA therapies. The expert panel proposed recommendations for the management of common comorbidities associated with PsA. Conclusion These consensus recommendations can guide physicians and healthcare professionals in the UAE in making proper treatment decisions, as well as efficiently managing comorbidities and monitoring therapies in patients with PsA.

Background: Many patients with rheumatic diseases are immunosuppressed and take forms of immunomodulator medication. Hence, these patients might be at a heightened risk of Covid-19 and have special concerns in regard to vaccines, such as safety and efficacy. Vaccines have been available for the population of UAE as of January 2021, these being Pfizer (the United States and Europe), Sinopharm (China), and AstraZeneca (United Kingdom). The aim of our paper was to examine the rate of vaccine uptake among our patients with rheumatic conditions in the United Arab Emirates. Methods: A questionnaire was distributed among patients with rheumatic diseases attending a rheumatology specialised clinic in the United Arab Emirates. We collected data on 149 consecutive patients who were seen during a one-month period from 10/06/2021 to 10/07/2021 in Dubai. Results: The mean age of the patients was 45.9 +/- 41.3. The majority of the patients had underlying rheumatic diseases (86.9%), the rest having conditions such as soft tissue pain or to rule out rheumatic conditions. 48.5% were taking immunomodulators. 41.7% of respondents had other chronic diseases. It was also found that 18.9% had Covid-19 previously, all of whom recovered, with the average duration of the illness being 11 days. 99.1% of individuals reported that receiving the Covid-19 vaccine was extremely important, and 95.0% had already received the vaccination. Their reasoning for receiving the vaccination varied from medical advice (17.5%), general worry about infection/ reinfection of Covid-19 (65.3%), in order to travel (8.4%), employee requirement (5.6%), and other reasons (3.2%). Specifically, 48.3% chose the Pfizer vaccine, 39.8% had Sinopharm, and 11.9% had AstraZeneca. These decisions on which vaccine to choose were influenced by the availability of the vaccine (35.1%), medical advice (16.9%), effectiveness (15.5%), safety and side effect profile (18.2%), age restrictions (2.7%), experience/ advice from friends and family (8.1%) and other reasons (3.4%). Conclusion: Overall, an overwhelming majority of our patients (95.0%) with rheumatic diseases in the specialised muscular-skeletal clinic in the UAE have received the Covid-19 vaccine. This reflects good public health service messaging and concentrated efforts from the medical community, UAE government, and the patient’s rheumatologists.

Objective Psoriatic arthritis (PsA), a chronic inflammatory arthropathy, is often underdiagnosed in Middle Eastern countries, substantially impacting the treatment of affected individuals. This article aims to highlight current unmet clinical needs and provide consensus recommendations for region-specific evaluation methods and nonpharmacological therapies in the United Arab Emirates (UAE). Method An extensive literature review was conducted, focusing especially on global and regional guidelines for the evaluation and treatment of PsA. These form the basis of the consensus statements formulated. Additionally, an expert panel of key opinion leaders from the UAE reviewed these guidelines and available literature at an advisory board meeting to identify unmet needs, bridge clinical gaps in the UAE, and develop consensus statements for the evaluation and treatment of PsA. Result The consensus statements were developed based on overarching principles for the management of PsA, evaluation of patients with PsA, and nonpharmacological approaches for the management of PsA. The overarching principles included adopting a targeted, multidisciplinary approach, along with collaboration between rheumatologists and dermatologists in cases of clinically significant skin involvement. The panel also highlighted the value of composite disease severity measures for characterizing clinical manifestations of PsA. In terms of nonpharmacological management approaches, lifestyle modification (comprising dietary change, exercise, and cessation of smoking) and psychotherapy were recommended. Conclusion The consensus statements will aid healthcare professionals in clinical decision-making in the context of PsA.

Objectives: This study aimed to explore gender equity in rheumatology leadership in the Asia-Pacific region as represented by the member national organizations (MNOs) of the Asia-Pacific League of Associations for Rheumatology (APLAR). Methods: We conducted a retrospective cross-sectional review of gender representation among the presidents of MNOs of APLAR in April 2022. We used the official website of each organization to acquire names and terms in the office of current and past presidents of each organization. The binary gender of each president was estimated using the name-to-gender inference platform Gender API (https://gender-api.com/). Proportions of male and female presidents were estimated for each organization. Data were compared for presidencies commencing before and in/after the year 2000. Results: We found a significant gap in gender parity, with most presidents in the region being men (210 of 252, 83%). More than one-third (7 of 19, 36.8%) of the MNOs had all male presidents, although the proportion of women improved from 7 to 25% in/after 2000 (P = 0.0002). A statistically significant increase in female representation was observed in Australia (P = 0.0268, from 7 to 39%) and New Zealand (P = 0.0011, where the proportion of female presidents increased from 0 to 45%), but not in other countries. Conclusion: A significant gap in gender parity exists in rheumatology leadership in the MNOs of APLAR. Trends suggest improvement over the last two decades, although statistically significant improvement is limited to a small number of countries.

