Bioactive Edible Gel Films Based on Wheat Flour and Glucose for Food Packaging Applications

In order to prepare bioactive edible gel films with enhanced properties, the feasibility of using wheat flour as a raw material with glucose added at several concentrations was studied in this investigation. Films were prepared with glucose concentrations of 0.5, 0.7 and 1 g/g of flour and characterized for their physicochemical properties, including water content, solubility, degree of swelling, chemical structure by FT-IR (ATR) spectroscopy, morphology by SEM microscopy, thermal properties by DSC, gas and water vapor permeability and antioxidant activity. Biodegradation studies were also carried out in soil for 27 days and evaluated by weight loss measurements. It was found that the gel film with the higher glucose concentration exhibits a homogeneous and continuous structure with no cracks and no fragility, accompanied by an increased thickness and solubility and a decreased degree of swelling compared to those with lower concentrations. The chemical structure of all films was verified. Moreover, the increase in glucose content leads to better gas barrier properties with lower oxygen, CO2 and water vapor transmission rates and increased water vapor permeability. A slightly elevated melting temperature was observed in the films with higher glucose content. Higher antioxidant activity was also associated with higher percentage of glucose. Finally, the biodegradation of the films ranged from 13 to nearly 70%. Therefore, it can be concluded that the addition of glucose to wheat flour in concentration up to 1 g/g could result in edible gel films with excellent properties to be used in food packaging applications.

AB0809 Assessment of the Impact of Axial Spondyloarthritis on Patient’s Social Life. Results from the European Map of Axial Spondyloarthritis (EMAS)

Background

As spinal mobility becomes progressively impaired and pain levels escalate, difficulty in performing simple physical routines places a huge burden on axial spondyloarthritis (axSpA).

Objectives

The aim is to evaluate the impact of axSpA on patients’ social life and to identify the factors associated with this.

Methods

Data from 2,846 unselected patients participating in EMAS, an online survey (2017-2018) across 13 European countries, were analysed. Impact of axSpA on social life was assessed by: “Score your relationships since you have been affected by Spondylitis / Spondyloarthritis” [Much worse to much better relationships with spouse, family, friend, and neighbours], and “Please indicate the frequency with which you do the following activities since you became affected by Spondylitis/ Spondyloarthritis?” [Much less frequent to much more frequent engagement in restaurants, cultural outings, travel, and sports]. Patients who rated at least one relationship as “worse/much worse” and at least one of social activity as “less/much less frequent” were considered to have a negatively impacted social life. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health via the General Health Questionnaire GHQ-12 (0-12) were assessed. Univariable and multivariable binary logistic regression were used to identify variables possibly explaining negative impact on social life (n= 2,120).

Results

Mean age was 43.8±12.3 years, 61.5% female, 49.2% had a university degree, and 68.2% married. 44.9% (n= 1,205) patients had their social life negatively impacted since the onset of axSpA.

Those experiencing a negative impact on their social life were more frequently females (49.5% vs. 37.5% males, p<0.001), divorced/separated (59.5% vs. 34.4% widowed, p<0.001), and on sick leave (temporary and permanent) or unemployed (63.9%, 60.9% and 57.0% vs. 36.8% employed, p<0.001). Furthermore, those whose social life was negatively impacted reported greater BASDAI (6.2 vs. 5.0), functional limitation (24.4 vs. 17.4), spinal stiffness (8.4 vs. 7.3), longer diagnostic delay (9.7 vs. 7.4), poorer mental health (6.7 vs. 3.6), anxiety (62.6% vs. 37.1% no anxiety), depression (61.9% vs. 38.5% no depression), or sleep disorders (55.7% vs. 37.5% no sleep disorders), all p<0.001.

The variables associated with negative impact on social life in the multivariable logistic regression were higher disease activity (OR=1.15), poor mental health (OR=1.14), being on a sick leave/unemployed (OR=1.49), divorced/separated (OR=1.46), anxiety (OR= 1.41) and female gender (OR= 1.30; Table 1).

Table 1.

Factors associated with a worsening social life (n= 2,120)

Univariable logistic analysisMultivariable logistic analysisORCI 95%ORCI 95%Age0.990.98, 0.991.000.99, 1.01Gender. Female11.631.39, 1.911.301.06, 1.60Marital status. Divorced/separated21.931.48, 2.501.461.05, 2.04Employment status. Sick Leave/Unemployed32.662.24, 3.171.491.20, 1.85BASDAI (0-10)1.411.35, 1.481.151.08, 1.22Functional Limitation (0-54)1.031.02, 1.031.021.09, 1.02Spinal Stiffness (3-12)1.201.16, 1.241.061.01, 1.11Diagnostic delay1.021.01, 1.031.010.99, 1.02GHQ-12 (0-12)1.221.19, 1.241.141.11, 1.17Anxiety2.842.39, 3.371.411.08, 1.83Depression2.592.17, 3.101.140.87, 1.49Sleep disorders2.101.79, 2.461.020.81, 1.27

1Female vs. male; 2Divorced/separated vs. single/married/widow; 3Sick leave/unemployed vs. other employment status.

Conclusion

Almost half of the axSpA patients reported to have negatively impacted their social life. Being female, divorced/separated, on sick leave/unemployed, with higher disease activity, poor mental health, and anxiety increase the likelihood of worsening social life. As relationships with others and engagement in social or community activities influence quality of life, greater attention to enabling individuals to participate socially through controlling disease activity and addressing mental health comorbidity in the management of axSpA.

Acknowledgements

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests

Marco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Raj Mahapatra: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, José Correa-Fernández: None declared, Laura Christen Employee of: Novartis Pharma AG, Carlos Jesús Delgado-Domínguez: None declared, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis and Pfizer

AB1121 HOW FEARS AND HOPES HAVE EVOLVED IN PATIENTS WITH RMDs THROUGHOUT THE COVID-19 PANDEMIC? RESULTS FROM THE REUMAVID STUDY (PHASE 1 AND 2)

Background

The COVID-19 pandemic has generated uncertainties and concerns along with expectations and hopes that may be of relevance to patients with rheumatic diseases.

Objectives

The aim of this study is to assess changes in the fears and hopes of patients with rheumatic diseases throughout the two phases of REUMAVID.

Methods

REUMAVID is an international cross-sectional study collecting data through an online survey in seven European countries led by the Health & Territory Research group of the University of Seville, together with a multidisciplinary team including patient representatives, rheumatologists, and health researchers. Data were collected in two phases: Phase 1 (P1) between April-July 2020 and Phase 2 (P2) between February-April 2021. Demographics, health behaviours, employment status, access to healthcare services, disease characteristics, WHO-5 Well-Being Index and Hospital Anxiety and Depression Scale (HADS). Participants rated a series of fears (infection, medication consequences, lack of medication, impact on healthcare, lost job, civil disorder) on a scale from zero (“no concern at all”) to five (“extremely concerned”) and hopes (treatment/vaccine availability, going outside, travel, economic situation, treatment continuation, health status) on a scale from zero (“no hopeful at all”) to five (“extremely hopeful”). Descriptive analysis and Mann-Whitney test were used to explore fears and hopes in both phases of REUMAVID.

Results

A total of 3,802 participants were recruited across both phases in REUMAVID with comparable demographic characteristics: mean age 52.6 (P1) vs. 55.0 years (P2), 80.2% female (P1) vs. 83.7% (P2), 69.6% married (P1) vs. 68.3% (P2), and 48.6% university educated (P1) vs. 47.8% (P2). Most prevalent RMD was axial spondyloarthritis in P1 (37.2%), and rheumatoid arthritis in P2 (53.1%).

In P1 and P2 the major concern was the impact on healthcare in the future (3.1 and 3.2 out of 5, p=0.051). Compared to P1, patients in P2 had less fears about RMD medications not reaching the country (2.4 vs. 1.9, p<0.001), civil disorders (2.0 vs. 1.8, p=0.001), or losing their jobs (1.4 vs. 1.5, p=0.003). Comparing hopes with P1, patients in P2 had greater hopes about availability of treatments or vaccines suitable for COVID-19 (3.2 vs. 3.9, p<0.001), to be able to go out as before the pandemic (3.1 vs. 3.5, p<0.001), to be able to travel as before the pandemic (2.8 vs. 3.3, p<0.001), maintain and even improve the current economic situation after the pandemic (2.6 vs. 3.0, p<0.001), and to be able to continue their treatment as usual (3.8 vs. 3.8, p=0.049; Table 1)

Table 1.

Bivariate analysis of patients’ fears and hopes in both phases of REUMAVID (N= 3,802, unless specify)

Mean ± SDP-valueFirst Phasen= 1,800Second phasen= 2,002FearsImpact on healthcare in the future, n= 3,6533.1 ± 1.63.2 ± 1.60.051Treatment taken could make you more likely to get serious illness from COVID-19 infection, n= 3,6512.8 ± 1.82.9 ± 1.80.160More likely to be infected due to the condition, n= 3,6492.8 ± 1.72.9 ± 1.70.040Lack of medication, n= 3,6562.4 ± 1.81.9 ± 1.8<0.001Civil disorder, n= 3,6342.0 ± 1.61.8 ± 1.70.001Lost job, n= 3,5661.5 ± 1.91.4 ± 1.90.003HopesAvailability of a treatment or vaccine suitable for COVID-19, n= 3,3183.2 ± 1.53.9 ± 1.3<0.001*Continue treatment as usual, n= 3,3063.7 ± 1.43.8 ± 1.30.049*Go out as before the COVID-19 pandemic, n= 3,3183.1 ± 1.53.5 ± 1.4<0.001*Don’t get infected with COVID-19 and continue in the same health, n= 3,2803.5 ± 1.53.5 ± 1.50.696Travel as before the COVID-19 pandemic, n= 3,3112.8 ± 1.63.3 ± 1.5<0.001*Maintain or improve economic situation after the COVID-19 pandemic, n= 3,3102.6 ± 1.73.0 ± 1.7<0.001*

Conclusion

During the first phase of REUMAVID at the beginning of the pandemic, patients with RMDs were more fearful and less hopeful compared to the second phase. These fears were notable in terms of lack of medication for their RMD, while during the second phase, patients were hopeful of a treatment or vaccine against COVID-19, and of being able to go out and travel as before.

