Objective. To evaluate societal costs and quality-adjusted life years (QALYs) of treatment strategies for patients with recent-onset active rheumatoid arthritis (RA). Methods. Patients (n ‫؍‬ 508) were randomly allocated to 1 of 4 treatment strategy groups: sequential monotherapy, step-up combination therapy, initial combination therapy with prednisone, or initial combination therapy with infliximab. For 2 years, patients reported cost and utility measures. Results. Average QALYs (ideally 2.00) for groups 1-4 were 1.29, 1.31, 1.32, and 1.41, respectively, for the British EuroQol (P < 0.05 for group 4 versus groups 1-3); 1.41, 1.43, 1.44, and 1.52, respectively, for the Dutch EuroQol (P < 0.05 for group 4 versus groups 1-3); and 1.38, 1.38, 1.39, and 1.44, respectively, for the Short Form 6D (P < 0.05 for group 4 versus groups 1-3). The Time Trade-Off showed no significant differences. In the primary analysis, using the friction cost method to value productivity, the cost-utility ratio for group 4 against the next best alternative was estimated at €130,000 (95% confidence interval €27,000, €3,000,000) per QALY. Using the human capital method, the value of sustained productivity in group 4 largely compensated for the extra medication costs. Conclusion. Initial combination therapy with infliximab for patients with recent-onset active RA resulted in significantly better quality of life than other strategies. Using the friction cost method, costs to achieve this improvement are generally considered too high, and initial combination therapy with prednisone should be preferred. However, depending on the extent to which productivity is valued, infliximab costs could be largely compensated for by savings on productivity. Since patterns of infliximab use had not yet stabilized after 2 years, longer followup may change the economic conclusions.

BackgroundEnthesitis is one of the manifestations of psoriatic arthritis (PsA), but no clear definition for the diagnosis exists. To further evaluate the added value of sonographic evaluation of entheses in diagnosing enthesitis, more knowledge on factors associated with sonographic enthesitis is needed.ObjectivesWe aim to evaluate which clinical characteristics are associated with sonographic enthesitis changes in a cross-sectional PsA population.Methodsestablished PsA patients were asked to participate, irrespective of enthesitis complaints. Patients were interviewed on history of musculoskeletal complaints (MSC), more specifically if they had complaints during activities and whether they avoided physical activities (during exercise, work, household tasks, hobbies, chores). Tenderness was determined in the MASEI entheses and those in the Leeds Enthesitis Index (LEI) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES). Previously we showed that a modified Madrid Sonographic Enthesitis Index (MASEI, i.e. excluding knee enthesis thickness and scoring PD-signal semi-quantitatively) distinguishes entheses of PsA patients from those of healthy volunteers (1). A sonographist unaware of clinical findings scored the modified MASEI. Multivariable linear regressions of structural (erosions, calcifications, structure) and inflammatory (thickness, bursitis and PD) modified MASEI scores were performed (transformed for a better distribution). Variables included age, gender, PsA duration, medication use (non/nsaids vs. sDMARDs vs. bDMARDs), LEI + MASES and avoidance (no vs. yes).Results84 PsA patients participated (45 males, mean age 55, median disease duration 8 years). Median modified MASEI was 12 (IQR 7.25–17), with a structural component score of 7 (3–10) and inflammatory component score of 6 (3.5–8.5). 8 patients used no medication or NSAIDs only, 36 used sDMARDs and 40 used bDMARDs. 45 patients reported avoiding activities. In a multivariable analysis, inflammatory modified MASEI was negatively associated with avoidance (i.e. fewer inflammatory changes in patients reporting avoidance) and positively associated with age, BMI and use of biologics. Structural MASEI was positively associated with age only.ConclusionsAvoiding physical activities is associated with fewer inflammatory changes of the entheses. More inflammatory changes are seen in older or overweight patients and patients on biologicals, in the latter possibly due to more active disease.References Wervers K, Rasappu N, Vis M, Tchetverikov I, Kok MR, Gerards AH, et al. AB0733 Masei Shows Substantial Changes in The Entheses of Young Healthy Volunteers – Amending Its PD Score and Excluding Knee Entheses Thickness Provides Better Discrimination of Enthesitis in Psoriatic Arthritis Patients. Ann Rheum Dis 2016;75:1155. Disclosure of InterestNone declared

