Showing papers by "Elena Nikiphorou published in 2015"

Clinical effectiveness of CT-P13 (Infliximab biosimilar) used as a switch from Remicade (infliximab) in patients with established rheumatic disease. Report of clinical experience based on prospective observational data

Abstract: Objective: To gain clinical experience on the effectiveness and safety of switching from infliximab-Remicade(INX) to infliximab-biosimilar-CT-P13(INB) in patients with established rheumatic disease.Methods: Patients receiving INX treatment at a rheumatology clinic consented to switching from INX to INB. Patient reported outcomes (PROs), disease-activity, and inflammatory markers were recorded at every visit. Generalized estimating equation models and time-dependent area under the curve (AUC) before/during INX and INB treatments were employed.Results: Thirty-nine consecutive patients [mean (SD) age 53 (11), 17 F] with various rheumatic diseases were switched to INB after a mean (SD) of 4.1 (2.3) years on INX. Thirty-one patients were on concomitant methotrexate. At a median (range) of 11 (7.5-13) months following the first administration of INB, AUCs for disease activity and PROs were similar for INX and INB. They were better compared to those prior to INX. Eleven patients (28.2%) discontinued INB, due to ...

The Effect of Disease Severity and Comorbidity on Length of Stay for Orthopedic Surgery in Rheumatoid Arthritis: Results from 2 UK Inception Cohorts, 1986–2012

Abstract: Objective. To examine factors predicting length of stay (LoS) for orthopedic intervention in rheumatoid arthritis (RA). Methods. LoS for orthopedic intervention was examined in 2 consecutive, multicenter inception cohorts: the Early RA Study (n = 1465, 9 centers) and the Early RA Network (n = 1236, 23 centers). Date, type of orthopedic procedure, and LoS were recorded and validated against national data, the UK National Joint Registry, and the UK Hospital Episode Statistics database. Clinical, laboratory, and radiographic measures and comorbidity recorded at baseline and annually were examined for their predictive power on LoS using regression analysis. Results. A total of 770 of 2701 patients (28.5%) had 1602 orthopedic interventions: 40% major (mainly total hip/knee replacements), 24% intermediate (mainly hand/wrist and ankle/foot surgery), and 16% minor (mainly soft tissue surgery). Median (interquartile range) LoS was 8 (5–13), 3 (1–5), and 1 (0–2) days for major, intermediate, and minor interventions, respectively. Older age predicted longer LoS (p Conclusion. Comorbidity and standard clinical and laboratory markers of disease activity affect the LoS for orthopedic surgery in RA, which has important clinical and economic implications, providing a target for improving patient outcomes.

Direct health costs of inflammatory polyarthritis 10 years after disease onset: results from the Norfolk Arthritis Register

Abstract: Objectives. To explore the change in direct medical costs associated with inflammatory polyarthritis (IP) 10 to 15 years after its onset. Methods. Patients from the Norfolk Arthritis Register who had previously participated in a health economic study in 1999 were traced 10 years later and invited to participate in a further prospective questionnaire-based study. The study was designed to identify direct medical costs and changes in health status over a 6-month period using previously validated questionnaires as the primary source of data. Results. A representative sample of 101 patients with IP from the 1999 cohort provided complete data over the 6-month period. The mean disease duration was 14 years (SD 2.1, median 13.6, interquartile range 12.6–15.4). The mean direct medical cost per patient over the 6-month period was £1496 for IP (inflated for 2013 prices). This compared with £582 (95% CI £355–£964) inflated to 2013 prices per patient with IP 10 years earlier in their disease. The increased cost was largely associated with the use of biologics in the rheumatoid arthritis subgroup of patients (51% of total costs incurred). Other direct cost components included primary care costs (11%), hospital outpatient (19%), day care (12%), and inpatient stay (4%). Conclusion. The direct healthcare costs associated with IP have more than doubled with increasing disease duration, largely as a result of the use of biologics. The results showed a shift in the direct health costs from inpatient to outpatient service use.

OP0179 Different Levels of Moderate Disease in Rheumatoid Arthritis (RA) are Associated with Varying Risk for Joint Destruction and Failure. Time to Update Das Cut-Offs for Biologic Dmard Use?

