However, diabetes/hyperglycemia and/or dyslipemia artes were not different between groups. Metabolic syndrome was also significantly more prevalent among patients with KOA (Table ). When analyzing the history of complications of cardiovascular disease such as ischemic heart disease or cerebrovascular complications, patients with KOA also showed a significantly higher rate as compared with the control group (16/184 (61.5%) vs. 9/254 (3.5%), p <0.05).[Table ] Conclusions: In a primary care setting patients with knee OA showed a high prevalence of cardiovascular risk factors and metabolic syndrome and what is more important cardiovascular disease complications appeared to be also more prevalent in this population.

Background There are many patients with osteoarthritis (OA) that are misdiagnosed as rheumatoid arthritis (RA) in general practice in Colombia. False positive diagnosis of RA is made on the basis of proximal or distal compromise in hands associated with low level positive rheumatoid factor. As a result, they are treated with disease modifying anti-rheumatic drugs (DMARDs), leading to higher economic costs for health system. Objectives The aim of this study was to calculate the possible direct economic costs of care of OA patients misdiagnosed as RA in a 12 month period in a cohort of patients derived to a specialized RA center in Colombia. Methods A descriptive cross sectional study was performed. Patients derived during a 12 month period to a RA specialized center with presumptive diagnosis of this disease and found finally diagnosed with OA were included in analysis. For confirmation or ruling-out RA diagnosis was followed a standardized protocol by a rheumatologist. Percentages and averages were calculated for demographic and clinical characteristics of the cohort of patients in which final diagnosis of OA was made. We described the direct costs in colombian pesos (COP) of their care assuming an average of 4 visits/year to general practitioner (6.000 COP/consultation), 2 visits/year for physiatrist and orthopedics (16.000 COP/consultation) and 4 set/year of conventional laboratories (40.000 COP/set). Cost of medication doses were calculated for an average use of methotrexate, sulfasalazine, chloroquine and prednisolone (103.000 COP/monthly). Indirect costs were not calculated. Results From 2841 patients evaluated, in 1511 patients (53.2%) diagnosis of RA was confirmed, the remaining 1330 patients (46.8%) had a wrong diagnosis of RA. Between incorrect differential diagnosis were found: osteoarthritis in 896 patients (67.36%), systemic lupus erythematosus in 104 patients (7.81%), Sjögren syndrome in 50 patients (3.75%), spondyloarthropathies in 45 patients (3.38%), gout in 28 patients (2.1%) and other diagnoses in 15.56% of the remaining population. As above mentioned, 896 patients (67.36% of misdiagnosed patients) had finally OA. Of this patients, 629 (76.2%) were women and 267 (29.79%) men, with an average age of 59.5 years (range between 9-92 years). For each patient we calculated 24.000 COP/year for general practitioner visits, 64.000 COP/year for specialized medicine visits, 160.000 COP/year for laboratory sets and 1’236.000 COP/year for medications. This leads to a total cost of 1’484.000 COP/year per patient. From a total of 896 misdiagnosed patients the cost rises to 1’329’664.000 COP. These patients had an average of 4.5 years of wrong treatment for their misdiagnosis, making the cost rise up to 5’983’488.000 COP (3 million US dollars). Conclusions There is an important economic implication of the misdiagnosis of OA as RA, being this the most frequent mistake in the diagnosis of this disease. The implementation of educational programs for health care primary physicians and specialized RA centers cou...

Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to developing of defined therapeutic targets and tools to achieve them resulting in the Treat to Target (T2T) initiative. This strategy is being used last year in Colombia in a specialized in RA center. Objectives The aim of this study was to describe general change in Disease Activity Score 28 (DAS28) using T2T strategy for a 12 month period in a large cohort of patients from a Colombian specialized in RA center. Methods A descriptive cross-sectional study was performed. Patients from one specialized rheumatologic center with diagnosis of RA (ACR 1987 and 2010 ACR/EULAR criteria) were assessed applying a T2T strategy. A standardized follow-up was designed by authors using DAS28: every 3-5 weeks (for DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.2 and ≤5.1), and every 11-13 weeks (DAS28 <3.2). It was measured tender joint counts (TJC), swollen joint counts (SJC), DAS28 and HAQ at every visit. In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. Were included patients who seen at least 3 times their doctor. We calculated percentages and averages from this data and divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA) patients. Global change in DAS28, joint counts and HAQ was determined at beginning, 6 and 12 months. Results 1511 patients were included in this study, 1190 (78.75%) women and 321 (21.25%) men. The majority (97.6%) of patients had established disease (more than 2 years of duration); 84% of patients were in conventional therapy and 16% were using biologics. During following in 9.2% of biologic users medication was stopped because adverse event or inefficacy; in 17.9% biologic was switched. As above mentioned, for analysis we divided patients in two classes: Rem/LDA patients and MDA/SDA patients. For the initial visit, we found only 38% patients in Rem-LDA activity and 62% patients in moderate-severe activity according to DAS28. At 6 and 12 months we found improvement to 56% and 71% respectively in patients of Rem/LDA group. On the other hand was observed a decrease to 44% and 29% (at 6 and 12 months correspondingly) in patients of MDA/SDA group. The difference of medians for each variable showed improvement with statistical significance (p<0.00). It was not established improvement in HAQ with statistical significance. Conclusions This study shows general improvement of DAS28 in a cohort of RA patients from a specialized center treated under recommendations of T2T strategy; it was found a globally increase in the percentage of patients in Rem-LDA activity group and decrease in MDA/SDA group. This revision shows importance of using of T2T follow-up and treatment for this disease and was verified that achieving remission/LDA is a realistic goal in clinical practice. Obviously, standard T2...

