OBJECTIVES:Fibromyalgia (FM) and post-traumatic stress disorder (PTSD) share key clinical features, including sleep disturbance, fatigue, cognitive symptoms and affect dysregulation, yet they are classified as distinct disorders. We examined whether FM and PTSD represent separable phenotypes or overlapping stress-related symptom profiles using a distributional similarity approach. METHODS:In an international cross-sectional online survey of adults aged 18-65 years, participants with a self-reported clinical diagnosis of FM or PTSD, and healthy controls, completed validated measures of somatic symptom burden, trauma-related symptoms, psychological vulnerability traits, comorbidities, and emotional activation patterns (EASEL-3). Case definitions were operationalised using established thresholds for polysymptomatic distress and PTSD symptom severity. To address unequal group sizes and reduce case-definition circularity, we applied adaptive sub-sampling with bootstrap resampling and quantified between-group similarity using Hellinger distance, complemented by stability analyses. RESULTS:Across somatic, psychological and affective domains (threat, drive and soothing systems), FM and PTSD showed substantial overlap with limited discriminatory capacity, while both differed clearly from healthy controls. Nearly half of participants meeting criteria for one condition also met criteria for the other, indicating high co-occurrence. CONCLUSIONS:These findings question the strict nosological separation of FM and PTSD and are compatible with a spectrum model of stress-related disorders. They further suggest that systematic trauma assessment and integrated, mechanism-based treatment strategies should be considered in the management of both conditions.

Background/Objectives: The aim of this study was to assess the relationship between the decline in rheumatoid arthritis (RA) disease activity—induced by periodontal treatment—and changes in the microbiology of subgingival plaque and serum antibody levels against the periodontal bacterium Porphyromonas gingivalis. Methods: Twenty-two RA patients with periodontitis underwent non-surgical periodontal treatment and assessment for the disease activity score of 28 joints (DAS28); antibody response to P. gingivalis virulence factors arginine (Rgp) and lysin (Kgp) gingipain; peptidyl arginine deiminase (PAD)2/4-activity; and the presence of P. gingivalis, Tannerella forsythia, and Prevotella intermedia in subgingival plaque through the evaluation of colony-forming units (CFUs) at baseline, two months, and six months post-treatment. Results: Periodontal treatment significantly reduced P. gingivalis CFUs at two and six months, and T. forsythia and P. intermedia CFUs at two months. Anti-RgpB IgG levels decreased at two months (p = 0.020). Higher baseline anti-RgpB IgG levels (r = −0.44, p = 0.039) and P. gingivalis CFU (r = −0.47, p = 0.028) correlated with greater reductions in DAS28. Greater reductions in P. gingivalis CFU were also associated with greater declines in DAS28 (r = 0.426, p = 0.048 and r = 0.467, p = 0.028, at two and six months, respectively). Anti-Kgp IgG and PAD2/PAD4 activity were not significantly affected by periodontal treatment. Conclusions: The impact of periodontal treatment on RA disease activity is more pronounced in patients with higher baseline P. gingivalis load and antibody response to RgpB. Better microbiological responses to periodontal treatment are associated with greater improvements in rheumatological symptoms. Further research is needed to confirm these findings and fully elucidate the underlying mechanisms.

The Imbalance of Threat and Soothing Systems model of fibromyalgia proposes that affect (dys)regulation, indexed by an overactive threat system and an underdeveloped soothing system, may contribute to fibromyalgia. This model has not been tested empirically. Individuals with fibromyalgia and controls (N = 2416) completed measures of affect regulation and symptomatology. At group-level, participants with fibromyalgia reported greater intensity of threat-related emotions (e.g., anger, anxiety, and disgust) and lower drive- (e.g., pleasure, enthusiasm) and soothing-related emotions (e.g., contentment, relaxation). Supervised machine learning using affect regulation system scores and discrete emotions distinguished fibromyalgia from controls with good discrimination (AUC = 0.74–0.83). Threat-related emotions contributed most to fibromyalgia classification, whereas soothing-related emotions contributed most to control classification. These findings align with the model and highlight affective processes as clinically relevant correlates and potential treatment targets in fibromyalgia.