Abstract: Background Sustained high disease activity in RA is known to result in worse outcomes. However, many patients remain in moderate disease activity states, yet their outcomes, are less well studied. Objectives To examine orthopaedic surgery as a surrogate marker of joint failure in patients who remain at different moderate disease activity levels in the first 5 years from disease-onset. Methods The Early RA Study (ERAS, n=1465, 1986-1999) and the Early RA Network (ERAN, n=1236, 2002-2012) collected standard clinical, radiological and laboratory measures yearly for a maximum (median) 25 (10) and 10 (3) years respectively. Clinical databases were validated with national sources: the National Joint Registry, Hospital Episode Statistics & National Death Register. Treatment regimens followed guidelines of the era, mainly conventional DMARDs & latterly biologics. Joint interventions were categorized into major (large joint replacements), intermediate (mainly synovectomies & arthroplasties of wrist/hand, hind/forefoot) or minor (mainly soft tissue). Mean DAS28 was calculated for each patient from year1 (after treatment-onset) to 5 and categorized into either remission [RemDAS ≤2.6], low [LowDAS >2.6 -3.2], low moderate [LowModDAS= >3.2-4.19], high moderate [HighModDAS 4.2-5.1] or high DAS [HighDAS >5.1]. Results A total of 2044 (76%) patients had at least two DAS28 recorded between year 1-5: 21% in RemDAS, 15% in LowDAS, 26% in LowModDAS, 21% in HighModDAS, 18% in HighDAS categories. The table shows that on moving from remission through to low/moderate/high states there was a progressive worsening in baseline clinical & laboratory variables. In multivariate Cox regression models controlling for age at disease onset, gender, recruitment year, symptom duration, baseline rheumatoid factor, BMI, HAQ, erosions and Haemoglobin, HighModDAS (HR 1.80, 95%CI 1.05-3.11, p=0.034) and HighDAS (HR 2.59, 95%CI 1.49-4.52, p=0.001) predicted higher risk for intermediate surgery, unlike LowModDAS or LowDAS categories. In the case of major joint surgery, LowModDAS (HR 2.07, 95%CI 1.28-3.33), HighModDAS (HR 2.16, 95%CI 1.32-3.52) and HighDAS (HR 2.48, 95%CI 1.50-4.11) all predicted an increasing risk (p Conclusions Patients who remain in low or high moderate disease activity levels in the first 5 years of disease, despite conventional DMARD therapy, have similar risks for joint failure and surgery as those with persistently high DAS. This is highly relevant in health systems where restrictions exist in the use of biologic DMARDs, which are based on DAS cut-offs and exclude moderate RA. Disclosure of Interest None declared

OP0313 The Use and Impact of Social Media in Modern Rheumatology Practice Based on a Survey by the Emerging Eular Network (Emeunet)