Background There is a lack of expertise in the diagnosis of rheumatoid arthritis (RA) in primary care centers maybe worldwide and commonly, many patients with osteoarthritis (OA) are misdiagnosed with RA, leading to wrong treatment with consequent clinical impact. Objectives The aim of this study was to describe demographic and clinical characteristics of a cohort of patients with OA derived to a specialized in RA center with presumptive RA diagnosis. Methods A descriptive cross sectional study was realized. There were revised records of patients that were referred to a specialized in RA center in a 12 month period with presumptive diagnosis of this disease. For confirmation or ruling-out RA diagnosis was followed a standardized protocol: a complete medical record was fulfilled by a rheumatologist; it was measured rheumatoid factor and anti-citrullinated antibodies, and finally other laboratories depending on each case. Also were made x-rays of hands and/or feet; in some cases of persistent doubt about RA diagnosis was done comparative MRI of hands. Percentages and averages were calculated for the demographic and clinical characteristics of the cohort of patients in which final diagnosis of OA was made. Results From 2841 patients evaluated, in 1511 patients (53.2%) diagnosis of RA was confirmed, the remaining 1330 patients (46.8%) had a wrong diagnosis of RA. Between incorrect differential diagnosis were found: osteoarthritis in 896 patients (67.36%), systemic lupus erythematosus in 104 patients (7.81%), Sjögren syndrome in 50 patients (3.75%), spondyloarthropathies in 45 patients (3.38%), gout in 28 patients (2.1%) and other diagnoses in 15.56% of the remaining population. As above mentioned, 896 patients (67.36% of misdiagnosed patients) had finally OA. Of this patients, 629 (76.2%) were women and 267 (29.79%) men, with an average age of 59.5 years (range between 9-92 years). False positive diagnosis of RA was made on the basis of proximal or distal compromise in hands associated with low level positive rheumatoid factor; many of patients didn’t have x-ray of hands, ultrasonography or MRI. Majority of these patients were followed not on a regular basis by general physicians or internists and treated with non-biologic and biologic (n=2) disease modifying anti-rheumatic drugs (DMARDs) in the past, for an average time of 4.5 years. Conclusions Almost half patients with presumptive RA diagnosis in primary care centers in Colombia are misdiagnosed as shown in this large cohort. Most frequent diagnosis of patients misdiagnosed with RA was OA, being more than two thirds of them, predominantly women. This study shows the need for the implementation of specialized clinics in RA with early referral approaches and educational strategies for primary care physicians and other related specialists in order to avoid the clinical impact of this wrong diagnosis. Disclosure of Interest None Declared

Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to elaborate defined therapeutic targets and tools to achieve them. As a result, the Treat to Target (T2T) initiative was developed. Objectives The aim of this study was to analyze the results of applying T2T strategy in a large cohort of patients with RA during 30 weeks. Methods Patients from one specialized rheumatologic center with diagnosis of RA (ACR 1987 and 2010 ACR/EULAR criteria) were assessed applying a T2T strategy. A standardized follow-up was designed by authors using DAS28: every 3-5 weeks (for DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.2 and ≤5.1), and every 11-13 weeks (DAS28 <3.2). It was measured tender joint counts (TJC), swollen joint counts (SJC), DAS28 and HAQ at every visit. In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. Were included patients who seen at least 3 times their doctor. Outcome: disease activity (joint counts and DAS28) at baseline and six months later; also difference in functionality (HAQ). Statistical analysis: central tendency measures and dispersion measures for continuous variables. For categorical and qualitative variables were used percentages. Bivariate correlations were performed by means of continuous variables with Spearman’s correlation. For categorical variables was used Pearson’s correlation. Meancontrastwas performedthrough t-student. Results 563 patients. 77% women and 23%men; median age 58±10 y/o. 81% of patients were using conventional DMARDs and 19% biologic agents. Medians of disease activity measures at baseline were: DAS28: 3.5±2.0, TJC: 3.5±5.2, SJC: 2.0±3.8 and HAQ 0.3±0.5; 30 weeks later DAS28 was 3.0±1.1, TJC: 2.4±3.0, SJC: 0.9±2.4 and HAQ 0.3±0.7. The difference of medians for each variable showed improvement with statistical significance (p<0.05) except for HAQ. At the beginning 37.6% of patients were in remission and 11.3% in low disease activity (LDA), 30 weeks later this percentages increased to 45.8% and 19.5% respectively (p<0.00). On the other hand, the proportion of patients in moderate (MDA) or severe (SDA) disease activity reduced (for MDA from 35.8% to 28.7% and for SDA from 14.9% to 5.6%) with statistical significance (p<0.00). Taken as a whole, It was improvement in global DAS28 from 3.6 (CI 95% 3.3-3.7) at beginning to 3.0 (CI 95% 2.9-3.1) at 30 weeks (p<0.001). Conclusions Application of T2T was accurate to perform tight and adequate control of RA patients. There was improvement in disease activity (TJC, SJC and DAS28) and was demonstrated that achieving remission/LDA is a realistic goal in clinical practice. On the other hand standard T2T follow-up in patients with RA should be done based on: correct application of composite disease activity scores, treatment decisions and subsequent visits based on DAS28 results, and an established clinical guideline. Disclosure of Interest None D...