Rheumatoid arthritis (RA) is a highly heritable complex disease with unknown etiology. Multi-ancestry genetic research of RA promises to improve power to detect genetic signals, fine-mapping resolution and performances of polygenic risk scores (PRS). Here, we present a large-scale genome-wide association study (GWAS) of RA, which includes 276,020 samples from five ancestral groups. We conducted a multi-ancestry meta-analysis and identified 124 loci (P < 5 × 10−8), of which 34 are novel. Candidate genes at the novel loci suggest essential roles of the immune system (for example, TNIP2 and TNFRSF11A) and joint tissues (for example, WISP1) in RA etiology. Multi-ancestry fine-mapping identified putatively causal variants with biological insights (for example, LEF1). Moreover, PRS based on multi-ancestry GWAS outperformed PRS based on single-ancestry GWAS and had comparable performance between populations of European and East Asian ancestries. Our study provides several insights into the etiology of RA and improves the genetic predictability of RA. Multi-ancestry genome-wide association analyses identify 124 risk loci for rheumatoid arthritis, of which 34 are novel. A polygenic risk score based on multi-ancestry data showed comparable performance between populations of European and East Asian ancestries.

OBJECTIVES:The primary objective was to develop an educational video to teach patients with rheumatoid arthritis (RA) self-assessment of their disease activity. Secondary objectives were to validate the video, identify the challenges in producing it, and the responses to these challenges.METHODS:Rheumatologists from 7 Middle Eastern Arab countries (MEAC) discussed unmet needs in the education of patients with RA. They reviewed pre-existing educational audiovisual material and drafted the script for a new video in Arabic. The video was produced in collaboration with a technical team, then validated by patients using a standardized interview. At each step of production, challenges were identified.RESULTS:Twenty-three rheumatologists from MEAC identified unmet needs in patients' education. A video was produced, explaining the concepts of treat-to-target and showing a patient performing self-assessment using DAS-28. Sixty-two patients were interviewed for validation and found the video to be useful and easy to understand, albeit not replacing the physician's visit. Most common challenges encountered included acceptance of patient empowerment, agreement on DAS-28 as composite measure, production of a comprehensible written Arabic text, and addressing the population cultural mix.CONCLUSION:Despite challenges, the video was well accepted among patients and can be used for clinical and research purposes. It is particularly useful in pandemic periods where social distancing is recommended.