Acknowledgements

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League for People with Rheumatism (CYLPER) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests

Marco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Laura Christen Employee of: Novartis Pharma AG, José Correa-Fernández: None declared, Elsa Mateus Grant/research support from: Pfizer, grants from Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern and GAfPA, LAURENT GRANGE: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi and UCB, Shantel Irwin: None declared, Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB

POS0064-PARE DESIGN OF AN INNOVATIVE MHEALTH SOLUTION FOR FIGHTING STIGMA ASSOCIATED WITH CHRONIC PAIN

Background:

Pain is associated with a plethora of diseases. The statistics reveal that chronic pain affects around 100 million people across Europe and is closely associated with high unemployment rates, depression, substance abuse & social exclusion. Stigma is a significant and persistent problem for those with chronic pain. Lack of public awareness & stigma associated with pain affect not only patients but also society.

Objectives:

The present research proposes a holistic solution to combat stigma using the latest technological developments. A mobile health application has been designed in order to serve the various stakeholders (patients, families, community) in the field under study. The objective of the final “StigmApp” solution is 4-fold:(i) to facilitate pain management, (ii) to aware the general public, (iii) to educate all different parties & (iv) to facilitate actions & research to combat stigma. Another innovative feature is that it delivers the required information to each party in a highly automated, personalized & digestible way making the whole experience enjoyable, while ensuring user engagement.

Methods:

A multidisciplinary team was formed at the beginning of the project in order to ensure the desired outcome. Two patient organizations from Cyprus & Greece, two behavioral scientists, three physicians, one psychologist, ten citizens, ten patients, two marketeers and two experts in mobile health applications participated. A participatory design methodology was followed in order to capture & address the whole user experience.

Results:

An iterative process was followed bringing & different end-users on board. The different parties evaluated and assessed all modules implemented providing appropriate feedback. It currently runs only on Android operating system and supports: (i) pain management (intense &points of pain, medications used, underlying diseases, life style, etc.),(ii) raise awareness & education (through information nuggets & bite-sized learning), (iii) “Share your story” option to inspire others, (iv) fund raising using crowd-funding techniques, (v) become a volunteer, (vi) organize an inspiring event, (vii) networking, (viii) automatic creation of infographics on how pain affects peoples’ lives. It has been awarded the first prize by BMP Innovation Grant.

Conclusion:

StigmApp has been designed to support the ecosystem around chronic pain regardless of the underlying disease. Our main concern is to raise awareness in order to fight stigma associated with pain & make life easier for patients & their families. The involvement of all different potential actors in the design guarantees a product/service that could meet their needs & can be applied in real life. In the next months the final solution will be piloted by a number of different end users in order to assess it under real life conditions.

References:

[1]Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review & meta-analysis of population studies. BMJ Open 2016 Jun 20;6(6):e010364. DOI:10.1136/bmjopen-2015-010364. PMID:27324708; PMCID: PMC4932255.

[2]Koumpouros Y, Georgoulas A. A systematic review of mhealth funded R&D activities in EU. Trends, technologies and obstacles, Informatics for Health&Social Care. 2020;45(2):168-187. DOI:10.1080/17538157.2019.1656208. Epub2019 Nov 19. PMID:31743060.

[3]Lalloo C, Jibb LA, Rivera J, Agarwal A, Stinson JN. There’s a Pain App for That: review of patient-targeted smartphone applications for pain management.Clin J Pain.2015;31(6):557–63. DOI:10.1097/AJP.0000000000000171.

[4]De Ruddere, Liesa, Craig, Kenneth D. Understanding stigma & chronic pain:a-state-of-the-art review,PAIN:August 2016-Volume 157-Issue 8-p1607-1610, doi:10.1097/j.pain.0000000000000512

Acknowledgements:

The project is funded by the Brain, Mind, and Pain, Patient-Centred Innovation Grant.

Many thanks to the two patient organizations Hellenic League Against Rheumatism & Cyprus League Against Rheumatism for their valuable contribution in the project.

Disclosure of Interests:

None declared.

POS0244 PATIENT JOURNEY WITH AXIAL SPONDYLOARTHRITIS: CRITICAL ISSUES FROM THE PATIENT PERSPECTIVE. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

The journey of axial spondyloarthritis (axSpA) for most patients is slow and arduous.

Objectives:

The goal of this analysis is to describe the journey to diagnosis and further management in axSpA patients.

Methods:

2,846 unselected patients participated in EMAS, a cross-sectional study (2017-2018) across 13 European countries. Descriptive analysis of sociodemographic factors, insurance scheme, diagnostic journey and post diagnosis healthcare utilization was performed. Mann-Whitey test was used to analyse possible differences between BASDAI (>4 v ≤4) and the number of visits to healthcare professionals and follow-up tests undertaken.

Results:

Mean age was 43.9 years, 61.3% were female, 48.1% university educated, 67.9% married, 53.9% employed and 81.7% had public health insurance. Mean age at symptoms onset was 26.6 (11.1), while mean age at diagnosis was 33.7 (11.5) and mean diagnostic delay was 7.4 years. Over 50% had a diagnostic delay of ≥4 years. Prior to receiving a diagnosis, patients visited on average 2.6 specialists. The most commonly performed diagnostic tests were x-rays (72.3%), HLA B27 tests (65.4%) and MRIs (64.3%). 78.4% were diagnosed by a rheumatologist while 14.9% received their diagnosis by a GP. Patients who experienced a diagnostic delay of more than a year (n= 2,208) undertook a considerable number of visits to specialists and medical tests in the year prior to participating in EMAS, which increased with disease activity. Patients with active disease (BASDAI >4) reported a higher number of visits to rheumatologists (3.7±3.5 vs 2.9±2.6), general practitioners (6.6±10.0 vs 3.5±4.1), physiotherapists (19.3±25.0 vs 11.7±17.0), and psychologists/psychiatrists (3.4±10.7 vs 1.9±7.7). Patients with active disease also undertook more x-rays (1.8±2.8 vs. 1.3±1.9), MRI scans (0.9±1.2 vs. 0.6±1.1), and blood tests (4.7±4.4 vs 3.6±3.2). However, one in five patients visited the rheumatologist only once in the year prior to EMAS (21.1%).

Conclusion:

Diagnostic delay continues to be a key challenge in the axSpA patient journey, with patients waiting an average of 7.4 years and visiting multiple doctors prior to diagnosis. Once diagnosed, disease management presents a further challenge, as patients with higher disease activity reported more healthcare professional visits as well as medical tests. Safeguarding health and controlling healthcare utilization requires effective disease management, greater education for non-specialists, rapid referral routes for diagnosis and collaborative care between specialists and non-specialists.

Figure 1.

axSpA Patient journey according to EMAS

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all participants who participated in this study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis and Pfizer, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

POS0960 PRESENCE AND ASSOCIATED FACTORS OF FATIGUE IN PATIENTS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Fatigue/tiredness is an essential aspect of disease for patients with axial spondyloarthritis (axSpA). However, little is known about its prevalence and associated factors.

Objectives:

The aim is to assess the prevalence of fatigue and associated factors in a large sample of patients with axSpA patients from 13 European countries.

Methods:

Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries were analyzed.

The presence of fatigue/tiredness was evaluated using the Visual Analogue Scale from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): “How would you describe the overall level of fatigue/tiredness you have experienced? (0-10)”. Risk of poor mental health was assessed using the 12-Item General Health Questionnaire (GHQ-12; 0-12).

Possible associated factors included: Socio-demographic and disease characteristics, disease activity and function and mental health disorders.

The Mann-Whitney test was used to compare the means of variables of two categories vs. the numerical variables, the χ2 test was used to compare the distribution between the categorical variables. Binary logistic regression and multiple linear regression were used to identify possible predictors.

Results:

A total of 2,846 axSpA patients participated in the EMAS survey: mean age was 43.9 years, 61.3% female, 48.1% had a university degree, 67.9% were married and 71.3% were HLA-B27 positive. Fatigue/tiredness was associated with younger age (6.4±2.3 vs 5.5±2.4), being female (6.6±2.2 vs 5.7±2.4), lower educational level (6.9±2.4 vs 6.0±2.0) and separated or divorced persons (6.8±2.2 vs 6.2±2.3; all p<0.001). Those reporting work impact (6.8±2.1 vs 5.8±2.4), physically inactive (6.9±2.2 vs 6.1±2.3) or those with sleep disorders (7.0±2.0 vs 5.8±2.4), anxiety (7.0 ± 2.0 vs 5.9±2.4) or depression (7.2±1.9 vs 5.9±2.4; all p<0.001) also presented greater fatigue, as did those with higher morning stiffness (r=0.499) and functional limitation (r=0.257), and poorer mental health GHQ-12 (r=0.419). Finally, the variables independently associated with fatigue were female gender (B=0.427), being physical inactive (B=-0.395) and those with greater morning stiffness severity (B=0.349; see Table 1). In addition, those on temporary and permanent sick leave, along with the unemployed, presented greater fatigue (7.1, 6.8 and 7.1 respectively).

Table 1.

Linear regression analysis to predict presence of fatigue/tiredness (N = 2052)

SimpleMultivariateB95% CIp-valueB95% CIp-valueAge-0.018-0.025, -0.011<0.001*-0.015-0.022, -0.008<0.001Gender (female)0.8380.659, 1.017<0.001*0.4270.264, 0.590<0.001Marital status (married)0.1900.042, 0.3390.012*0.1620.021, 0.3020.024*Educational level (university)-0.274-0.402, -0.146<0.001*-0.128-0.245, -0.0120.031*BMI (Overweight/Obesity)0.151-0.026, 0.3280.094NANANAMorning stiffness severity (0-10) *0.4730.442, 0.505<0.001*0.3490.314, 0.385<0.001*Functional limitation (0-54)0.0380.032, 0.044<0.001*0.0140.008, 0.019<0.001*Reported Work impact (yes)0.9360.753, 1.119<0.001*0.2280.068, 0.3890.005*Physical activity (yes)-0.726-0.968, -0.485<0.001*-0.395-0.611, -0.178<0.001*Sleep disorder (yes)1.1911.013, 1.368<0.001*0.2760.095, 0.4580.003*Anxiety (yes)1.1390.950, 1.327<0.001*0.002-0.215, 0.2200.982Depression (yes)1.2741.079, 1.469<0.001*0.2230.001, 0.4460.049*GHQ-12 (0-12) **0.2340.215, 0.254<0.0010.1100.088, 0.132<0.001*

*As measured by the respective item of the BASDAI scale

**12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental health

Conclusion:

Fatigue/tiredness was highly prevalent among axSpA European patients with female gender, engage in physical activity and those with greater morning stiffness severity most strongly associated, and the unemployed presenting greatest fatigue.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

AB0677 GENDER DIFFERENCES ON THE IMPACT OF THE COVID-19 PANDEMIC AND LOCKDOWN IN PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

The COVID-19 pandemic has impacted health, lifestyle, treatment and healthcare of European patients with rheumatic and musculoskeletal diseases (RMDs).