Abstract: Background The use of social media (SM) platforms and networks is fast expanding yet their impact especially within the professional world is often under-appreciated and has not been systematically evaluated. Objectives To perform an online survey on the use, perceptions and impact of SM within the rheumatology professional world and beyond. Methods A questionnaire prepared by rheumatologists from different countries within the EMEUNET group was designed to assess perceptions and the impact of SM among users and non-users. EMEUNET is a Europe-wide network of more than 1000 young rheumatologists addressing educational needs and promoting research interests. The survey covered a range of questions from basic demographic information to perceptions on the use and impact of SM in a professional or other. The survey was advertised via three main routes: Twitter, Facebook and by direct email to EMEUNET members. Results 233 anonymized responses were collected from 47 countries. The majority completed the survey via email (90%), the rest via Tw (6%) and FB (4%). 72% of responders were within the age group of 30-39 years. 66% were female; 51% were in a combined clinical/academic job setting. 83% were active users of at least one SM platform with a mean weekly use of 7 hrs, and 71% of those used SM in a work-related manner. The majority used SM for communicating with friends/colleagues (79%), news updates (76%), entertainment (69%), rheumatology clinical (50%) and research (48%) updates. Table 1 shows SM sites and the frequency of use. FB was the dominant SM platform with 91% using it although only 68% professionally, whereas LinkedIn was the dominant platform for professional-related communication. The latter included using SM as a source of information (81%); expanding professional networks (76%); new resources (59%); learning new skills (47%) and establishing a professional online presence (46%). Work-related SM users had a significantly increased use of SM (8 hrs weekly) of which 5 hours were work-related. The main obstacles for not using SM in a work-related manner were “lack of knowledge on how to do so” (44%) followed by “not suitable for individual needs” (30%). 9% were concerned regarding negative impact on their reputation. 68% felt that SM is a safe way of communicating with other people although of those not using SM 37% expressed concerns regarding its safety, exposure of private life and being a time-consuming process. 30% of non-SM users justified not using SM due to lack of knowledge; 26% considered SM unsuitable for their needs and 41% expressed no interest in SM. Conclusions The results highlight that use of SM within rheumatology professionals and basic scientists is considerable, for social but mostly professional reasons. SM provides a good source of information for educational purposes and potential for networking. he lack of knowledge on how to use SM in a work related manner highlights the need for providing resources necessary to enable more widespread use of SM. Despite concerns regarding the safety of SM and exposure of private life, the majority of respondents had a positive view towards SM. Acknowledgements We thank Dr David O9Reilly for his contribution. Disclosure of Interest None declared

Rheumatoid Arthritis in the 21st Century: Treatment Patterns and Disease Activity States

Abstract: The treatment of rheumatoid arthritis (RA) has dramatically changed in the past 2 decades, with emphasis placed on prompt diagnosis and treatment aiming for early and sustained remission. The concept of “treat to target” (T2T) represents a therapeutic paradigm of modern rheumatology practice and there exists a strong evidence base supporting early and intensive therapeutic approaches to target and eradicate inflammation. This has been possible with new, improved treatments and combination regimens1,2,3,4. However, while inflammation can be reversed, the extent of reversibility of disease outcomes such as joint destruction and functional capacity is dependent both on the duration and degree of inflammation. The timing of intervention is thus important, highlighting an important aspect of disease: the early phase of RA and the therapeutic “window of opportunity.”5 The latter is supported by many observations on disease course and outcomes, including progression of radiographic damage and reduced opportunity for disease-modifying antirheumatic drug (DMARD)-free sustained remission with prolonged symptom duration6. In this issue of The Journal , Littlejohn and colleagues report on disease activity trends in RA based on 5-year data (2009–2014) from the OPAL-QUMI (Optimising Patient outcome in Australian Rheumatology-Quality Use of Medicines Initiative) study7, a multicenter, cross-sectional, non-interventional study of patients with RA treated in Australia. Although predominantly descriptive, their study is highly relevant and informative regarding conventional, real-world rheumatology practice, treatment strategies, and disease activity states. Almost 9000 patients were included in the study, with age and sex distributions typical of RA cohorts. The high number of patients and participating rheumatologists are an important strength of the study. Over 37,000 Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) test results were available, with the largest part (46.2%) falling in the remission … Address correspondence to Prof. T. Sokka, Jyvaskyla Central Hospital, 40620 Jyvaskyla, Finland. E-mail: tuulikki.sokka-isler{at}ksshp.fi

SAT0343 How Much Does Fatigue Contribute to the Physician and Patient Global Estimates in Different Rheumatic Diseases? Analysis from Routine Care on a Multidimensional Health Assessment Questionnaire (MDHAQ)