Background: Managing patients with chronic rheumatic diseases is increasingly relying on the collaboration of a multidisciplinary team, including the rheumatology nurse who can aid assessment of disease activity among other healthcare tasks. However, this practice, although common in Europe and North America, is still poorly implemented in the Middle eastern Arab countries (MEAC). Objectives: To evaluate the concordance between the physician’s and the nurse’s assessment of disease activity in patients with rheumatoid arthritis (RA) in the MEAC. Methods: During a routine patient visit to one of 9 rheumatology clinics located in 7 Middle Eastern Arab countries, the physician and the rheumatology nurse (who was already working in the clinic) performed the disease activity score 28 (DAS), Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) in a blinded manner. The concordance regarding the 3 continuous scores was calculated using paired t-test. The agreement between physician- and nurse-DAS categories (remission, low, moderate and high disease activity) was calculated using weighted kappa for category comparison. Predictive factors of positive concordance between physician- and nurse-DAS were identified using binary logistic regression. Results: The study included 373 patients’ measurements over a period of two years (2018 to 2019). The mean age of the patients was 49.6 years (±28.2), 82.6% were females, and the mean disease duration was 11.3 years (±7.5). The mean physician-DAS was slightly higher (3.97 (±1.52)) than the nurse-DAS (3.90 (±1.54)) (p=0.002), with a mean difference of +0.08 [95%CI 0.03; 0.12] (Table 1). The difference in the DAS individual items, the CDAI and the SDAI were not statistically significant. Table 1. Comparison of the disease activity measures reported by the physician and by the nurse. Physician Nurse p-value Total Joint Count 4.87 (2.26) 5.02 (6.20) 0.152 Swollen Joint Count 2.13 (3.88) 2.15 (3.83) 0.790 Global Assessment 3.30 (2.41) 3.32 (2.43) 0.702 DAS-28 3.97 (1.52) 3.90 (1.54) 0.002 CDAI 14.26 (12.53) 14.38 (12.59) 0.515 SDAI 21.51 (23.57) 21.61 (21.66) 0.527 When analyzing DAS as a categorical 4-items variable, the agreement between the physician and the nurse was present in 79.36% of the cases (weighted kappa was 0.77 [95%CI 0.73;0.83] which is considered as excellent, and was higher in patients with high disease activity (Figure 1). A positive concordance between the physician- and the nurse-DAS was associated with the country (higher in Egypt, p<0.001) and the status of higher disease activity (p<0.001). Conclusion: The agreement between the DAS-28 performed by the physician and by the nurse was excellent and was associated with the country and a higher disease activity. The present study confirms that the support of a trained nurse for evaluating disease activity in RA is feasible in the Arab countries and may save some valuable time in the clinic, whilst maintaining the quality of care for patients with RA. Figure 1. Agreement between physician- and nurse-DAS categories Acknowledgements: The authors would like to acknowledge the patients for participating in the study and the assistants/ students/ nurses who assisted in the data collection: Dr. Fatima Abdul Majeed Al Hawaj, M. Atef Ahmed, M. Mohammad Alhusamiah, Ms Raquel De Guzman, Ms Lina Razzouk. Disclosure of Interests: None declared

To evaluate the perceptions of patients with rheumatoid arthritis (RA) about self-assessment of their disease activity after watching an educational video. Consecutive patients with RA consulting their rheumatologist in six Middle Eastern Countries were invited to watch an educational video developed to teach self-assessment using Disease Activity Score (DAS-28). Then, a rheumatology nurse conducted a semi-structured interview and collected the patients' perception about the understanding of the video, feasibility, capability and confidence in performing self-assessment using Likert-type items. The degree of confidence with self-assessment was correlated to the patients' socio-demographic characteristics. Sixty-two patients were included and had an overall positive reaction to the video. It was easy to understand in 96% and helped facilitate self-assessment in 92% of cases. Self-assessment was considered totally feasible in 74%, and 66% of patients were capable of always doing it, with a confidence of 60% (always) to 34% (sometimes). Confidence was associated with a higher educational level. Nevertheless, 77% of patients felt that the self-assessment would not fully replace the physician's visit. Open-ended questions identified five themes: better understanding of the disease, easier communication with the rheumatologist, less consultation time, difficulty with the scoring part and importance of practice. Patients with RA felt that self-assessment was feasible and helpful in understanding RA, improving communication with the rheumatologist and shortening the visit time.

Background: Management of rheumatoid arthritis is complicated due to different disease presentations and the multiplicity of drugs. Although most patients are informed about the risks of treatment, there remain possible side-effects, which patients are not informed about to avoid the 'information dump.’ Rheumatologists have to balance what they believe is essential to tell patients versus what reasonable patients believe they need to know to make an informed consent. Objectives: To determine differences in information that the physicians give, regarding the possible side effects of treatment options for rheumatoid arthritis, and what the patients actually want to know. Methods: To conduct this pilot study, a questionnaire was devised to assess what patients and prescribing rheumatologists, from the Gulf Cooperative Council, consider important for being informed about, including the possible adverse events with biologic drugs in rheumatoid arthritis. Results: A total of 20 patients and 13 physicians completed the questionnaire. Physicians routinely discussed the increased risk of infections (100%), skin rashes at injection sites (92%),falling white blood cell counts, and alterations in liver enzymes (84%). Patients were less interested in learning about infections (72%) and more interested in learning about rare complications, such as an increased risk of heart failure and cancer (81%), which doctors were less likely to discuss. Conclusions: There is a discordance between what doctors inform patients about and what patients want to know regarding the risks of biologic therapy in rheumatoid arthritis. This information gap can have a significant legal implications in routine practice if a patient develops a rare side effect of which they have not been informed. We propose a solution of both verbal and signed informed consent to bridge the gap.