Objectives:

The aim is to evaluate gender differences on the impact of the first wave of the COVID-19 pandemic in the wellbeing, life habits, treatment, and healthcare access of European patients with RMDs.

Methods:

REUMAVID is an international collaboration led by the Health & Territory Research at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs, recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom during the first phase of the pandemic (April-July 2020). Mann-Whitney and χ2 tests were used to analyse differences between gender regarding sociodemographic characteristics, life style, treatment, healthcare, and patient-reported outcomes.

Results:

1,797 patients were included in this analysis. 80.2% were female and a mean age of 52.6 years. The most common diagnosis was inflammatory arthritis (81.7% male vs 73.8% female). There was a higher prevalence of fibromyalgia among females (20% vs 7.0% male). Overall, females reported worse self-perceived health (67.0% vs 51.4%, p<0.001), higher risk of anxiety (59.5% vs 48.1%, p<0.001), and depression (48.0% vs 37.2%, p<0.001). Females reported a greater increase in smoking (26.5% vs 17.5%, p=0.001), although they were less likely to drink alcohol (34.5% vs 25.4%, p=0.013), and also engaged less in physical activity (53.0% vs 60.3%, p=0.045). Overall, females were more likely to keep their scheduled rheumatology appointment (43.3% vs 34.1% of males (p=0.049; Table 1) with a higher proportion of females having their rheumatic treatment changed (17.0% vs 10.7%, p=0.005).

Conclusion:

The first wave of the COVID-19 pandemic and the containment measures have worsened self-perceived health status of patients with RMDs, affecting genders differently. Females reported worse psychological health and life habits such as increased smoking and reduced physical activity, while males increased their alcohol consumption and were less likely to attend their rheumatology appointments.

Table 1.

Bivariate analysis by gender (N= 1,797 unless specify)

Mean ± SD or n (%)P- valueMale(N= 355)Female(N= 1,442)Sociodemographic characteristicsDiseaseInflammatory arthritis1290 (81.7)1,064 (73.8)Fibromyalgia25 (7.0)287 (19.9)Connective tissue disease218 (5.1)195 (13.5)Osteoarthritis52 (14.6)255 (17.7)Osteoporosis10 (2.8)104 (7.2)Vasculitis37 (2.0)29 (2.0)SAPHO1 (0.3)14 (1.0)Age, years52.8 ± 14.252.5 ± 12.90.896Educational levelUniversity162 (45.6)711 (49.3)0.215Marital statusMarried or in relationship269 (75.8)983 (68.2)0.002*Member of a Patient organisation, N=1,795Yes188 (53.0)559 (38.8)<0.001*Patient-reported outcomesHADS Anxiety, N=1,766Risk168 (48.1)843 (59.5)<0.001*HADS Depression, N=1,766Risk130 (37.2)680 (48.0)<0.001*Wellbeing, N=1,774WHO-5 ≤ 50188 (53.4)681 (47.9)0.064Self-perceived health, N=1,783Fair or bad182 (51.4)958 (67.0)<0.001*Change in health status during COVID-19 pandemic, N=1,783Worse333 (94.1)1,339 (93.7)0.799Life style during COVID-19 pandemicSmoking, N=555More than before20 (17.5)117 (26.5)0.001*Alcohol consumption, N=1,083Quit drinking71 (25.4)277 (34.5)0.013Physical activity, N=1,126Yes144 (60.3)470 (53.0)0.045*Treatment and healthcareAble to meet rheumatologist, N= 721No89 (65.9)332 (56.7)0.049*Access to GP, N=688No43 (39.4)248 (42.8)0.512

1Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.

Acknowledgements:

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, Elsa Mateus Grant/research support from: Pfizer, grants from Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, LAURENT GRANGE: None declared, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB., Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

POS0990 FACTORS ASSOCIATED WITH ENGAGING IN PHYSICAL ACTIVITY IN AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Physical activity is an essential component in axial spondyloarthritis (axSpA) care, improving physical and mental well-being.

Objectives:

This analysis aims to identify factors associated with engaging in physical activity among axSpA patients.

Methods:

Data from 2,424 unselected patients participating in EMAS (N=2,846), a cross-sectional study (2017-2018) across 13 European countries, were analysed. Engaging in physical activity was assessed by the following item: “Do you do any physical or sporting activity?” for which participants could report at least 1 physical activity or that they did not do any physical activity. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health using General Health Questionnaire GHQ-12 (0-12) were assessed. Mann-Whitney and Pearson’s χ2 tests were used to analyse relationships between engaging in physical activity and sociodemographic factors, patient-reported outcomes, employment, lifestyle and comorbidities. Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining engagement in physical activity.

Results:

Mean age was 43.9±12.3 years, 61.3% were female, 48.1% had a university degree and 67.9% were married. 81.8% (n= 2,329) engaged in at least one kind of physical activity. Those physically active were typically male (85.3% vs 79.7% female, p<0.001), university educated (86.0% vs 78.0%, p<0.001), married (83.1% vs 79.2% unmarried, p=0.046), and members of a patient organisation (86.4% vs 78.9% non-member, p<0.001). 25.1% of obese patients (n=533) did not engage in physical exercise (v. 16.6% not obese, p<0.001). Those not engaging in physical activity reported greater disease activity (6.0 vs 5.4 BASDAI, p<0.001), functional limitation (21.6 vs 20.2, p=0.010), spinal stiffness (8.3 vs 7.6, p<0.001), and poorer mental health (5.9 vs 4.8 GHQ-12, p<0.001). Furthermore, 83.9% of those employed (n=1,457) were physically active, versus 73.7% unemployed (n=205; p<0.001). In the multivariable binary logistic regression, the qualitative variables associated with engaging in physical activity were belonging to a patient organisation (OR= 1.91), not being obese (OR= 1.58), being university educated (OR= 1.54), and being male (OR= 1.39). The quantitative variables associated with engaging in physical activity were lower spinal stiffness (OR=0.90), better mental health (OR=0.96), and one-year age increase (OR=1.02). (Table 1).

Table 1.

Regression analysis for variables explaining engagement in physical activity (n=2,424)

Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI7OR95% CI7Gender. Male11.481.21, 1.811.391.06, 1.82Educational level. University21.731.42, 2.111.541.18, 2.00Marital Status. Married31.731.06, 1.581.180.91, 1.54Patient organization. Member41.71)1.39, 2.101.911.43, 2.55Body Mass Index. Not Obese51.691.35, 2.121.581.17, 2.13Employment status. Employed61.281.06, 1.561.000.76, 1.32Quantitative variablesOR95% CI7OR95% CI7Age1.011.00, 1.021.021.01, 1.03BASDAI (0-10)0.860.82, 0.910.960.89, 1.04GHQ-12 (0-12)0.940.92, 0.960.960.93, 0.99Functional Limitation (0-54)0.990.99, 1.001.000.99, 1.01Spinal Stiffness (3-12)0.900.86, 0.940.900.84, 0.95Proportion of life with axSpA (0-1)2.831.50, 5.352.000.91, 4.39

1Male vs Female; 2University vs no university; 3Married vs unmarried; 4Member vs not; 5Not obese (underweight, normal and overweight) vs obese; 6Employed vs not (unemployed, sick leave, retirement, housework and student).795% CI for test H0: OR=1

Conclusion:

These results show that increasing age, being male, university educated, member of a patient organisation, not obese, having lower spinal stiffness, and better mental health increase the probability of engaging in physical activity. Physical activity is an important part of axSpA care and patient organizations play a critical role in enhancing access to and participation in physical activity.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

POS0989 FACTORS ASSOCIATED WITH INABILITY TO WORK AND DISABILITY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Axial spondyloarthritis (axSpA) is associated with a high burden of disease, which may lead to inability to work and disability.

Objectives:

This analysis aims to identify factors associated with inability to work and disability among European axSpA patients.

Methods:

Data from 2,846 unselected patients participating in EMAS, a cross-sectional study (2017-2018) across 13 European countries were analysed. The sample was divided into those on permanent sick leave or with a recognised disability (Group 1) and those with neither permanent sick leave nor a recognized disability (Group 2). Mann-Whitney and Pearson’s χ2 tests were used to analyse possible differences between groups regarding sociodemographic characteristics, patient-reported outcomes [BASDAI (0-10), GHQ-12 (0-12), functional limitation (0-54) and spinal stiffness (3-12)], lifestyle habits, working life, and comorbidities). Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining being on permanent sick leave and disability, for which 1,657 patients were included.

Results:

Mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 67.9% were married. Patients in Group 1 (34.4%; n=978) were more likely to be women (54.3%), married (71.1%), with higher disease activity (BASDAI 5.9 vs. 5.3), functional limitation (25.1 vs. 18.0), spinal stiffness (8.6 vs. 7.3; all p<0.001), and longer diagnostic delay (8.1 vs 7.1 years; p = 0.01) than those in Group 2 (65.6%; n=1,868). In addition, 88.0% of Group 1 (n=728) had difficulties in finding a job due to axSpA throughout life; and more than 30.0% reported a diagnosis of anxiety, depression, or sleep disorders. Moreover, being in Group 1 was associated with higher functional limitation in all daily activities. In the multivariable binary logistic regression, the qualitative variables associated with permanent sick leave or disability were: difficulties finding work (OR= 2.52), belonging to a patient organisation (OR= 1.54) and work choice determined by axSpA (OR= 1.38). The quantitative variables associated with permanent sick leave or disability were: higher spinal stiffness (OR= 1.09), older age (OR= 1.03), longer disease duration (OR= 1.03), shorter diagnostic delay (OR= 0.98), and higher functional limitation (OR= 1.01) (Table 1).