Abstract: Background Fatigue is an important problem for many patients with rheumatic diseases. Fatigue has been associated with disease severity, psychological distress, and a poorer quality of life in rheumatoid arthritis (RA) [1]. Although an important symptom for patients, it is controversial how much fatigue may contribute to the level of disease activity. Objectives To evaluate possible associations between fatigue and global estimates of disease activity according to the patient and the physician in patients with different rheumatic diseases. Methods All patients seen in one academic clinical setting complete a multidimensional health assessment questionnaire (MDHAQ) in 5-10 minutes in the waiting area, prior to seeing the rheumatologist in the infrastructure of usual care. The two-page MDHAQ includes physical function (FN) in 10 activities of daily living, three 0-10 visual analog scale (VAS) for pain (PN), patient global estimate (PATGL), and fatigue (FT), and demographic data. PATGL and physician global estimate (DOCGL) were used to define four disease activity categories at the following predefined levels: 6 for “high”. Median values for fatigue and interquartile range (IQR) were compared in 4 categories according to 4 diagnoses: rheumatoid arthritis (RA), osteoarthritis (OA), systemic lupus erythematosus (SLE), and fibromyalgia (FM). Results Analyses included 612 consecutive patients, 173 with RA, 199 with OA, 146 with SLE and 94 with FM. Median fatigue score was significantly higher in FM (7, IQR=5-8) p Conclusions Fatigue scores are associated with severity of disease activity in structural conditions such as RA, OA, and SLE, but do not appear to be similarly associated in myofascial pain syndromes. This is evident both from the physician9s and from the patient9s perspective. Fatigue is a relevant and important symptom, which can be collected in the infrastructure of routine care as a quantitative VAS on an MDHAQ in patients with all rheumatic diagnoses. References Nikolaus S, Bode C, Taal E, et al. Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review. Arthritis Care Res (Hoboken) 2013; 65:1128-46 Disclosure of Interest None declared

AB0945 Clues to Recognize Fibromyalgia From a Patient Self-Report Multidimensional Health Assessment Questionnaire (MDHAQ) and Physician Rheumetric Checklist

Abstract: Background Fibromyalgia (FM) is characterized by widespread musculoskeletal pain and a broad range of symptoms. While FM generally is easily recognized, it may pose a diagnostic challenge, particularly in patients with mild inflammatory diseases. Objectives To assess whether a two-page patient self-report Multidimensional Health Assessment Questionnaire (MDHAQ) and one-page physician RHEUMETRIC checklist can provide strong clues to the presence of FM. Methods All patients seen in one academic clinical setting complete a two-page MDHAQ in 5-10 minutes in the waiting area, prior to seeing the rheumatologist, in the infrastructure of usual care. The MDHAQ includes physical function (FN) in 10 activities of daily living scored 0-10, three 0-10 visual analog scales (VAS) for pain (PN), patient global estimate (PATGL), and fatigue (FT), a 60-item symptom checklist, and demographic data. Scores were computed for RAPID 3 (0-30, i.e., the sum of three 0-10 scores for FN, PN and PATGL), total number of symptoms (0-60), and fatigue VAS. RHEUMETRIC is a one-page physician checklist with four 0-10 VAS for overall global patient status (DOCGL), and levels of inflammation (reversible signs) (DOCINFL), damage (irreversible signs) (DOCDAM), and “neither” inflammation nor damage (DOCNON) e.g. fibromyalgia. Mean MDHAQ and RHEUMETRIC scores were compared in 4 diagnosis groups: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoarthritis (OA), fibromyalgia (FM), using MANOVA, adjusted for age, symptom duration and education. Results Analyses included 205 patients, 50 with RA, 66 with SLE, 57 with OA, and 32 with FM. Mean scores on each of the MDHAQ scales were significantly higher in FM than in other diagnoses (p Conclusions A diagnosis of FM is made on the basis of a patient history and physical examination. Simple 2-page patient and physician questionnaires provide standard information from a patient history and physician evaluation, which may include useful clues to the presence of FM. Completion of an MDHAQ by each patient and RHEUMETRIC by rheumatologists at each visit could be of value to recognize FM in busy clinical settings. Disclosure of Interest None declared

AB1172 Biologic DMARD Treatment in Cyprus Based on Six Year Data from a National Hospital Covering a Population of Greek-Cypriot