Patient education is universally recognised as a cornerstone of fibromyalgia management, yet no international guideline offers operational guidance on what and how should be taught or within what clinical context. The result in real practice is predictable: structured education is seldom delivered, and when it happens it is intuitive and variable. This review addresses that gap by describing the Guided Self-Discovery Education (GSDE), a structured approach refined over more than two decades of clinical practice and designed to fit within the ordinary medical consultation with no specialised training. GSDE rests on three methodological commitments: validate the suffering before attempting any explanatory work; elicit the patient's own understanding of her condition rather than transmitting a generic explanation; and target the dominant drivers of alarm-system activation in fibromyalgia, stress, dispositional traits and biographical emotional load. The approach is grounded in the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model, for which a recent large-sample international study provides initial empirical support. GSDE is positioned as complementary to Pain Neuroscience Education, the only other structured body of guidance on educating patients with chronic pain, from which it differs along four axes: validation-first sequencing, personal versus general explanatory models, targeting of dominant fuels rather than kinesiophobia alone, and deliverability in the ordinary consultation. The clinical Self-Reflection instrument used to prepare the ground for the personalised model is reproduced in full. Empirical validation of GSDE by randomised controlled trial remains the principal research agenda. In the meantime, the proposal offers a usable method for clinicians facing the operational silence of current guidelines.

It is postulated that fibromyalgia reflects a neurobiologically rooted imbalance between overactivated threat systems and hyporesponsive soothing systems, shaped by adversity. Adverse childhood experiences leave epigenetic marks that sensitise pain and stress pathways. Emotions have measurable biological correlates-they modulate immune, neuroendocrine and inflammatory processes that sustain chronic pain. The patient–clinician relationship is a biologically active intervention, operating through placebo mechanisms, neural synchrony and vagal coregulation. Compassionate, validating clinical encounters can restore safeness and improve outcomes-not only in fibromyalgia but across a wide range of chronic pain conditions.

PV214 / #533 Poster Topic:AS23 - SLE-Diagnosis, Manifestations, & Outcomes Recently, a EULAR/ACR 2019 systemic lupus erythematosus (SLE) classification criteria (EULAR/ACR 2019) score≥20 was identified in a SLE inception cohort with less than 2 years from diagnosis as a marker for more severe disease, including higher disease activity, more frequent flares, higher use of immunosuppressants, lower probability of achieving remission, and more damage accrual. However, this analysis has not been performed in SLE patients with longer disease duration.[1] The aim of our study was to assess a EULAR/ACR 2019 score ≥20 as a marker for severe disease in a prevalent SLE cohort. We performed a cross-sectional multicenter study of patients fulfilling the EULAR/ACR 2019 classification criteria for SLE in the Portuguese registry of rheumatic diseases (Reuma.pt). Disease activity (SLE-DAS) and the EULAR/ACR score were assessed at the last visit, between June 2023 and March 2024. Groups of patients with EULAR/ACR 2019 score ≥20 or <20 were compared for demographic, clinical and treatment features, with parametric and non-parametric tests, as appropriate. Separate models were tested using different definitions of severe SLE (dependent variable), as present/absent: (1) cumulative SLE major organ involvement; (2) moderate/severe disease activity, defined as SLE-DAS>7.64; (3) ongoing immunosuppressants; (4) ongoing systemic prednisolone>7.5 mg/day; (5) organ damage, defined as SLICC/ACR Damage Index (SDI) ≥ 1. Predictors for each of these definitions were assessed in a 2-step approach with logistic regression (LR) univariate analysis, followed by multivariate LR models including variables with p<0.10 in the first step, while excluding variables with multicollinearity. Multivariate analysis was used to identify independent predictors and estimate the respective adjusted odds ratios (OR) with 95% confidence intervals. There were 2459 patients registered in Reuma.pt, from 37 participating centers. A total of 709 patients, from 18 centers, who had data on and fulfilled the EULAR/ACR 2019 classification criteria and had a SLE-DAS scoring were included, 65.6% having an EULAR/ACR 2019 score≥20. These patients were younger at diagnosis (p<0.001), had longer disease duration (p<0.001), higher SLE-DAS score (p=0.001), received less frequently antimalarials (p=0.004), and were more frequently treated with synthetic and/or biologic immunosuppressants (p<0.001) and glucocorticoids (p<0.001). On univariate LR analysis, a EULAR/ACR 2019 score≥20 was associated with all definitions of severe disease (Table 1). On multivariate LR analysis, a EULAR/ACR 2019 score≥20 was an independent predictor of cumulative major organ involvement (OR 7.30, 95% CI 4.86-10.95, p<0.001), moderate/severe disease activity (OR 7.36, 95% CI 2.18-24.82, p=0.001), ongoing immunosuppressants (OR 2.73, 95% CI 1.82-4.09, p<0.001), and ongoing systemic prednisolone>7.5 mg/day (OR 2.71, 95% CI 1.29-5.69, p=0.009), adjusted for significant covariates. In the multivariate LR, a EULAR/ACR score≥20 was not associated with organ damage, defined as SDI≥1. Table 1 Univariate and multivariate logistic regression analysis for severe SLE A EULAR/ACR 2019 score ≥20 is associated with severe disease in a prevalent SLE cohort. Although this is not surprising, given the similarity and close relationship between items included in all instruments, this score may, in association with measures of disease activity, contribute to management in clinical practice, stratification of cases in observational studies and selection of patients for clinical trials.References:[1.] Whittall-Garcia LP. Ann Rheum Dis. 2021;80(6):767-74. * Carolina Mazeda and Beatriz Mendes contributed equally and share first authorship.

