BackgroundThe beliefs that patients have regarding their medication, namely about its need and concerns regarding possible adverse effects, are a determining factor for adherence and therapeutic success1.ObjectivesDetermine which sociodemographic and clinical factors are associated with beliefs related to medication, either in terms of necessity or concerns about medication, in patients with Rheumatoid Arthritis (RA) or Psoriatic Arthritis (PsA).MethodsObservational study, with a sample consisting of 58 patients (female 72,4%, male 27,6%; mean age = 51,0 ± 13,2 years; education < 9 years 39,7%, ≥ 9 years 60,3%). Of these, 33 had a diagnosis of RA and 25 of PsA (mean years of disease duration = 8,2 ± 7,3 years; mean disease activity by DAS28-PCR or DAS28-PCR 3 variables = 2,32 ± 0,95). Between March 2021 and June 2021, a brief questionnaire was applied with sociodemographic and clinical variables, such as the use of classic or biological DMARDs and their administration´s route. The Specific Beliefs About Medication Scale (BMQ) was anonymously applied, adapted from the Beliefs About Medicines Questionnaire, comprising 2 sections: section 1 – Specific Needs, patients beliefs about the need for medication; section 2 – Specific Concerns, beliefs related to the dangers of addiction and long-term toxicity or side effects. Higher scores (scale from 5 to 25 points), in sections 1 and 2, reflect the belief of greater need and greater concern regarding medication, respectively. The average scores in section 1 and in section 2 of the BMQ were 9 and 15,7 points, respectively. Statistics: descriptive, Student t-Test, Pearson Correlation and ANOVA, p<0,05.ResultsPatients with PsA and younger age had a higher mean score in section 2 of the BMQ (p= 0,049 e p<0,01, respectively). The variables male gender, education ≥ 9 years and shorter duration of the disease also showed a tendency to be associated with the higher score in section 2 of the BMQ, with p-values close to statistical significance (p=0,091, p=0,074 and p=0,094, respectively). In the multivariate analysis with the above variables, only the diagnosis of PsA showed a statistically significant association with the score in section 2 of the BMQ (B=4,269; p<0,001; CI 95%=[2,060-6,477]). There was also a statistically significant correlation (p=0,007) between the scores in section 1 and section 2 of the BMQ. Regarding analysis of the sample by diagnosis, there was an association between the subcutaneous route of drug administration in individuals with RA and greater concern with the adverse effects of the medication (p=0,007), and between low disease activity and greater belief in the specific need for medication for the disease (p=0,006).ConclusionIn this study, patients with PsA were more concerned about the possible adverse effects of medication than patients with RA. RA patients who take subcutaneous drugs are more afraid of the drug’s toxic potential, and those with lower disease activity have a greater need to comply with the prescribed therapy, which can be explained by the previous effectiveness of the drug in disease control. It was also found that the greater the belief in the need for medication, the greater the concern with its possible long-term harmful effects.References[1]Smolen JS, Gladman D, McNeil HP, et al. Predicting adherence to therapy in rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis: A large cross-sectional study. RMD Open. 2019;5(1):1-13. doi:10.1136/rmdopen-2017-000585AcknowledgementsI have no acknowledgements to declare.Disclosure of InterestsNone declared

O presente artigo reflete sobre a dimensão investigativa no Serviço Social, mediante análise das tendências temáticas e metodológicas dos Trabalhos de Conclusão de Curso dos egressos do curso de Serviço Social do Campus Arapiraca da Universidade Federal de Alagoas (UFAL). O objetivo é apresentar as convergências e divergências dessa produção científica com as Diretrizes Curriculares da ABEPSS, identificando tendências de pesquisa e possibilidades de investigação ainda pouco acionadas no processo de formação em Serviço Social.