Table 1.

Regression analysis for variables explaining being on permanent sick leave or disability (n=1,657)

Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI3OR95% CI3Gender11.571.34, 1.831.240.97, 1.57Educational level21.711.46, 2.001.080.86, 1.35Member of a patient organisation. Yes1.961.67, 2.291.541.23, 1.94Smoking. Yes1.281.08, 1.511.220.96, 1.55Difficulty finding job due to axSpA. Yes3.712.89, 4.772.521.83, 3.47Work choice determined by axSpA. Yes1.691.43, 1.991.381.09, 1.75Anxiety diagnosis. Yes1.271.07, 1.510.980.72, 1.34Depression diagnosis. Yes1.581.33, 1.891.250.92, 1.69Sleep disorder diagnosis. Yes1.331.13, 1.560.950.73, 1.23Quantitative variablesOR95% CI3OR95% CI3Age. Years1.041.03, 1.041.031.01, 1.04BASDAI (0-10)1.181.13, 1.241.060.98, 1.13Functional limitation (0-54)1.031.02, 1.031.011.00, 1.02Spinal stiffness (3-12)1.251.20, 1.291.091.03, 1.15Diagnostic delay1.011.01, 1.020.980.96, 0.99Disease duration1.041.03, 1.051.031.01, 1.04

1Male vs Female; 2No university studies vs university studies. 395% CI for test H0: OR=1

Conclusion:

One third of patients reported being on permanent sick leave or having a recognised disability. They were more likely to have higher spinal stiffness scores, were older in age, experiencing difficulty finding a job, and belonged to a patient organisation. Increased efforts in relation to early access to effective treatments and the creation of flexible working environments are essential for axSpA patients to continue working and remain active, which benefits their quality of life.

Acknowledgements:

This study was supported by Novartis Pharma AG.The authors would like to thank all patients who participated in this study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

POS1213 IMPACT OF THE COVID-19 PANDEMIC AND LOCKDOWN ON WELLBEING ON PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

The COVID-19 pandemic has impacted the wellbeing of patients with Rheumatic and Musculoskeletal Diseases (RMDs).

Objectives:

The aim is to assess emotional well-being and its associated factors in patients with RMDs during the first wave of the COVID-19 pandemic.

Methods:

REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. 1,800 participants were recruited by patient organisations. Data was collected between April and July 2020. Participants were divided into two groups: 1) Participants with poor wellbeing (World Health Organization-Five Wellbeing Index (WHO-5) ≤ 50), 2) Participants with good wellbeing (WHO-5 >50). The Mann-Whitney and χ2 tests were used to analyse possible relations between sociodemographic characteristics, lifestyle, and outdoor contact with wellbeing during the first wave of the COVID-19 pandemic. Univariate and multivariate binary logistic regression was used to determine the impact of the independent variables associated with poor wellbeing.

Results:

1,777 patients with 15 different RMDs were included. The mean age was 52.7, 80.2% female, 48.7% had a university degree, and 69.7% were married or in a relationship. The most frequent diagnoses were inflammatory arthritis (75.4%). 49.0% reported poor wellbeing. 57.7% of patients who belonged to a patient organisation reported good wellbeing (vs 46.3% who did not, p<0.001). Those who reported poor wellbeing had higher disease activity (51.4% vs 41.3%, p<0.001), a higher risk of anxiety (54.3% vs 41.7%, p<0.001) and depression (57.0% vs 42.1%, p<0.001), and poorer self-perceived health (53.0% vs 41.8%, p<0.001), compared to those who did not. A higher proportion of those who engaged in physical activity presented good wellbeing (54.0% vs 46.5%, p=0.012). 57.4% of the patients who were unable to attend their appointment with their rheumatologist reported poor wellbeing, compared to 48.2% who did attend (p=0.027). Patients who did not walk outside (56.2%) or who lacked elements in their home to facilitate outside contact (63.3%) experienced poor wellbeing (p<0.001). The factors associated with poor wellbeing were lack of elements in the home enabling contact with the outside world (OR=2.10), not belonging to a patient organisation (OR=1.51), risk of depression (OR=1.49), and not walking outside (OR=1.36) during the COVID-19 pandemic (Table 1).

Conclusion:

Almost half of the patients with RMDs reported poor emotional wellbeing during the first wave of the COVID-19 pandemic. The lack of elements in the home that facilitate outdoor contact, not belonging to a patient organisation, the presence of anxiety, and not walking outside during the pandemic increase the probability of poor emotional well-being. These results highlight the importance of environmental factors and the role of patient organisations in addressing the effects of the pandemic and its containment measures.

Table 1.

Logistic regression for poor wellbeing WHO-5 (N=1,104)

Univariate logistic analysisMultivariate logistic analysisOR95% CI1OR95% CI1Patient organisation. Non-member1.571.30, 1.891.511.18, 1.93Disease activity (VAS ≥ 4)1.501.21, 1.861.160.85, 1.56Risk of anxiety (HADs, 0-21)1.671.38, 2.021.200.92, 1.58Risk of depression (HADs, 0-21)1.831.51, 2.211.491.12, 1.99Self-reported health. Fair to very bad1.581.30, 1.911.260.94, 1.68Change in health status. Worse1.271.06, 1.531.050.80, 1.38Physical activity. No1.351.07, 1.711.080.83, 1.40Talked with rheumatologist during the pandemic. No1.451.04, 2.031.040.68, 1.61Walk outside during COVID-19 pandemic. No1.471.19, 1.831.361.02, 1.81Element in home with outdoor contact. No1.931.42, 2.622.101.41, 3.15

195% CI for test H0: OR = 1

Acknowledgements:

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB., Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, LAURENT GRANGE: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Shantel Irwin: None declared, Clare Jacklin Grant/research support from: has received grant funding from Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

POS0065-PARE HEALTH IMPACT OF OVERWEIGHT AND OBESITY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Growing evidence on the negative role of overweight and obesity on the health outcomes of patients with axial spondyloarthritis (axSpA) exists.

Objectives:

The aim of the study is to evaluate the association between Body Mass Index (BMI) categories and sociodemographic, disease-characteristics and patient-reported outcomes (PROs) in a large sample of axSpA patients.

Methods:

Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries were analyzed. Using self-reported height and weight patients were classified into under and normal weight (<24.9 Kg/m2), overweight (25.0-29.9Kg/m2) or obese (>30.0Kg/m2) following WHO guidelines. The Kruskal-Wallis test was used to compare the means of numerical variables between polytomous variables, the χ2 test was used to compare the distribution between the categorical variables. Simple and multivariate logistic regression were used to identify possible associated factors.

Results:

A total 2,846 axSpA patients participated in the EMAS survey: mean age was 43.9 years, 61.3% female, 48.1% had a university degree and 67.9% were married and 71.3% were HLA-B27 positive. The percentage of patients with obesity was 18.7%, overweight 33.5%, normal weight 44.0% and underweight 3.8% with an accumulate prevalence of overweight/obesity of 52.2% (compared to 51.6 % of the EU’s population1). Those with obesity engage less frequently in sport (50.1% vs 33.3%; p<0.001) and in intimate relationships since disease onset (36.5% vs 20.4%; p<0.001), have higher functional limitations when tying shoe laces (46.8% vs 33.6%; p<0.001) and higher functional limitations regarding housework (52.2% vs 48.2%; p=0.024). Furthermore, they present greater disease activity (6.1±1.8 vs 5.4±2.0; p<0.001) and spinal stiffness (8.6±2.3 vs 7.4±2.5; p<0.001) compared to under and normal weight. For obese patients, the percentage of depression is higher (34.5% vs 23.7%; p<0.001), presenting a poorer mental health (5.7 ± 4.3 vs 5.0 ±4.2; p<0.001). The factors most strongly associated with obesity were higher functional limitation when tying shoe laces (OR=1.467; p<0.001), the female gender (OR=1.433; p<0.001) and lesser frequency of intimate relation (OR=1.239; p<0.001; see Table 1).

Table 1.

Logistic regression analysis to predict presence of obesity (N = 1,194)

SimpleMultivariateOR95% CIp-valueOR95% CIp-valueAge1.0261.018, 1.034<0.0011.0261.012, 1.040<0.001Gender (female)1.3361.095, 1.6290.0041.4331.031, 1.9900.032Marital status (married)1.3841.184, 1.617<0.0010.9820.746, 1.2920.897Educational level (university)0.7760.681, 0.884<0.0011.0460.849,1.2890.674Employment status (employed)1.0350.987, 1.0850.154NANANAEngage in sports (much less than before)1.3131.202, 1.433<0.0011.1430.978, 1.3360.093Travel/ excursions (much less than before)1.3161.186, 1.461<0.0010.9810.800, 1.2020.852Intimate relations (much less than before)1.5711.393, 1.772<0.0011.2391.003, 1.5300.047Tying shoe laces (high)1.4331.232, 1.666<0.0011.4671.176, 1.8300.001Housework / cleaning (high)1.2261.048, 1.4340.0110.7600.596, 0.9700.028BASDAI (0-10) N:2,5841.2201.156, 1.288<0.0011.1271.021, 1.2440.018Spinal Stiffness (3-12) N:2,6601.1841.136, 1.234<0.0011.0570.987, 1.1330.115Sleep disorders diagnosis1.5581.284, 1.892<0.0011.0450.753, 1.4490.793Depression diagnosis1.6481.340, 2.027<0.0011.2670.892, 1.7990.186Psychological distress GHQ-12 (0-12)1.0531.029, 1.078<0.0010.9950.954, 1.0380.813

Conclusion:

Results from the largest European axSpA survey reveal a similar prevalence of overweight and obesity to the general population. However, compared to normal weight, obese patients present greater disease activity, spinal stiffness and poorer mental health. Additionally, women with axSpA appear to be more vulnerable than men to obesity.