Abstract: Background Biologic DMARDs have revolutionised the treatment of a number of rheumatic conditions, beyond rheumatoid arthritis (RA). Access to biologics varies across different countries. In Cyprus, the guidelines (agreed between the Cypriot Rheumatology Society and Government Pharmaceutical Services) which take into account financial constraints, recommend the cheapest anti-TNF agent as first line therapy. Between 2007 and 2013 (then after a new tender there was change in the line), the first line recommended therapy for Rheumatoid Arthritis (RA) was infliximab (3mg/kg); 2nd line etanercept and 3rd line adalimumab, whereas for Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PSA) first line was etanercept, 2nd line humira and 3rd infliximab (5mg/kg). Objectives To record the response rate and adherence to first line biologic treatments in a local population in Cyprus based on existing guidelines and recommendations. Methods This was a retrospectively evaluation of patients started on biologic treatment at the national Nicosia Hospital in Cyprus, between 2007-2013. 45 (29%) RA patients from a total 153, 20/34 (58%) AS and 21/32 (65%) PSA patients were analyzed. Results During these 6 years only 3 (15%) AS patients were changed to a second anti-TNF (2 due inefficacy, 1 due to development of inflammatory bowel disease). In the PSA group 4 (19%) patients moved to 2nd line due to inefficacy and in the RA group, 24 (54%) patients moved to 2nd line (5 due to severe infusion reactions, 3 due to infections and the rest due to inefficacy). In the case of RA if the total dose of infliximab was over 400 mg/8 weeks the protocol demanded a switch to 2nd line biologic. RA patients were 3.6 times more likely to switch to a 2nd line agent than the AS and PSA patients, mainly due to inefficacy (RR 3.6, 95% CI 1.21-10.45 p=0.02). Conclusions Etanercept was found to be generally well tolerated in AS and PsA, with patients adhering to treatment whereas in the case of RA infliximab was poorly tolerated and adhered to in the majority of patients. With the recent introduction of biosimilars and in the current financial climate, such experience should be kept in mind when developing protocols and treatment pathways, in order to optimise patient management and outcomes. Disclosure of Interest None declared

THU0310 Quantitative Assessment of Fatigue in Routine Care Using a Multidimensional Health Assessment Questionnaire (MDHAQ)

Abstract: Background Fatigue generally is captured as a qualitative description rather than as quantitative data to compare from one visit to the next. Fatigue is included on a multidimensional health assessment questionnaire (MDHAQ) as a 0-10 visual analogue scale (VAS), facilitating quantification. Objectives To assess fatigue VAS scores in patients with 4 different rheumatic conditions: rheumatoid arthritis (RA), osteoarthritis (OA), systemic lupus erythematosus (SLE), and fibromyalgia (FM), and to analyze possible associations of fatigue scores with other quantitative clinical scores included on the MDHAQ. Methods All patients seen in one academic clinical setting complete an MDHAQ in 5-10 minutes in the waiting area, prior to seeing the rheumatologist, as part of the infrastructure of routine care. The two-page MDHAQ includes physical function in 10 activities of daily living, three 0-10 VAS for pain, patient global estimate, and fatigue, 60-symptom checklist, and demographic data. RAPID 3 (0-30) is the sum of three 0-10 scores for function, pain, and patient global estimate. A cross-sectional study was performed in patients in 4 diagnosis groups: RA, OA, SLE, and FM. Median scores for fatigue and other MDHAQ scales were computed in the four diagnosis groups, and compared by Kruskall-Wallis one way analysis of variance. Correlations also were calculated to evaluate possible associations of fatigue with other MDHAQ scores. Results Analyses included 612 patients, 173 with RA, 199 with OA, 146 with SLE and 94 with FM. Fatigue scores were highest in FM, and differed significantly from RA, SLE, and OA (p 0.53, p 0.66, p 0.60, p 0.33, p 0.32, p Conclusions Fatigue scores may be collected in the infrastructure of routine care as quantitative data on an MDHAQ, with no extra work for the doctor and minimal interference with clinic patient flow. Fatigue scores are associated with scores on other MDHAQ scales at considerably higher levels in RA and SLE than in OA and FM. Disclosure of Interest None declared

Giant Cell Arteritis of the Lower Limb Presenting as Peripheral Arterial Disease and Mantle Cell Lymphoma Two Years Later

Abstract: C l i n M e d International Library Citation: Corsava S, Psarelis S, Nikiphorou E (2015) Giant Cell Arteritis of the Lower Limb Presenting as Peripheral Arterial Disease and Mantle Cell Lymphoma Two Years Later. Clin Med Rev Case Rep 2:034 Received: May 22, 2015: Accepted: June 06, 2015: Published: June 09, 2015 Copyright: © 2015 Corsava S. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Corsava et al. Clin Med Rev Case Rep 2015, 2:2

