Objective: Classify comorbidities with greatest impact on Rheumatoid Arthritis (RA) patients. Develop and validate a prospectively applicable comorbidity index for classifying RA patients according to their comorbid disorders which might impact alter their hospitalization and mortality risk. Methods:A weighted index which considers the number and impact of comorbid conditions was developed based on clinical registry of a cohort of 2029 patients with early RA monitored over 10-years. Logistic and Cox Regression analyses were implemented to estimate the risk of mortality. Regression coefficients were used to develop the index score. ROC curve for the invented index was used to evaluate the discriminating ability of the index and identify different cutoff values that can delineate patients at different stages for risk of death. Disease activity parameters were considered.Results: Comorbidities (18 conditions) were strongly associated with the 10-year death risk, and composed the RA-comorbidity index, include Cardiovascular (7 comorbidities), infection, osteoporotic fractures, falls risk, Depression/anxiety, functional status (HAQ >2), diabetes mellitus, steroid therapy >5 mg, DAS-28 >3.6), renal/liver/ lung disease and tumors. Considering the comorbidities number, the comorbidities adjusted relative risk were employed as weights to develop a weighted index. Validation using ROC curve revealed AUC of 97%. Conclusion:The RA-comorbidity index is a valid method for assessing risk of death in RA patients. The index enables the treating physician to include comorbidities valuation and treatment in their standard practice. It can be used to identify targets, predict resource utilization, and detect the potential targets for lowering high costs, by prospectively recognizing RA patients at high risk.

Objectives: 1. to assess the validity of an electronically comorbidity assessment strategy to identify comorbid conditions among inflammatory arthritis patients in standard practice. 2. To evaluate the impact of e-comorbidity assessment on the patients' care and adherence to therapy. Methods:A cohort of 112 RA and 111 PsA subjects diagnosed according to RA ACR/EULAR criteria and PsA CASPAR criteria were followed longitudinally for 36 months. The patients were classified into a study group (112 patients) whose electronic patient-reported comorbidities were compared to a control group of 111 patients who were managed according to standard protocols. The sensitivity, specificity, positive and negative predictive values of the electronic data entry were compared to ICD-10 medical record (reference standard) and rheumatology clinic visits outcomes. Results:The sensitivity for identifying comorbidities using the electronic approach (median, 99.2%; interquartile range [IQR]: 96%-100%) outperformed those recorded using using ICD-10 codes (median, 66%; IQR: 50%-74%); and those recorded using clinic letters (median, 38%; IQR: 32%-54%). The median PPV and NPV were 97.7% (IQR: 96-100%) and 99.6% (IQR: 99-100%) for the e-comorbidity tool Vs 61.8% (IQR: 41%-76%) and 97.4% (IQR: 91%-98%) for the ICD-10 codes, physician recorded comorbidity respectively. The patients' adherence to antirheumatic therapy was significantly (p<0.1) higher in the studied group.Conclusions: e-comorbidity assessment offered a specific and dynamic approach tailored to the patient's needs over the 3-years study period, which is applicable in standard practice. Patient reported e-comorbidity outperformed the standard medical recording systems and can have a role in healthcare management and research.

Objectives: To develop and assess the psychometric properties of an instrument/questionnaire for evaluation of ''motivation'' amongst children and adolescents living with inflammatory arthritic conditions. Methods:Based on content analysis, semi structured group discussion and Rasch analysis, ten domains were identified, hence, the questionnaire was developed including: 10-items scale (0-10 on VAS scale). Each item was supported by illustrations explaining both ends of the measure. Construct validity was assessed by correlating the score of the questionnaire to disease activity scores; patient reported outcomes; as well as adherence to therapy. Reliability and comprehensibility and sensitivity to change were also assessed. Results:The questionnaire was assessed in 142 children (43 JIA, 33 systemic arthritis, 34 enthesitis related arthritis, 32 cSLE) Results revealed that the developed illustrated questionnaire mean score correlated significantly (p<0.001) with disease activity measures: JADAS-27, SLEDAI-2K and JSpADA, reflecting its validity. It also correlated significantly (p<0.001) with the scores of functional disabilities, health related quality of life and medication adherence. The questionnaire was reliable (Cronbach's alpha 0.946) and had no mis fitting items. The illustrations were well received, and this was reflected on the questionnaire comprehensibility (97.2) and sensitivity to change (p<0.01). Conclusions:The illustrated children motivation measure, is a patient-centered unidimensional scale that is valid, reliable and comprehensible. The measure has good psychometric properties and can be used at the individual child's level to tailor management and monitor changes in response to therapy. The illustrations enhanced the questionnaire perception by the children as well as the parents.

Objective: 1. Identify whether there is a discordance on comparing the patient versus the rheumatologist perspective on remission in RA; and, 2. Determine, from the patient perspective, the relation of patient reported outcomes to the most prevalent specific disease aspects reported in RA patients who achieved remission. Methods: Early RA patients diagnosed according to ACR/EULAR criteria were treated according a treat-to-target regime with regular disease activity monitoring. Remission was measured as: 1) patient perceived-; and 2) Physician perceived-remission. The study included 188 RA patients and 87 rheumatologists. All participants were asked to complete a survey composed of all domains identified in relation to the disease remission. 10 cm visual analogue scale was used to illustrate the importance of each domain. Results: The top 4 domains reported in the patients' cohort who achieved remission were: pain (76%), functional ability (71%), quality of life (69%) and fatigue (43%), whereas the top 4 in the rheumatologist cohort were: low disease activity score (88%), radiologic remission and progression of erosions (76%), lab measures (ESR, CRP) (57%) followed by work difficulties (49%). There was a dynamic pattern of the most important domains reported when patients are stratified according to age, disease duration, comorbidity and motivation. Conclusion: Different factors are important for rheumatologists and RA patients regarding disease remission. Treatment satisfaction is determined not only by disease activity indices but also by other patient-oriented factors. PROMs could optimise targeted therapy as it can play a significant role in identifying disease activity parameters relevant to both the treating rheumatologist as well as the patient.