References:

[1]EU Eurostat. Overweight and obesity - BMI statistics.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, José Correa-Fernández: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

POS0961 PREVALENCE AND ASSOCIATED FACTORS OF SLEEP DISORDERS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Sleep is an essential health aspect that is often impacted in patients with axial spondyloarthritis (axSpA).

Objectives:

This analysis aims to assess the prevalence and associated factors of sleep disorders in a large sample of European axSpA patients.

Methods:

Data were analyzed from 2,846 unselected patients with self-reported clinician-given diagnosis of axSpA of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries. Socio-demographic data; BASDAI [0-10] scores; engagement in physical activity; axSpA influence on work choice (assessed with yes/no question “Was your current or past work choice in any way determined by axSpA?”); risk of psychological distress (12-item General Health Questionnaire [GHQ-12; 0-12]); functional limitation [0-54] and self-reported anxiety and depression were evaluated. Presence of sleep disorders was assessed by the question: “Please indicate whether you have been diagnosed with any of the following: sleep disorders”. A Mann-Whitney test was used to compare the means of numerical variables between dichotomous variables, the Chi-Square test was used to compare the distribution between the categorical variables. Simple and multivariable logistic regression models were used to identify associations between sleep disorders and disease characteristics, mental health and work-related variables.

Results:

Age of respondents was 43.9 years; 61.3% were female; 48.1% had a university degree; 67.9% were married and 71.3% were HLA-B27 positive. The prevalence of sleep disorders was 39.0%. In the bivariate analysis, presence of sleep disorders was associated with female gender (68.3% vs. 31.7%; p<0.001); overweight/obese (56.5% vs. 49.8%; p<0.001); increased BASDAI scores (6.1±1.8 vs. 5.0±2.1; p<0.001); fatigue (7.0±2.0 vs. 5.8±2.4; p<0.001); morning stiffness (5.8±2.4 vs. 4.8±2.4; p<0.001), work impact (56.5% vs. 38.2%; p< 0.001); anxiety (56.8% vs. 12.5%; p<0.001); depression (51.8% vs. 10.1%; p<0.001) and higher GHQ-12 scores (6.4±4.0 vs. 3.9±3.9; p<0.001). However, factors that remained independently associated with sleep disorders in the multivariable analysis were anxiety (OR=3.8 p<0.001) and depression (OR=3.1 p<0.001) and female gender (OR=1.4; p=0.002) [Table 1].

Table 1.

Regression analysis to predict presence of sleep disorders (N=2191)

Simple logistic regressionMultivariable logistic regressionOR95% CIp-valueOR95% CIp-valueGender (female)1.591.36-1.87<0.0011.401.13-1.730.002Marital status (married)1.130.99-1.280.074NANANAOverweight/Obesity1.311.12-1.530.0011.391.14-1.710.001BASDAI (0-10)1.331.27-1.39<0.0011.070.95-1.210.246Fatigue/Tiredness (0-10)*1.281.23-1.33<0.0011.040.97-1.120.271Morning Stiffness intensity (0-10)*1.191.15-1.23<0.0011.050.98-1.130.188Reported Work impact (yes)2.101.78-2.48<0.0011.291.05-1.580.015Anxiety (yes)9.187.58-11.11<0.0013.842.99-4.94<0.001Depression (yes)9.537.78-11.66<0.0013.092.37-4.02<0.001GHQ-12 (0-12)**1.161.14-1.19<0.0011.031.00-1.060.029

*As measured by the respective item of the BASDAI scale.

**12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental health.

Conclusion:

Sleep disorders were highly prevalent among axSpA European patients and strongly associated with female gender and reporting worse mental health, and spinal stiffness. Patients on permanent and temporary sick leave were more likely to report sleep disorders. The strong association between sleep disorders with both anxiety and depression should encourage rheumatologists to screen their patients with sleep disturbance in case they require additional specialist support.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

OP0264-HPR “I LITERALLY CONVINCED MYSELF I WAS GOING TO CATCH IT AND DIE”: LIVED EXPERIENCES OF THE COVID-19 PANDEMIC BY PEOPLE WITH RHEUMATIC DISEASES FROM FOUR EUROPEAN COUNTRIES

Background:

The COVID-19 pandemic has resulted in unforeseen challenges for humanity, taking a significant toll, especially the immune-suppressed individuals. In this regard, the health and general well-being of people with rheumatic diseases, the great majority users of immunosuppressives, have been at stake.

Objectives:

To explore the impact of the COVID-19 pandemic on people with rheumatic diseases on immunosuppression during the first wave, concerning a) (self-)management of their disease; b) interaction with the health care team; c) emotional well-being and d) overall health.

Methods:

A qualitative study was conducted following a phenomenological approach. Adults (>18 years) with a rheumatic disease from four European countries (Cyprus, England, Greece, Portugal). Patients were recruited through patient’s associations and social media and were invited to participate in semi-structured, audio-recorded interview or focus groups, between July - August 2020. Following a pilot study the information provided was transcribed verbatim, anonymized and translated into English where necessary. An inductive approach was adopted to carry out a thematic framework analysis with the assistance of ATLAS.ti to identify key themes and subthemes. Data validation strategies were employed, and Ethical approval and informed consent were obtained.

Results:

Participants were 24 patients (21 women, age range 33 to 74 years) divided by 7 focus-groups and 1 individual interview. Most frequent diagnoses were rheumatoid arthritis (n=7), lupus (n=4), juvenile idiopathic arthritis (n=3).

Three key themes with 3-7 subthemes were identified within the analytical framework, centred around the impact of the Covid-19 on patients’ lives (Figure 1): i) individual person (e.g. fear for myself and family, social isolation and lack of personal freedom, more time with family) ii) health settings (e.g. (un)clear information about risks of contamination, fear or risk of shortages of medication, remote consultations), and iii) work and community (e.g. persistent stress due to mass media exposure, lack of awareness by others about patients’ rheumatic disease and its disclosure, hope and suspicion about new vaccine development: “I hear that they will ask vulnerable groups to have the vaccine first (...) Why is that? we will be again the innocent victims”). Findings were similar across countries, except for spirituality (i.e. the pandemic as “the hand of God”), a coping subtheme particular to Portugal. These main themes resonated well with the social ecological model and Walsh’s Family Resilience Process [1,2].

Conclusion:

When experiencing a significant life-event people require some time to process the different lived experiences. This study provides insights on how patients from four countries coped with the new challenges. Such insights are invaluable for health care providers and policy makers, in guiding more meaningful support tailored to individual needs, especially at times of crisis. The study highlights the impact of COVID-19 on the lives of people with rheumatic disease. A follow-up study is currently underway to examine the effect of subsequent waves of the pandemic.

References:

[1]Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39(3):364-72. doi: 10.1177/1090198111418634.

[2]Walsh F. Family resilience: a framework for clinical practice. Fam Process. 2003;42(1):1-18. doi: 10.1111/j.1545-5300.2003.00001.

Acknowledgements:

We thank the participants of this study.

Disclosure of Interests:

None declared

POS0988 FACTORS ASSOCIATED WITH PAIN INTENSITY IN AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Pain is a hallmark of axial spondyloarthritis (axSpA) and can significantly deteriorate patients’ health status.

Objectives:

This analysis aims to investigate factors associated with pain intensity in a large sample of European axSpA patients.

Methods:

2,846 unselected patients participated in EMAS, a cross-sectional study (2017-2018) across 13 European countries. Data from 2,636 participants who reported pain were analysed. Pain was measured by the mean of two BASDAI questions (range 0 “no pain” to 10 “most severe pain”): “How would you describe the overall level of AS neck, back or hip pain you have had?” and “How would you describe the overall level of pain/swelling in joints other than neck, back, hips you have had?”. Linear regression analysis was applied to identify associations between pain intensity and sociodemographic factors, patient-reported outcomes [BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), mental health using the 12-item General Health Questionnaire GHQ-12 (0-12)], work life, physical activity and comorbidities, for which 850 patients were included.

Results:

The mean age of the sample was 44 years, 61.4% were female, 49.4% had a university degree and 67.7% were married. The average reported pain intensity was 5.3 (±2.2); 76.2% reported pain intensity ≥4, with the greatest intensity reported by women (5.5 vs 4.9, p<0.001), those not university educated (5.6 vs 5.0, p<0.001), separated or divorced compared to singles (5.8 vs 5.2, p=0.004), and not physically active (5.7 vs 5.2, p<0.001). In addition, employed patients who experienced work-related issues reported greater pain (5.2 vs 3.9) as did those who experienced/ believed they would face difficulties finding work due to axSpA (5.9 vs 4.3), and those whose employment choice was determined by axSpA (5.7 vs 4.9; all p<0.001). Moreover, associations with anxiety (5.9 vs 5.0), depression (6.1 vs 5.0) and sleep disorders (5.9 vs 4.9; all p<0.001) were also found. The multiple linear regression model showed that those with higher pain intensity reported at least one work-related issue (B=0.65), difficulties finding work due to axSpA (B=0.48), not having attended university (B=0.38), greater spinal stiffness (B= 0.29), being female (B=0.26) and poorer mental health (GHQ-12) (B=0.10) (Table 1).

Table 1.

Regression analysis of the variables associated with pain intensity (0-10 NRS), n=850

UnivariableMultivariableB95% CIB95% CIGender. Female10.6040.432, 0.7750.2600.003, 0.517Educational level. No University20.6710.504, 0.8380.3760.118,0.634Marital Status. Divorced/Separated30.4950.209, 0.780-0.044-0.468, 0.380Body Mass Index. Obese40.362-0.097, 0.821NANAGHQ-12 (0-12)0.1820.163, 0.2010.1000.064, 0.137Functional Limitation (0-54)0.0360.030, 0.0410.009-0.001, 0.018Spinal Stiffness (3-12)0.3570.326, 0.3880.2880.234, 0.342Diagnostic Delay, years0.0200.010, 0.030-0.015-0.032, 0.002Work-Related Issues. Yes1.3381.095, 1.5820.6540.338, 0.970Difficulty finding job due to axSpA. Yes1.5681.362, 1.7740.4760.176, 0.776Work choice determinate by axSpA. Yes0.8080.633, 0.9830.199-0.069, 0.467Physical activity. No0.4940.263, 0.725-0.128-0.497, 0.242Anxiety diagnosis. Yes0.9350.753, 1.117-0.047-0.416, 0.321Depression diagnosis. Yes1.1070.919, 1.2950.115-0.270, 0.500Sleep disorder diagnosis. Yes1.0420.871, 1.213-0.091-0.392, 0.211

1Female vs Male; 2No university studies (no schooling, primary and high school) vs University studies; 3Divorced/separated vs single, married and widow; 4Obese vs not obese (underweight, normal and overweight).