BackgroundInflammatory Bowel Disease (IBD) is a chronic disease that affects up to 0.5% of the population, comprising both Crohn's Disease (CD) and ulcerative colitis (UC). Various extra-intestinal manifestations can occur, among which spondyloarthritis (SpA). SpA can manifest with both axial and peripheral manifestations, but prevalence estimates of these manifestations differ widely.ObjectivesTo provide a pooled estimate of the prevalence of axial and peripheral manifestations of SpA in patients with IBD and to identify factors that might influence the prevalence estimates.MethodsWe systematically searched Embase, Pubmed, OvidSP, Scopus and Web-of-science databases from inception to May 2014. All articles addressing the prevalence of axial and/or peripheral manifestations of spondyloarthritis in adult IBD patients were included. Risk of bias was assessed using a quality assessment tool including items on selection bias, non-response bias, sample size and misclassification of SpA diagnosis.ResultsOut of 4846 studies, 60 studies were included. Sample size varied from 9 to 4454. Methodological quality of the included studies was moderate, with only a slight majority scoring positively on the individual items of the quality assessment tool. With regard to axial manifestations, the pooled prevalence of sacroiliitis was 0.11 (95% CI 0.08–0.014), whereas the pooled prevalence for ankylosing spondylitis was 0.03 (95% CI 0.03–0.04). For peripheral arthritis the pooled prevalence was 0.14 (95% CI 0.12–0.16). Few estimates were available for the prevalence of enthesitis (range from 0.01 to 0.54) and dactylitis (range from 0 to 0.04). For both axial and peripheral manifestations, the prevalence was higher in patients with CD than in patients with UC.Heterogeneity between studies was large, which might be explained by methodological quality as well as difference in geographic area, clinical setting and the use of criteria for case ascertainment as shown in figure 1 for the prevalence of SI and AS.ConclusionsSpondyloarthritis is a common extraintestinal manifestation in IBD. Peripheral arthritis is slightly more common with a pooled prevalence of 0.14 than axial manifestations as sacroiliitis (pooled prevalence 0.11) and ankylosing spondylitis (pooled prevalence 0.03). For both axial and peripheral manifestations, the prevalence is higher in patients with CD than in patients with UC.Disclosure of InterestNone declared

BackgroundOver the last couple of years early arthritis clinics provided quick access for patients with inflammatory arthritis. However, although early access to specialized care is now available, adequate referrals are also required to shorten the doctors' delay. Therefore, general practitioners (GPs), the ones who refer, should be aware of symptoms distinguishing between inflammatory and non-inflammatory disease in patients at risk for spondyloarthritis (SpA).ObjectivesTo describe GP's ability to recognize symptoms suggestive of spondyloarthritis.MethodsThe AppSpA study was set up, a cross-sectional study focusing on awareness and knowledge of SpA in GPs and patients at risk for SpA. For the present study a single survey was developed and send out to GPs in various regions of the Netherlands. This survey was based on a study by Jois et al, which looked into recognition of symptoms of inflammatory back pain. Since we were also interested in the ability of GPs to recognize peripheral manifestations of SpA, we added some extra questions.Results183 of the 950 GPs completed the survey, leading to a participation rate of 19.3%. Of the participating GPs the mean age was 47.2 years (SD 10.3) and 47.5% were male. Mean time working as a GP was 15.4 years (SD 13.5).Almost all GPs (94.5%) indicated to be familiar with the term SpA, but 55.5% associated it only with axial manifestations. Up to one third of the GPs associated the term SpA with psoriatic arthritis (23.7%) and Inflammatory Bowel Disease (33.5%).With regard to the recognition of signs of inflammatory pain, especially morning stiffness and pain relieve by NSAIDs were recognized (Table 1), whereas pain improvement with exercise was recognized in less than 25% of cases. When we focus on the peripheral manifestations of SpA; out of six signs for inflammatory peripheral disease, only 43.2% of GPs recognized at least three of these symptoms. For the eight axial signs, 60.6% recognized at least four symptoms.If GPs thought about inflammatory symptoms, the majority asked for the presence of psoriasis (83.6%) and inflammatory bowel disease (72.1%). GPs less often ask about other SpA related symptoms such as uveitis (61.8%), enthesitis (19.1%) and dactylitis (19.1%).ConclusionsOverall, recognition of inflammatory disease by GPs is suboptimal, where GPs are more aware of axial manifestations compared to peripheral manifestations. The recognition of these signs and symptoms of SpA in primary care needs improvement in order to facilitate the necessary referrals to rheumatologists.AcknowledgementThis survey is part of initiative to develop a communication platform which was financially supported by AbbVie.Disclosure of InterestNone declared