Background:Involving the patients with rheumatoid arthritis (RA) in the assessment of their disease may increase their adherence to treatment, improve the disease outcomes and facilitate the application of telehealth. We previously reported an excellent concordance between the Disease Activity Score (DAS-28) performed by physicians and patients at the baseline visit of this prospective study (1).Objectives:To evaluate the persistence of the concordance between the physician’ and the patient’s assessment of disease activity in RA using DAS-28 after one year.Methods:At the baseline visit, patients with RA from 7 Middle Eastern Arab Countries (MEAC) were briefed about DAS-28 by their rheumatologist during a routine consultation and given smartphone access to a video in Arabic language explaining the performance of DAS-28. At 3, 6 and 12 months (± 3 months), the patients were asked to self-report DAS-28, blinded to the physician’s assessment. Concordance between the continuous DAS-28 at each visit was calculated using paired t-test numerically and the Bland-Altman method graphically. Agreement between physician- and patient-DAS categories (remission, low-, moderate- and high disease activity) was calculated at each visit using weighted kappa for category comparison. Weighted kappa of the different agreements were compared over time using their respective confidence intervals (CIs). Predictive factors of positive concordance between physician and patient-DAS were identified using binary logistic regression.Results:The study included 428 patients over a period of three years (2018 to 2020). The mean age of participants was 49.8 years, 82.5% were females, 44.3% had a university degree and the mean disease duration was 11.4 years.At baseline, the average patient-DAS was higher (4.06 (±1.52)) than the physician-DAS (3.97 (±1.52)). The mean difference was -0.09 [95%CI -0.14; -0.04] and most of the pairs were within the limit of agreement in the Bland-Altman graph, indicating a good concordance, particularly in cases of remission.During the study follow-up, 299 patients consulted for visit 2 (69.9% of the total population), 232 for visit 3 (54.2%) and 199 for visit 4 (46.5%). The weighted kappa was 0.80 [95%CI 0.76;0.85] at visit 1 and 0.79 [95%CI 0.72;0.88] at visit 4 (Figure 1 showing kappa for DAS-28, CDAI and SDAI as well). A minor numerical decrease in kappa was observed over time; however, the CIs were overlapping over the four visits and the agreement was considered stable, remaining in the excellent range. At visit 4, a positive concordance between the physician- and the patient-DAS was associated with the profession (lower in blue collar, p=0.001), the educational level (higher in high school and university, p=0.034) and the baseline physician’s DAS (higher in high disease activity, p=0.46).Conclusion:The agreement between the DAS-28 performed by the physician and by the patient was excellent at baseline and remained stable over one year. A positive concordance was associated with the profession, the educational level and the level of disease activity. The present study can help the rheumatologist make informed decisions about the patients who may be suitable for a remote evaluation of their disease activity, that can be of particular interest in the context of the COVID-19 pandemic.References:[1]Ziade N, Saad S, al Mashaleh M, et al. Perceptions of Patients with Rheumatoid Arthritis about Self-Assessment of Disease Activity after Watching an Educational Video: Qualitative Pilot Results from the Auto-DAS in Middle Eastern Arab Countries Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10).Acknowledgements:The authors would like to acknowledge the patients for participating in the study and the assistants/ students/ nurses who assisted in the data collection: Dr. Fatima Abdul Majeed Al Hawaj, M. Atef Ahmed, M. Mohammad Alhusamiah, Ms Raquel De Guzman, Ms Lina Razzouk.Disclosure of Interests:None declared

Platelet-rich plasma (PRP) is an autologous blood product with platelets above circulating levels and releases several growth factors after activation. PRP may help to decrease joint inflammation by modulating synovial cell proliferation and differentiation and inhibition of catabolic pathways in various articular conditions. Though PRP has shown good efficacy in osteoarthritis and other musculoskeletal conditions such as synovitis, epicondylitis, skeletal muscle injuries, and tendinopathy, there is limited experience for the use of PRP in patients with rheumatoid arthritis. Precise mechanisms of action of PRP are not known. We present clinical experience for treatment with PRP (2–4 ml) in four patients with rheumatoid arthritis who had inadequate response and persistent pain and inflammation with intra-articular steroids. Irrespective of past and ongoing treatments and duration of disease, all patients showed improvement in the visual analog scale and disease activity score of 28 joints at 4 and 8 weeks after injection. There was an improvement in joint inflammation on ultrasound imaging in some patients. These effects were sustained for up to 1 year. No adverse effects were reported in any patient. PRP may be a safe and useful therapy in patients with rheumatoid arthritis who fail to respond to one or more established treatment options.