Conclusion:

Pain was most strongly associated with working life impairment, as well as with spinal stiffness. Pain was also associated with suffering from depression, anxiety and sleep disorders. Understanding how pain affects individuals and shared-decision making between rheumatologists and patients are essential for long-term disease management and preserving quality of life of axSpA patients.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the EMAS study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

AB0676 FEARS AND HOPES DURING THE COVID-19 PANDEMIC IN PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

The first wave of the COVID-19 pandemic led to a rapidly evolving global crisis characterized by major uncertainty.

Objectives:

The objective is to assess COVID-19-related fears and hopes in patients with rheumatic and musculoskeletal diseases (RMDs) during the first wave of the pandemic.

Methods:

REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from 1,800 patients with a diagnosis of 15 RMDs recruited by patient organisations in Cyprus, France, Greece, Italy, Portugal, Spain and, the United Kingdom. Data are collected in two phases, the first phase between April and July 2020, the second in 2021. Participants rated a series of fears (infection, medication consequences, lack of medication, impact on healthcare, job loss, civil disorder) on a Likert scale from zero (“no concern at all”) to five (“extremely concerned”) and their hopes (treatment/vaccine availability, going outside, travel, economic situation, treatment continuation, health status) on a Likert scale from zero (“not hopeful at all”) to five (“extremely hopeful”). The Mann-Whitney and Kruskal-Wallis tests were used to analyse the different fears and hopes according to socio-demographics characteristics, disease and health status.

Results:

1,800 patients participated in the first phase of REUMAVID. The most frequent RMDs group was inflammatory arthritis (75.4%), the mean age was 52.6 years and 80.1% were female. The most important fear for patients was the impact of the COVID-19 pandemic on healthcare (3.1 out of 5), particularly for those younger in age (3.0 vs 3.2, p=0.004), female gender (3.2 vs 2. 9 of men, p=0.003), experiencing greater pain (3.1 vs 2.8, p=0.007), with higher risk of anxiety (3.3 vs 2.9 of without anxiety, p<0.001) and depression (3.3 vs 2.9 without depression, p<0.001). The possible impact of anti-rheumatic medication and the development of severe disease if they became infected with COVID-19,was mostly feared (2.8 out of 5), by those receiving biological therapy (3.1 vs 2.5 not biological therapy, p<0.001) or those with underlying anxiety (2.9 vs 2.6 without anxiety, p=0.007). The risk of contracting COVID-19 due to their condition (2.8 out of 5), was especially feared by those with vasculitis (3.2 out of 5), who were female (2.9 vs 2.5, p<0.001), using biologics (2. 9 vs 2.7 of no use, p=0.003), in greater pain (2.8 vs 2.4, p<0.001), with a risk of anxiety (3.0 vs 2.6 without anxiety, p=0.004), and risk of depression (3.0 vs 2.6 without depression, p<0.001). The major hopes were to be able to continue with their treatment as usual (3.7 out of 5), particularly for those taking biologics (3.8 vs 3.6 not taking, p=0.026), those with a better well-being (3.8 vs 3.6 with worse well-being, p=0.021), without anxiety (3.8 vs 3.6 at risk, p=0.004) and without depression (3.8 vs 3.6 at risk, p=0.007). Hoping not to become infected with COVID-19 and to maintain the same health status, were especially those who were older (3.6 vs 3.4 p=0.018) without anxiety (3.4 vs 3.6 at risk, p=0.005), and without depression (3.6 vs 3.4 at risk, p=0.006). Another important hope was the availability of a treatment or vaccine for COVID-19, which was important for patients experiencing better well-being (3.3 vs 3.0 with worse well-being, p<0.001; Figure 1).

Conclusion:

The outstanding COVID-19-related fear expressed by European patients with RMDs was its impact on healthcare, while the greatest hope was to be able to continue treatment. Younger patients reported more fears while older patients were more hopeful. Those receiving biologics had greater fears and hopes associated with their treatment. In addition, patients at risk of mental disorders presented greater fears and less hopes.

Figure 1.

Fears and Hopes of REUMAVID participants

Acknowledgements:

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB., Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Shantel Irwin: None declared, LAURENT GRANGE: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

AB0675 COUNTRY COMPARISON ON THE IMPACT OF THE COVID-19 PANDEMIC ON PATIENTS WITH RHEUMATIC DISEASES. RESULTS FROM THE REUMAVID STUDY (PHASE 1)

Background:

The COVID-19 pandemic has impacted every aspect of life of European patients with rheumatic and musculoskeletal diseases (RMDs).

Objectives:

The aim is to evaluate country differences on the impact of the first wave of the COVID-19 pandemic on life habits, healthcare access, health status, mental health and wellbeing in European patients with RMDs.

Methods:

REUMAVID is an international collaboration led by the Health & Territory Research group at the University of Seville, together with a multidisciplinary team including patient organisations and rheumatologists. This cross-sectional study consisting of an online survey gathering data from patients with a diagnosis of 15 RMDs in Cyprus, France, Greece, Italy, Portugal, Spain, and the United Kingdom. Participants were recruited by patient organisations (April-July 2020). The Kruskal-Wallis and χ2 tests were used to analyse differences between countries and independent variables.

Results:

1,800 patients participated in the first wave of the COVID-19 pandemic (REUMAVID). 37.8% of Spanish patients increased their smoking consumption during the pandemic followed by Cyprus (32.1%) and Portugal (31.0%), while alcohol consumption was higher in the UK (36.3%) and France (27.0%). 82.3% of patients in Spain unable to attend their appointment with their rheumatologist, either due to cancellations or other personal reasons. Access to primary care was most limited in Portugal and Italy, where only 45.0% and 51.6% got access. 61.9% in Italy and 53.3% in Spain experienced a worsening of their health during the pandemic. 68.5% in Spain and 67.8% in Portugal were at risk of anxiety. The highest proportion at risk of depression was found in Greece (55.4%), Cyprus (55.1%), and Italy (54.8%). 66.9% of patients in Spain reported poor wellbeing, compared to 23.8% in Italy and 30.1% in Portugal (Table 1).

Conclusion:

The first wave of the pandemic and the related containment measures heterogeneously affected patients with RMDs across European countries, who overall increased harmful habits, experienced more difficulties in accessing healthcare and, reported poor mental health and well-being.

Table 1.

Bivariate analysis between European countries (N=1,800, unless specified)

Mean ± SD or n (%)UKn: 558Spainn: 464Francen: 229Greecen: 57Cyprusn: 101Italyn: 127Portugaln: 264- Inflammatory arthritis1509 (91.2)402 (86.6)147 (64.2)33 (57.9)57 (56.4)89 (70.1)120 (45.5)- Fibromyalgia53 (9.5)14 (3.0)26 (11.4)14 (24.6)28 (27.7)53 (41.7)124 (47.0)- Connective tissue disease236 (6.5)15 (3.2)13 (5.7)25 (43.9)33 (32.7)30 (23.6)61 (23.1)- Osteoarthritis140 (25.1)29 (6.3)102 (44.5)0 (0.0)8 (7.9)15 (11.8)13 (4.9)- Osteoporosis50 (9.0)3 (0.6)20 (8.7)2 (3.5)9 (8.9)18 (14.2)12 (4.5)- Vasculitis39 (1.6)1 (0.2)6 (2.6)3 (5.3)3 (3.0)5 (3.9)9 (3.4)- Sapho (only France)15 (6.6)Smoking, More than before.N= 55616 (10.3)48 (37.8)22 (24.7)8 (23.5)9 (32.1)8 (20.5)26 (31.0)Alcohol consumption, More than before. N= 1,08599 (36.3)48 (10.3)27 (27.0)4 (7.0)4 (4.0)4 (13.3)11 (18.3)Unable to meet rheumatologist. N= 72283 (48.8)186 (82.3)27 (30.3)18 (64.3)22 (51.2)9 (31.0)77 (56.2)Access to primary care. N= 68987 (76.3)65 (67.7)32 (76.2)14 (60.9)17 (60.7)65 (51.6)117 (45.0)Change in health status, Much worse or worse. N=1,786214 (38.4)245 (53.3)98 (43.0)24 (42.9)38 (38.4)78 (61.9)135 (51.9)WHO-5. Poor well-being (≤50).N= 1,777292 (52.5)303 (66.9)100 (43.9)21 (37.5)46 (46.5)30 (23.8)78 (30.1)Risk of anxiety. N= 1,769241 (43.6)309 (68.5)118 (52.0)31 (55.4)61 (62.2)78 (61.9)175 (67.8)Risk of depression. N= 1,769186 (33.6)232 (51.4)101 (44.5)31 (55.4)54 (55.1)69 (54.8)138 (53.8)

Note: all relations were significant at the 0.001 level. 1Including: Axial Spondyloarthritis, Rheumatoid Arthritis, Psoriatic Arthritis, Juvenile Idiopathic Arthritis, Gout and Peripheral Spondyloarthritis; 2Including: Systemic Lupus Erythematosus, Sjögren’s Syndrome, Systemic Sclerosis and Myositis; 3Including: Polymyalgia Rheumatic and Vasculitis or Arteritis.