FRI0075 The Impact of Comorbidity on Functional Status in RA, 10 Years from Disease-Onset. Results from Two Large Uk Inception Cohorts

Abstract: Background Comorbidities in Rheumatoid Arthritis (RA) can have a negative impact on functional ability. However, the extent of this impact is less well understood, especially in established disease. In the absence of a standardised and validated tool for comorbidity data collection, understanding which comorbidities at the early stages of disease have the greatest impact on functional outcomes is important in terms of preserving functional status and optimising disease management. Objectives To examine the effect of comorbidities by the first year of RA on 10-year functional status using the health assessment questionnaire (HAQ). Methods Data from two multi-centre (n=32) UK inception cohorts (1986-2013), the Early RA Study and Early RA Network (total n=2701) were used. DMARD-naive patients were recruited at presentation and standard clinical, laboratory and radiographic variables recorded at baseline and yearly thereafter. Date and cause of death was provided by the Medical Research Information Service. The presence of comorbidities and extra-articular manifestations was recorded at individual disease level. These were grouped into the standard ICD10 systems (n=15) and further subdivided by severity, e.g. cardiovascular major (ischaemic heart disease, cardiac failure) or minor (benign cardiac arrhythmias). Multivariate Cox regression analysis adjusting for age at disease onset, gender, baseline HAQ, BMI and presence of rheumatoid factor and recruitment year was used, with HAQ as the outcome at year 10. HAQ was examined as a binary outcome using the median HAQ at 10 years (1.13) as the cut-off since HAQ distribution did not allow for it to be treated as continuous in linear or generalized linear models. Results Of the patients with HAQ scores available at year 10, 189 and 99 patients had at least one major and one minor comorbidity respectively recorded by the first year of disease (1yr prevalence: 26.3% and 13.8%). Higher HAQ at 10yrs was significantly predicted in separate models by major respiratory comorbidities (HR 1.29, 95% CI 0.99-1.66, p=0.05) and major spinal disease (HR 2.03, 95%CI 1.08-3.09, p=0.026). Major respiratory disease included bronchiectasis and chronic obstructive pulmonary disease (COPD) and major spinal disease included C-spine subluxation, spinal stenosis and slipped disc disease with neurological compromise. At individual disease level, COPD was found to be the only significantly predictive comorbidity for higher HAQ at 10yrs (HR 1.48, 95% CI 1.08-2.01; p=0.013). Conclusions Co-existent major respiratory and spinal diseases are significant predictors of functional status at 10yrs from disease-onset in RA. At individual disease level, COPD predicted higher HAQ at 10yrs, highlighting its impact together with conventional measures of RA severity on functional status. Targeting and closely managing these conditions is therefore important in terms of long-term functional outcomes in RA. Acknowledgements We are indebted to all the nurses and rheumatologists from both cohorts for their participation and contribution to the study. Disclosure of Interest None declared

SAT0550 Familial Mediterranean Fever in the Greek Cypriot Population. Experience from Two Centres