The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®. RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between rheumatoid arthritis and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD) with a view to updating FRAX. The resource comprised 1,909,896 men and women, aged 20–116 years, from 29 prospective cohorts in which the prevalence of RA was 3

PV175 / #503 Poster Topic:AS19 - Patient-Reported Outcome Measures Fatigue is a major symptom in patients with systemic lupus erythematosus (SLE) significantly impacting health-related quality of life (HR-QoL). Causes of fatigue in SLE are multifactorial and not well understood. A novel framework categorizes SLE manifestations into type 1 and type 2. Type 1 manifestations can be ascribed to inflammation and captured in activity indexes, whereas type 2 symptoms (such as fatigue, pain, sleep, and mood disturbances) have no clear relation to disease activity. Type-2 SLE is defined using the polysymptomatic distress scale (PDSS). Objective: To identify predictors of fatigue in SLE patients. Cross-sectional study of SLE patients fulfilling ACR/EULAR 2019 and/or SLICC 2012 classification criteria followed in a Rheumatology outpatient clinic. Inclusion was from December 2023 to May 2024. The study included 200 patients with SLE (female: 92.0%; mean age: 46.4±14.3 years; median age at diagnosis: 28.5 [16.0] years). Severe fatigue was present in 28.6%. In the study population, 87.5% fulfilled the LDA treatment target, 30.5% had type 2 SLE, 38.5% had organ damage, and 17.0% were diagnosed with fibromyalgia. Patients with severe fatigue had worse scores in both PDSS and aPDSS (p<0.0001). The aPDSS cut-off that better predicted SLE type 2 was ≥9.50 (sensitivity 96.9%, specificity 99.9%). Univariate analysis showed significant variables for severe fatigue: female sex (p=0.04), age (p=0.02), disease duration (p=0.02), SLE-DAS (p=0.03), type 2 SLE (PDSS and aPDSS definitions) (p<0.001), and fibromyalgia (p<0.001), while LDA was protective (p<0.01). SLEDAI and SDI were not significant. Multivariate analysis revealed type 2 SLE [OR 25.33; 95% CI(10.63-60.31); p<0.001) and diagnosis of fibromyalgia [OR 3.51; 95% CI(1.16-10.69); p<0.05] as independent predictors of severe fatigue. Similar findings were found when using aPDSS, [OR 16.16; 95% CI(7.22-36.13); p<0.001)] for type 2 SLE and [OR 4.44; 95% CI(1.51-12.26); p<0.05] for fibromyalgia. In this cohort of SLE patients, type 2 lupus was the major predictor of severe fatigue. Physicians and patients should be careful not to attribute fatigue to inflammatory type 1 disease activity when the LDA treatment target is achieved. This should be taken into consideration for establishing the management strategy. * First and second authors listed share first authorship.