Acknowledgements:

This study was supported by Novartis Pharma AG. We would like to thank all patients that completed the survey as well as all of the patient organisations that participated in the REUMAVID study including: the Cyprus League Against Rheumatism (CYPLAR) from Cyprus, the Association Française de Lutte Anti-Rhumatismale (AFLAR) from France, the Hellenic League Against Rheumatism (ELEANA) from Greece, the Associazione Nazionale Persone con Malattie Reumatologiche e Rare (APMARR) from Italy, the Portuguese League Against Rheumatic Diseases (LPCDR), from Portugal, the Spanish Federation of Spondyloarthritis Associations (CEADE), the Spanish Patients’ Forum (FEP), UNiMiD, Spanish Rheumatology League (LIRE), Andalusian Rheumatology League (LIRA), Catalonia Rheumatology League and Galician Rheumatology League from Spain, and the National Axial Spondyloarthritis Society (NASS), National Rheumatoid Arthritis (NRAS) and Arthritis Action from the United Kingdom.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen and Novartis, Laura Christen Employee of: Novartis Pharma AG, Loreto Carmona: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Elsa Mateus Grant/research support from: Lilly Portugal, Sanofi, AbbVie, Novartis, Grünenthal S.A., MSD, Celgene, Medac, Janssen-Cilag, Pharmakern, GAfPA., Souzi Makri Grant/research support from: Novartis, GSK and Bayer., Pedro Plazuelo-Ramos: None declared, LAURENT GRANGE: None declared, Serena Mingolla: None declared, KATY ANTONOPOULOU: None declared, Dale Webb Grant/research support from: AbbVie, Biogen, Janssen, Lilly, Novartis and UCB, Clare Jacklin Grant/research support from: Abbvie, Amgen, Biogen, Eli Lilly, Gilead, Janssen, Pfizer, Roche, Sanofi & UCB, Shantel Irwin: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

SAT0374 ONSET OF AXIAL SPONDYLOARTHRITIS REPERCUSSIONS ON PATIENTS’ SOCIAL AND FAMILY LIFE: RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Axial Spondyloarthritis (axSpA) is associated with a high degree of functional limitation in daily life activities. However, few studies have evaluated the social and family burden from the patient’s perspective.

Objectives:

To describe the impact of axSpA on social and family life since disease onset, and the associated PROs.

Methods:

Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017-2018) across 13 European countries were analysed. The impact of axSpA on social and family life were assessed through four PROs: i) Impact on relationships with the spouse, family, friends, neighbours, and work colleagues since disease onset (5 point Likert scale; 1 “much better” – 5 “much worse”; ii) Frequency of social activities including outings to bars/restaurants, cinema/theatre/museums, practising sports, travel/excursions, and intimate relations since disease onset (5 point Likert scale; 1 “much more” – 5 “much less”); iii) Adaptations made to cope with axSpA since disease onset (yes/no question); iv) The degree of functional limitation in 18 daily activities (3 point Likert scale). Self-reported BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and psychological distress (GHQ-12) were analysed using Pearson’s correlation comparing the impact on relationships and frequency of social activities since disease onset.

Results:

Among 2,846 participants, mean age was 43.9 years, 61.3% were female, 48.1% had a university degree. The greatest impact on relationships (sum of ‘worse’ and ‘much worse’) since disease onset were those with work-colleagues (44.5%), friends (35.6%), and spouse (30.4%). Sport was the activity they reduced the most since disease onset (64.2%), followed by travel/excursions (57.3%) and intimate relationships (56.4%) (Fig. 1). 55.5% had purchased comfortable shoes (N = 2748) and 43.9% had made adaptations to their workplace (N = 2651). For those who reported their level of functional limitation in daily activities, the greatest limitations were in physical exercise (85.5%), cleaning the house (84.4%) and using stairs (79.2%) (Fig. 2). In the correlation analysis, BASDAI, spinal stiffness, functional limitation, GHQ-12 were associated with a worsening in all of relationships and social activities (p < 0.001) (Table 1).

Table 1.

Pearson’s correlation between social and family life changes and PROs

Relationships: 1 much better – 5 much worseBASDAISpinal StiffnessFunctional LimitationGHQ-12Spouse0.157*0.130*0.167*0.258*Family0.162*0.133*0.138*0.206*Friends0.211*0.173*0.180*0.282*Neighbours0.210*0.165*0.112*0.229*Work colleagues0.229*0.153*0.213*0.334*Frequency activities: 1 much more – 5 much lessBars / restaurants0.261*0.246*0.314*0.316*Cinemas / theatres / museums0.291*0.243*0.299*0.338*Do sports0.271*0.213*0.240*0.242*Travel / excursions0.308*0.218*0.307*0.362*Intimate relations0.284*0.254*0.288*0.321*

*p <0.001

Figure 1.

Reported social and family live changes since disease outset

Figure 2.

Reported level of functional limitation in daily live activities

Conclusion:

For most participants the onset of axSpA marked the worsening of personal relationships in different areas, as well as the reduction of social, leisure, and entertainment activities.

Acknowledgments:

Funded by Novartis Pharma AG

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Raj Mahapatra: None declared, Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB

FRI0315 GENDER DIFFERENCES IN PATIENT JOURNEY TO DIAGNOSIS AND PATIENT-REPORTED OUTCOMES: RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Growing evidence of similarities in male-female prevalence of axial spondyloarthritis (axSpA) has stimulated the need to evaluate gender differences in patient experiences.

Objectives:

To evaluate gender differences in diagnostic journey, disease-characteristics and patient-reported outcomes (PROs) in axSpA patients.

Methods:

Data from 2846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 countries were analysed. Socio-demographic characteristics, diagnosis, disease-characteristics, and PROs [BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54) and psychological distress (0-12, GHQ-12)] were compared between genders. Χ2(for categorical variables) and student-t (for continuous variables) were employed.

Results:

1,746 (61.3%) females participated in the EMAS, with homogeneous gender distribution across most countries (Fig 1). Compared to males, females reported longer diagnostic delay (6.1±7.4 vs 8.2±8.9; p<0.001), more visits to physiotherapists (34.5% vs 49.5%; p<0.001) and osteopaths (13.3% vs 24.4%; p<0.001) before being diagnosed (Table 1), higher disease activity in all BASDAI items and greater functional limitation, psychological distress and self-reported anxiety and depression (Table 2).

Table 1.

Disease characteristics by gender (N: 2846, unless specified)

Men (n: 1100)(mean ± SD or %)Women (n: 1746)(mean ± SD or %)p valueAge at onset of first symptoms, n: 272127.0 ± 11.826.4 ± 10.70.342Age at diagnosis, n: 272232.6 ± 12.234.4 ± 10.9<0.001Diagnostic delay, n: 26526.1 ± 7.48.2 ± 8.9<0.001Disease Duration, n: 271618.9 ± 13.316.1 ± 11.7<0.001HCP seen before diagnosis - General practitioner822 (74.7)1434 (82.1)<0.001 - Orthopaedic specialist377 (34.3)557 (31.9)0.190 - Physiotherapist380 (34.5)865 (49.5)<0.001 - Osteopath, n: 2166103 (13.3)339 (24.4)<0.001 - Other, n: 2220135 (14.0)233 (18.5)0.005Family history of axSpA (yes), n: 2244291 (33.5)584 (42.5)<0.001HLA-B27 (positive), n: 1799497 (80.2)786 (66.7)<0.001Uveitis (yes), n: 2096199 (25.2)270 (20.7)0.023IBD (yes), n: 2096113 (14.3)181 (13.9)0.688Table 2.

PROs by gender (N: 2846, unless specified)

Men (n: 1100)(mean ± SD or %)Women (n: 1746)(mean ± SD or %)p valueBASDAI, (0-10) n: 25845.1 ± 2.05.7 ± 1.9<0.001 - Fatigue, n: 26365.7 ± 2.46.6 ± 2.2<0.001 - Neck, back or hip pain, n: 26365.6 ± 2.46.2 ± 2.2<0.001 - Pain other than neck, back or hip, n: 26364.3 ± 2.74.9 ± 2.6<0.001 - Discomfort to touch or pressure, n: 26364.5 ± 2.75.6 ± 2.6<0.001 - Morning stiffness level, n: 26365.3 ± 2.65.9 ± 2.6<0.001 - Morning stiffness duration, n: 25844.5 ± 2.84.7 ± 2.80.070Stiffness, (3-12) n: 27077.7 ± 2.67.8 ± 2.40.107Functional Limitation, (0-54) n: 277119.1 ± 16.721.2 ± 16.0<0.001GHQ-12 ≥3, n: 2640564 (55.4)1060 (65.4)<0.001Anxiety243 (30.6)566 (43.3)<0.001Depression238 (30.1)472 (36.1)<0.001Figure 1.

Countries’ sample distribution stratified by gender (N: 2846)

Conclusion:

Important gender differences are observed in axSpA such as a longer patient journey to diagnosis, poorer PROs, and greater psychological burden in females. These results point to unmet needs in females with axSpA, requiring particular attention.

Acknowledgments:

Funded by Novartis Pharma AG

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Raj Mahapatra: None declared, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

OP0278 IDENTIFICATION OF PARAMETERS ASSOCIATED WITH A DIAGNOSTIC DELAY IN AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Early diagnosis of Axial Spondyloarthritis (axSpA) is crucial for timely access to specialist care and effective treatment.

Objectives:

To assess the current diagnostic delay in axSpA and identify the parameters associated with increased diagnostic delay in a European sample.

Methods:

Data from unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017- 2018) across 13 countries were analysed. Mean differences in diagnostic delay were analysed using Mann-Whitney and Kruskal-Wallis tests, among sociodemographic and disease-related factors. A multivariate linear regression analysis was carried out to identify the relative weight of the associated parameters in determining diagnostic delay.

Results:

2,846 patients participated in EMAS. Mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 53.9% were employed. Of the 2846 participants, 2652 provided information for calculating diagnostic delay. Mean age at symptom onset was 26.6 ± 11.1, mean age at diagnosis was 33.7 ± 11.5, and mean diagnostic delay was 7.4 ± 8.4 (Fig. 1). The following variables were associated with longer diagnostic delay in the bivariate analysis: older age, female gender, being diagnosed by a rheumatologist (Table 1). In the multivariate regression analysis younger age at symptom onset, number of HCPs seen before were associated with diagnostic delay (Table 2).

Table 1.