BackgroundEnthesitis is the hallmark of psoriatic arthritis (PsA) and may assist in distinguishing PsA from other forms of arthritis (1,2). Its clinical evaluation is hampered by lack of specificity of physical examination (3). Ultrasound (US) may provide information about its presence and response to treatment. Although some previous works have shown that enthesitis of the hand is important in PsA (4), most US studies and scores focused on greater size entheses.ObjectivesTo explore the prevalence of enthesitis of the hand in PsA patients as evaluated by US, and compare it with other inflammatory arthritides, namely rheumatoid arthritis (RA).MethodsCross-sectional study in which consecutive patients with PsA and RA were recruited for an US protocol evaluating 4 entheses of the hand including: 1. measurement of the extensor digitorum tendon central slip at its insertion at the middle phalanx of the 2nd and 3rd finger bilaterally; 2. search for the presence of power-Doppler (PD) sign; 3. identification of structural lesions.Linear regression models were built to test if diagnosis (PsA vs RA) explained part of the variance of the thickness of tendons insertion while controlling possible influences of age, type of work and body surface area. A ROC curve was built to find a mean thickness cut-off allowing distinction between PsA and RA. The prevalence of PD sign and structural lesions of the entheses was compared between groups.ResultsFifty-eight patients were recruited (29 with PsA and 29 with RA) and a total of 232 entheses were evaluated.Mean thickness of the interest entheses was superior in PsA patients compared to RA patients (2nd finger – 0.96 ± 0.16mm vs. 0.74 ± 0.09mm; 3rd finger – 0.96 ± 0.20mm vs. 0.76 ± 0.11mm).Linear regression models including diagnosis and potential confounders significantly explained mean thickness of both entheses (2nd finger – R2=0.56, p<.001; 3rd finger – R2=0.41, p<.001), with the diagnosis group being the most important predictor (Table 1). ROC curve (AUC 0.897, p<.001) showed a cut-off value of 0.925mm for the mean of the 4 entheses had a specificity of 93.1% for the identification of PsA patients.Table 1.Multiple linear regression models explaining thickness of the entheses.2nd finger (mean of both sides)3rd finger (mean of both sides)Linear regression modelR2=0.56p<.001***R2=0.39p<.001***Diagnosis (PsA vs RA)β=0.587; B=0.203mmp<.001***β=0.483; B = 0.182mmp<.001***In our sample, 8 (3.5%) entheses had a measured thickness above mean + 2 SD, all belonging to PsA patients; 6 (75%) had signs of ongoing inflammatory process as proved by the presence of PD sign (Figure 1). Regarding structural lesions, enthesophytes or bone irregularities/erosions were found in 13.8% of PsA entheses, which compared to 1.7% of RA entheses.Figure 1.Enthesitis of the central slip of extensor digitorum of the 3rd finger in a patient with PsA: swelling of the 3rd proximal interphalangeal joint (A) due to inflammatory process originating in the enthesis, with no signs of synovitis, as evaluated by US (B).ConclusionThis work reinforces enthesitis as a key lesion in PsA. It also shows enthesitis occurs significantly in small entheses, like the ones of the hand and that, in some instances, it may be the dominant lesion in a swollen joint. US may be valuable for establishing a diagnosis in the setting of inflammatory arthritis of unknown etiology.References[1]Mease P. Enthesitis in psoriatic arthritis (Part 3): clinical assessment and management. Rheumatology. 2020 Mar 1;59(Supplement_1):i21–8.[2]Sapundzhieva T, Karalilova R, Batalov A. Hand ultrasound patterns in rheumatoid and psoriatic arthritis: the role of ultrasound in the differential diagnosis. Rheumatol Int. 2020 Jun;40(6):837–48.[3]Kaeley GS. Enthesitis in psoriatic arthritis (Part 2): imaging. Rheumatology. 2020 Mar 1;59(Supplement_1):i15–20.[4]Smerilli G, Di Matteo A, Cipolletta E, Grassi W, Filippucci E. Enthesitis in Psoriatic Arthritis, the Sonographic Perspective. Curr Rheumatol Rep. 2021 Sep;23(9):75.Disclosure of InterestsNone declared