Abstract: Background Familial Mediterranean Fever (FMF) is an autoimmune inflammatory disease with autosomal recessive inheritance, characterized by recurrent serositis and episodes of fever. Previous genetic studies in Greek Cypriots have examined the frequency and the most common mutations observed in this population (1,2). Objectives To evaluate the clinical presentation of patients diagnosed with FMF and examine their genetic background and any association with clinical symptomatology. Methods This was a retrospectively analysis of 34 patients with a known diagnosis of FMF according to the Tel–Hashomer criteria. All patients were genetically tested for the common mutations and divided into three groups: A homozygotes (6), B heterozygotes (20) and C complex heterozygotes (9). Binary logistic regression with the outcome being presence of a specific symptom or not was used to examine the effect of various linear or categorical predictors e.g. age at symptom onset or presence of a specific gene. Independent effects were examined using Odds Ratios. Results Group A (homozygotes) consisted of the following genes: M694V, V726A, E-167-F479 (33%). The most common symptoms where abdominal pain (100%), fever (83%), joint pain (50%), chest pain (33%), pericarditis (16%). In group B (heterozygotes) the commonest mutation was V726A (35%), followed by E-167-F479 (30%), E148Q (20%) and M694V,R761H, K695R (5%). The most common symptoms where abdominal pain (65%), fever (60%), joint pain (30%), chest pain (33%). C group (complex heterozygotes) consisted of V726A- E-167-F479 and V726A-K695R (22%) mutations, and the V726A- R761H, V726A-M694V, V726A- E230K, V726A-M680I, M694V- M680I (11%). The most common symptoms in this group where fever (66%), abdominal pain (55%), joint pain (33%), chest pain (33%) pericarditis (11%). There were no statistically significant differences seen between the type of genetic composition and the timing of symptom-onset or clinical symptom presentation, possibly due to the small numbers used in the models. The odds of those less or equal to 15 years at symptom-onset for developing joint pain as one of the clinical manifestations were 0.85 times lower than those over 15 years, controlling for the three groups and gender in the models (p=0.04). There was no significant difference noted between other clinical manifestations and age, gender or genetic background. All patients were treated with colchine with good symptom-control. Only two patients (6%) (one heterozygote [V726A] the other homozygote [M694V]) where treated with additional tosilizumab and anakinra respectively due to incomplete symptom resolution, with a good outcome. Conclusions This study showed that the V726A gene presence appears to be a common finding in all groups (Homozygotes, heterozygotes and complex heterozygous). Heterozygotes can present with similar clinical manifestations to homozygotes, with the commonest symptoms being abdominal pain and fever. Colchicine is a reasonable first line treatment for these patients. References Vassos Neocleous, et al. Familial Mediterranean Fever Associated with MEFV Mutations in a Large Cohort of Cypriot Patients. Annals of Human Genetics 2014;00:1–8. Deltas K, et al. Familial Mediterranean Fever (FMF) Mutations Occur Frequently in the Greek Cypriot Population of Cyprus. Genetic Testing 2002;6(1). Disclosure of Interest None declared

AB1183 Joint Operations as an Indicator of Disease Severity and Burden in the Quest-RA Study: Table 1.

Abstract: Background Joint replacement surgery represents a remarkable mile stone in the care of patients with rheumatoid arthritis (RA), aimed at improving patients9 functional capacity and reducing pain. Prior to current therapeutic strategies, surgical joint intervention was a frequent event. Currently, orthopedic surgery is considered as a surrogate marker of failed medical treatment and joint destruction. Objectives To compare disease burden in RA patients with and without major joint operation (MJO) in the QUEST-RA study. Methods Consecutive unselected patients with RA receiving usual rheumatology care were included in QUEST-RA study between 2005 and 2012 in 107 clinics in 34 countries (16 with low and 18 with high Gross Domestic Product, GDP, cut at 20,000$/person at the year of enrollment). The review included history of MJO: total joint replacement or fusion of hips, knees, shoulders, elbows, ankles, wrists, and the atlantoaxial joint. Clinical data at the cross sectional visit included disease activity based on DAS28(ESR, 3 variables) and patient reported outcomes (PROs) for disease burden (pain, global health, fatigue on 0-10cm VAS and HAQ on 0-3). Mean values of these variables were compared using parametric statistics in patients with or without history of MJO, according to disease duration (5-10 vs. >10 years), adjusted for age and sex, in countries with low vs. high GDP. Results QUEST-RA includes 10,142 patients; joint operation data were available in 9069 patients (81%Female, mean age 55, median disease duration from symptom-onset 12 years, 74% RF+). Proportion of RA patients with a history of MJO was more than two times in high GDP countries [12.9% (663/5158)] compared to low GDP countries [5.8% (227/3911)] despite the latter having higher disease activity and worse PROs. Disease burden was higher in patients with a history of MJO across the groups (Table) except in patients with shorter disease duration 5-10 years in low GDP countries (all comparisons p=ns, data not shown). Conclusions In the real world setting in 2005-2012, history of MJO in patients with RA indicated higher disease burden and severity compared to patients without MJO. Disclosure of Interest None declared