Associations between sociodemographic and disease-related variables and diagnostic delay (N: 2,652)

VariableDiagnostic Delay (years)Mean ± SDP-valueAge categories18-344.4 ± 5.5<0.00135-517.9 ± 8.252-689.5 ± 10.2>687.3 ± 9.7GenderMale6.1 ± 7.4<0.001Female8.2 ± 8.9Education levelNo school completed8.0 ± 10.70.397Primary school7.6 ± 8.9High school7.6 ± 8.4University7.3 ± 8.3OccupationManual worker6.7 ± 8.30.163Non-manual worker7.3 ± 8.4Diagnosed by rheumatologistYes7.9 ± 8.7<0.001No5.7 ± 7.3HLA-B27Positive8.3 ± 8.30.775Negative8.7 ± 9.0Uveitis (ever)Yes8.0 ± 8.30.098No7.6 ± 8.4IBD (ever)Yes7.7 ± 8.70.944No7.5 ± 8.5Table 2.

Regression analysis between sociodemographic and clinical variables in relation to diagnostic delay

VariableUnivariable linear regressionMultivariable stepwise linear regressionB95% CIB95% CIAge at symptoms onset-0.289-0.316, -0.262-0.321-0.390, -0.253Female gender2.0991.442, 2.755NANAEmployed, Manual worker-0.604-1.953, 0.746NANAEducational status, University-0.343-0.986, 0.299NANADiagnosed by rheumatologist, Yes2.1171.321, 2.913NANANumber of HCPs seen before diagnosis1.7231.486, 1.9601.2580.739, 1.776HLA-B27, Positive-0.471-1.347, 0.404NANAUveitis (ever), Yes0.463-0.392, 1.319NANAIBD (ever), Yes0.123-0.971, 1.217NANAFigure 1.

Average years of diagnostic delay across EMAS countries (N: 2,652)

Conclusion:

In this large sample of axSpA patients from 13 different European countries, the average diagnostic delay was more than seven years. The fact that one of the most strongly associated parameters to diagnostic delay was number of HCPs seen before diagnosis suggests the need for urgent action to reduce incorrect referrals to shorten the patient journey to diagnosis across Europe.

Acknowledgments:

Funded by Novartis Pharma AG

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Raj Mahapatra: None declared, Souzi Makri: None declared, José Correa-Fernández: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB

OP0081 THE IMPACT OF AXIAL SPONDYLOARTHRITIS ON PATIENTS’ SEXUAL LIFE: RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Axial Spondyloarthritis (axSpA) involves a great degree of functional limitation in daily activities and psychological health, which can impact patients’ sexual life.

Objectives:

To study the determinants of reduced frequency of sexual activity and intimacy since disease onset in axSpA patients.

Methods:

Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 countries were analysed. The impact of axSpA on patients’ sexual life was evaluated by a question assessing changes in the frequency of intimate relations since the onset of axSpA on a 5 point Likert scale. Impact of axSpA on the spousal relationship since disease onset was also assessed using 5 point Likert scale. Other lifestyle variables included smoking and physical activity and burden of disease [BASDAI (0-10), spinal stiffness (3-12), functional limitation in intimate relations (0-2), and psychological distress (GHQ-12)]. Regression analysis were carried out to determine the relative weight of the assessed variables.

Results:

EMAS total sample mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 67.9% were married. Out of the 2,515 participants that reported on the frequency of intimate relations since disease onset, 56.4% declared that it was less or much less than before; 74.1% declared high or medium limitation in intimate relations; and 30.4% reported worsening relations with their spouse. A lower frequency of intimate relations was related to: older age, female gender, higher BASDAI, spinal stiffness, higher functional limitation in intimate relations, higher psychological distress, self-reported diagnosis of depression, worsening relationship with spouse since disease onset, higher BMI, smoking, lack of physical activity, and lack of biologics use. In the multivariate regression analysis, the most strongly associated variables with lower frequency of intimate relations were: functional limitation in intimate relations (β = 0.218; 95% CI 0.185 – 0.251), worse relationship with spouse (β = 0.207; 95% CI = 0.165 - 0.250), female gender (β = 0.150; 95% CI 0.071 – 0.229), and no engaging in physical activity (β = -0.135; 95% CI -0.234 – -0.036) (Table 2).

Conclusion:

EMAS results reveal a great impact of axSpA on patients’ sexual life, with multiple sociodemographic, lifestyle and PROs being associated with a lower frequency of intimate relations.

Table 1.

Regression analysis to predict frequency of intimate relations

Simple linear regressionMultivariable stepwise linear regressionB95% CIpB95% CIpAge (Years)0.0070.004,0.010<0.0010.0100.007,0.013<0.001Gender (Female)0.2150.146,0.284<0.0010.1500.071,0.229<0.001BASDAI0.1240.107,0.141<0.0010.0290.007,0.0500.010Spinal Stiffness0.0890.075,0.102<0.001NANA0.214Functional Limitation – Intimate relations0.2970.271,0.323<0.0010.2180.185,0.251<0.001GHQ-120.0670.059,0.075<0.0010.0350.024,0.045<0.001Depression (Yes)0.3750.298,0.452<0.001NANA0.064Relationship with spouse0.3430.306,0.380<0.0010.2070.165,0.250<0.001BMI0.0170.011,0.024<0.0010.0080.001,0.0150.031Smoking (Yes)0.0750.002,0.1480.044NANA0.907Physical activity (Yes)-0.212-0.306,-0.119<0.001-0.135-0.234,-0.0360.007Biologics (Yes)0.1880.110, 0.267<0.001NANA0.185

Acknowledgments:

Funded by Novartis Pharma AG

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Souzi Makri: None declared, Raj Mahapatra: None declared, Sergio Sanz-Gómez: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

Does proximity to the subventricular zone and expression of CXCR-4 and nestin affect prognosis in high-grade glioma?

BACKGROUND

It is suspected that infiltration of stem cell areas with high-grade glioma (HGG) generates a population that compromises treatment results and survival. In this prospective study we set to assess the prognostic value of the proximity of the contrast-enhancing lesion (CEL) on MRI to the subventricular zone (SVZ) and the expression of CXCR4 and nestin as potential factors in the stem cell migration pathway.

METHOD

All patients diagnosed with high-grade glioma over a three-year period from a single institution were enrolled in this prospective study. Based on MRI preoperative findings, the patients were classified into 4 Groups (I-IV) according to the proximity of the CEL on MRI to the SVZ. Histological samples were assessed with immunohistochemistry for nestin and CXCR4. Classification into groups and the presence of nestin and CXCR4 were evaluated as predictive factors for overall (OS) and progression free survival (PFS).

RESULTS

Fourty patients were included in the study. In multivariate analysis, Groups II, III and IV predicted longer OS in comparison to group I (p = 0.01; p < 0.01; p < 0.01 respectively) and group III and IV predicted longer OS in comparison to group II (p < 0.01; p = 0.04 respectively). Group III predicted longer PFS than group I and II (p = 0.01; p < 0.01 respectively). The expression rates of CXCR-4 and nestin could not predict OS or PFS.

CONCLUSIONS

In our study the classification according to the proximity of the contrast enhancing part of the lesion and the SVZ proved to be prognostically significant for both OS and PFS. Presence of CXCR4 or nestin was not predictive for OS or PFS.

EULAR revised recommendations for the management of fibromyalgia

OBJECTIVE

The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'.

METHODS

A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.

RESULTS

2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).

CONCLUSIONS

These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

Ultrastructural aspects of the effects of L-carnitine administration on epithelial cells in the aging rat tongue

BACKGROUND

The investigators hypothesized that degenerative changes accumulate in epithelial cells in the aging rat tongue and that carnitine administration is effective at reversing these alterations.

MATERIAL AND METHODS

To gain insights into the effects of carnitine on epithelial cells of the tongue, the investigators used 15 Wistar rats [3 experimental groups: 5- (A), 12- (B) and 18- (C) month old rats] with 4 rats per group and 1 control group with 1 rat per age group). L-carnitine was administered intraperitoneally to animals of the experimental group for 35 days. Samples of the tongue were processed for electron microscopy.

RESULTS

Degeneration of epithelial cells of the rat tongue was shown to begin early in life (5 months) and alterations were shown to accumulate while aging. L-carnitine administration eliminated degenerative changes when administered in the first age group A, while in the older rats the regeneration was only partial for the epithelium (groups B and C).

CONCLUSIONS

The results of this study suggest that profound ultrastructural alterations commence in the degenerating rat tongue and that L-carnitine administration results into partial regeneration of epithelial cells.

Pertussis outbreak detected by active surveillance in Cyprus in 2003

Pertussis is a disease of substantial public health importance that still lacks an efficient surveillance system. It has been a notifiable disease in Cyprus since 1930, and has had an incidence rate of 1 per 100,000 persons during the last 10 years. In 2001, the Greece-Cyprus Paediatric Surveillance Unit (GCPSU) was established with the aim of active surveillance for rare paediatric diseases, including weekly data reporting, zero reporting, and obligatory laboratory tests. From November 2002, pertussis has been included in the active surveillance scheme of GCPSU, resulting in a very early detection of an outbreak in June 2003 that led to immediate and successful action.

Collagen VI status and clinical severity in Ullrich congenital muscular dystrophy: phenotype analysis of 11 families linked to the COL6 loci

Ullrich's congenital muscular dystrophy (UCMD) is an autosomal recessive myopathy characterised by neonatal muscle weakness, proximal joint contractures and distal hyperlaxity. Mutations in the COL6A1, COL6A2 (21 q22.3) and COL6A3 (2 q37) genes, encoding the alpha 1, alpha 2 and alpha 3 chains of collagen VI, respectively, have been recently identified as responsible for UCMD in a total of 9 families. We investigated in detail the clinical and morphological phenotype of 15 UCMD patients from 11 consanguineous families showing potential linkage either to 21 q22.3 (6 families) or to 2 q37 (5 families). Collagen VI deficiency was confirmed on muscle biopsies or skin fibroblasts in 8 families. Although all patients shared a common phenotype, a great variability in severity was observed. Collagen VI deficiency in muscle or cultured fibroblasts was complete in the severe cases and partial in the milder ones, which suggests a correlation between the degree of collagen VI deficiency and the clinical severity in UCMD. No significant phenotypical differences were found between the families linked to each of the 2 loci, which confirms UCMD as a unique entity with underlying genetic heterogeneity.