PV215 / #526 Poster Topic:AS23 - SLE-Diagnosis, Manifestations, & Outcomes Treat-to-target (T2T) aiming for remission, or at least low disease activity (LDA), while tapering prednisone to ≤5 mg/day is established as a pillar for management of systemic lupus erythematosus (SLE) in the 2023 updated EULAR recommendations for clinical practice. The aim of our study was to investigate the attainment of the T2T goal in the SLE population from the Rheumatic Diseases Portuguese Registry (Reuma.pt) and identify unmet treatment needs. We performed a cross-sectional multicenter study of patients fulfilling the EULAR/ACR 2019 classification criteria for SLE in the Reuma.pt. The assessment was performed at the last visit occurring between June 2023 and March 2024. Disease activity and attainment of T2T were assessed with the SLE Disease Activity Score (SLE-DAS).[1] Patients with no SLE-DAS scoring were excluded. Patients were classified as in remission (clinical items of SLE-DAS =0 and prednisone ≤5 mg/day), low disease activity (LDA) (SLE-DAS ≤2.48 and prednisone ≤5 mg/day) and, for those not attaining T2T, in categories of disease activity (mild: 2.089.90). Descriptive analysis was performed, and a comparison between the remission vs. non-remission and LDA vs. non-LDA groups was performed using Student’s t-test, Fisher’s exact test, Chi-square or Mann-Whitney U tests, as appropriate. IBM SPSS Statistics software version 27 was used. p≤0.05 was considered statistically significant. There were 2459 patients with SLE from 37 centers registered in Reuma.pt. Of these, 1664 (67.7%) were excluded due to: missing data on fulfillment (n=1257, 51.1%) or no fulfillment (n=83, 3.4%) of EULAR/ACR classification criteria; missing data for SLE-DAS (n=324, 13.2%). A total of 795 patients from 18 participating centers were included [89.6% female; mean age 49.9 (SD 14.2) years] (Table 1). Main cumulative SLE clinical features included: mucocutaneous (72.5%), hematological (66.7%), arthritis (63.6%), nephritis (38.9%), serositis (19.4%) and neuropsychiatric lupus (6.8%). Remission was attained by 71.3% and an additional 3.0% were in LDA, meaning that the EULAR treatment target was achieved by 74.3%. The remaining patients presented active disease (mild 20%, moderate 2.6%, severe 3%). Hydroxychloroquine (HCQ) was prescribed to 88.3% of all patients. Patients not in LDA were more frequently treated with synthetic (69.1% vs 39.6%, p<0.001) and biologic (19.1% vs 8.5%, p<0.001) immunosuppressants. Of the patients with active SLE, 40.2% were receiving >7.5 mg/day of prednisolone-equivalent dose and 72.7% were treated with synthetic and/or biologic immunosuppressants. Table 1. Characteristics of the patients included (n=795). This subgroup of patients with SLE registered in Reuma.pt present a high rate of attainment of the T2T, and most are treated with HCQ, in line with the EULAR recommendations. The high number of patients excluded preclude the generalization of these conclusions. This provides benchmarking indicators demonstrating high quality of care. Furthermore, unmet needs for new and improved therapies are demonstrated, with over a quarter of patients presenting active disease despite more intensive standard-of-care. Longitudinal studies are needed to assess if T2T goals are sustained over time. Optimized treatment regimens are needed to attain recommended T2T goals in many SLE patients. Improvement of registry in Reuma.pt is indispensable for a representative national appraisal.References:[1.] Jesus D. Ann Rheum Dis 2021;80(12):1568-74. * Carolina Mazeda and Beatriz Mendes contributed equally and share first authorship.

Background Hypothesizing that early treatment yields improved prognosis, we aimed to investigate how the timing of immunosuppressive treatment relates to interstitial lung disease (ILD) development and the course of pulmonary function in systemic sclerosis (SSc).Methods A cohort was created using data from the EUSTAR database and Nijmegen Systemic Sclerosis cohort, including adult patients who started their first immunosuppressive treatment (i.e. mycophenolate mofetil, methotrexate, cyclophosphamide, tocilizumab or rituximab) after SSc diagnosis, and no signs of ILD on high-resolution CT. ILD-free survival and the course of forced vital capacity (FVC) % predicted were assessed for up to 5 years' follow-up comparing patients who started early (disease duration <= 3 years) vs late with immunosuppression.Results 1052 patients met the eligibility criteria. The early treatment group (n = 547, 52%) showed a higher prevalence of male sex, diffuse cutaneous subtype (53.1% vs 36.5%), and anti-topoisomerase-I antibody (ATA, 51.1% vs 42.7%). Most patients were treated with methotrexate (60.1%), whereas only a few patients were treated with biologics (1.7%). The incidence of ILD was 46.6% after mean (s.d.) 3.6 (1.4) years; the hazards ratio for ILD in the early treatment group was 1.13 (95% CI: 0.93, 1.38) after adjustment for confounders. FVC % predicted trajectories were comparable between groups.Conclusion Our findings did not confirm a preventive role of early initiation of immunosuppressive therapy vs late initiation on ILD development. However, our findings should be interpreted with caution, considering the high inflammatory, ATA-positive enriched nature of the cohort, confounding by indication, and that very few patients were treated with biologics.

Over the past decades our understanding of rheumatoid arthritis (RA) pathogenesis has improved remarkably and major breakthroughs in the treatment of RA were made with the advent of numerous targeted therapies and new treatment strategies. Despite these advances, several unmet needs remain, namely in achieving earlier and more accurate diagnosis, monitoring disease activity, predicting disease prognosis and optimizing treatment. To address these gaps, recent research has focused on identifying biomarkers that may enhance diagnostic precision, predict disease prognosis, and optimize treatment strategies. In this narrative review we will describe recent developments in RA biomarkers with demonstrated or promising clinical relevance.

Objective To assess which definition of remission best predicts good radiographic outcome (GRO) and good functional outcome (GFO) in rheumatoid arthritis, focusing the updated American College of Rheumatology/European Alliance of Associations for Rheumatology criteria.Material and methods Meta-analyses of individual patient data (IPD) from randomised controlled trials (RCTs). Six definitions of remission were considered: (1) Boolean with Patient Global Assessment (PGA)≤1 (Boolean); (2) Simplified Disease Activity Index (SDAI)≤3.3; (3) Clinical Disease Activity Index (CDAI)≤2.8; (4) Boolean with PGA≤2 (Updated-Boolean); (5) Boolean with Physician Global Assessment (PhGA≤1) replacing PGA (Boolean-PhGA) and (6) Boolean excluding PGA (3VBoolean). GRO was defined as a worsening ≤0.5 units in radiographic score and GFO as a no worsening in Health Assessment Questionnaire (HAQ), that is, ∆HAQ-DI≤0.0 units. Relationships between each remission definition at 6 and/or 12 months and GRO and GFO during the second year were analysed. Pooled probabilities for each outcome for each definition and their predictive accuracy were estimated.Results IPD from eight RCTs (n=4423) were analysed. Boolean, SDAI, CDAI, Updated-Boolean, Boolean-PhGA and 3VBoolean were achieved by 24%, 27%, 28%, 32%, 33% and 43% of all patients, respectively. GRO among patients achieving remission ranged from 82.4% (3VBoolean) to 83.9% (SDAI). 3VBoolean showed the highest predictive accuracy for GRO: 51.1% versus 38.8% (Boolean) and 44.1% (Updated-Boolean). The relative risk of GFO ranged from 1.16 (Boolean) to 1.05 (3VBoolean). However, the proportion of GFO correctly predicted was highest for the 3VBoolean (50.3%) and lowest for the Boolean (43.8%).Conclusion 3VBoolean definition provided the most accurate prediction of GRO and GFO, avoiding the risk of overtreatment in a substantial proportion of patients without increment in radiographic damage progression, supporting the proposal that 3VBoolean remission is preferable to guide immunosuppressive treatment. The patient’s perspective, which must remain central, is best served by an additional patient-oriented target: a dual-target approach.

Background: Around 38% of people with Rheumatoid Arthritis (RA) have sleep disturbances, a number that increases with disease duration. However, their origin is still poorly understood, and its management frequently neglected.[1] Objectives: To foster the understanding of sleep disturbances in patients with RA through a multifactorial explanatory model incorporating the influence of disease activity, perceived disease impact, personality traits and comorbidities, namely depression and anxiety. Methods: This is a cross-sectional analysis in a cohort from an outpatient clinic in a tertiary Portuguese hospital using a structural equation modelling estimation to analyse the associations between sleep disturbance and disease activity, perceived disease impact, personality traits, and depression and anxiety dimensions.Sleep disturbance was assessed using the Sleep Disturbance item (0-10, NRS) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire[2]; disease activity through the Disease Activity Score 28 joints in its three variables (3v) and C-reactive protein (CRP) variant (DAS28CRP3v)[3]; disease impact by the individual domains of RAID.7 questionnaire[4,5]; depressive and anxiety symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADS)[6]; and personality by the Ten Item Personality Inventory (TIPI)[7]. We designated the latent factor derived from TIPI as “Positive” personality, to denote the predominantly adaptive nature of the represented dimensions.Descriptive and correlational analyses were performed using SPSS®, v. 29 (IBM, Armonk NY, USA) software. Statistically significant effects were assumed for p<0.05. Results: A total of 302 RA patients were included in this analysis. The results obtained in the structural equation model indicated a good fit to the data, explaining 57% of the variance of the sleep disturbance (R2=0.57). “Positive” personality and disease activity explained 46% of the variance of perceived impact of disease (R2=0.46). Furthermore, the results corroborate a direct association between disease activity [DAS28CRP3v] and impact of disease (β=0.24; p<0.001) which, in turn, showed a significant positive direct relation with sleep disturbance (β=0.63; p<0.001). “Positive” personality traits had a total protective effect of β=-0.44 on sleep disturbance, including a direct effect of β=-0.18 (p=0.006) and an indirect effect of β=-0.26 (p=0.001) through perceived impact of disease, indicating a mediating influence in this association. The model also shows a direct negative relation between “positive” personality traits and perceived impact of disease (β=-0.41; p<0.001). Depression showed a significant positive direct relation with impact of disease (β=0.26; p=0.005) and a significant negative direct relation with “positive” personality (β=-0.37; p<0.001). Anxiety showed a significant negative direct relation with “positive” personality (β=-0.37; p<0.001) (Figure 1). Conclusion: Positive personality traits and perceived impact of disease seem to have a major role in explaining sleep disturbances in patients with RA. In contrast, disease activity and comorbidities such as depression and anxiety play a secondary role. This evidence reinforces the need to consider a multidisciplinary approach to people living with RA, that goes beyond a treat-to-target strategy focused solely on disease activity. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.Figure 1Estimated standardised direct effects for the proposed model.DAS28CRP3v= Disease Activity Score using 28 joints and C-reactive protein 3 variables. Circles represent latent factors. Squares represent measured variables (the scale scores). Arrows connecting circles and rectangles in one direction show a hypothesized direct relationship between the two variables. Circles with the letter “e” written in it represent the associated error.

ObjectiveAlthough aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults.DesignObservational analysis of DO-HEALTH, a double-blind, randomized controlled trial.Setting and ParticipantsMulticenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status.MethodsThe numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every 3 months. Decreased VA at baseline was defined as better-eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index, and use of walking aids.ResultsAmong the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. Overall, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) = 1.22, 95% CI 1.07, 1.38, P = .003] and 20% increased incidence rate of injurious falls (aIRR = 1.20, 95% CI 1.05, 1.37, P = .007).Conclusions and ImplicationsOur findings suggest that decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls, highlighting the importance of regular eye examinations and VA measurements for fall prevention, even in generally healthy and active older adults.

Objective Studies suggest RA patients could benefit from periodontal treatment. However, published data are inconsistent, and there is a need for better-controlled research. Our study aims to address these limitations.Methods In this exploratory randomized delayed-start study, 22 RA patients with moderate/severe periodontitis were subjected to full-mouth debridement. Periodontal and rheumatological assessments, including measuring anti-cyclic citrullinated peptide 2 (CCP2) IgG levels, were performed at baseline (V1), 2 months (V2) and 6 months (V3) after steps 1 and 2 of periodontal therapy. Primary outcome was changes in DAS for 28 joints (DAS28) between V2 and V1. Secondary outcomes were changes in other rheumatological or periodontal clinical parameters (V2 or V3-V1).Results RA disease activity was significantly higher in RA patients with severe periodontitis compared with moderate periodontitis at baseline, with significant positive correlations between several rheumatological and periodontal parameters. After periodontal treatment, RA patients with severe, but not moderate, periodontitis demonstrated significant improvements in DAS28 (Delta V2-V1, P = 0.042; Delta V3-V1, P = 0.001) and significant reduction in anti-CCP2 IgG levels at V3 (P = 0.032).Conclusion Periodontal treatment is locally effective in patients with RA and impacts RA disease activity and anti-CCP2 antibody levels in patients with severe periodontitis. Hence, our data suggest that periodontal assessment and treatment should be integrated in the management of RA patients within a treat-to-target strategy.Trial registration isrctn.com, http://www.isrctn.com, ISRCTN 17950307.