Background:Rheumatoid Arthritis (RA) has been associated with depression by up to 46% (1)Within the universe of manifestations of depression is learned helplessness (LH)LH is defined as an inadequate perception of the disease, generating feelings of defenselessness, loss of self-esteem, pessimism, and negativity. This leads to passivity, surrendering to fate, and thoughts that nothing within their power can change their situation, this condition produces a rapid deterioration which prevents responding adaptively to a traumatic situation, increasing the frequency of anxiety and depression. (2)Objectives:To assess the relationship between depression, LH, disability and disease activity among patients with RAMethods:Descriptive observational study included RA patients diagnosed according to ACR / EULAR 2010 randomly recruited between June and September 2019 at University Hospital “Dr. José Eleuterio González” in Monterrey, México.Beck Depression Inventory (BDI) and Rheumatology Attitude Index (RAI) were applied for measure depression and LH, to measure disability Health Assessment Questionnaire (HAQ-DI) was applied. CDAI and DAS28-PCR scales were used for measure disease activity.Descriptive analysis was carried out with measures of central tendency and dispersion. Spearman correlation were used for comparisons, according to the distribution of the variables. A p <0.05 was considered statistically significant.Results:A total of 177 patients were included, demographic and clinic features are presented in table 1. Prevalence of LH was 94.5% (167/177); 60% (100/167) mild levels (9-15) and 33% (67/167) high levels (>15). A significant correlation was found between higher levels of dysfunctionality and BDI and higher levels of LH (rho = 0.338; p = 0.001). There was a positive association when measuring CDAI (rho = 0.235; p = 0.002) BDI (rho=0.278 P=<0.001) and DAS28-PCR (rho=0.166; p=0.027) with higher levels of LH. There was no association found between other variables as gender, years of diagnosis of RA, years of study or presence of comorbidities like fibromyalgia or osteoarthritis.Table 1.Demographic and clinical characteristics of the patients. HAQ-DI Health Assessment Questionnaire RAI Rheumatology attitude index, DAS28-PCR Disease Activity Score CDAI Clinical disease activity index BDI Beck Depression InventoryDemographicsn = 177Gender Female n, %165 (93.3%). Male n, %12 (6.8%)Age (mean), SD.52.16 (12.8)Years of study (average), SD.8.3 (3.6)Years with RA (mean), SD.8.2 (8.0)RAI (mean), SD13.83 (3.9)HAQ-DI (mean), SD0.67 (0.77)CDAI (mean), SD12.0 (11.4)DAS28-PCR (mean), SD2.4 (0.6)BDI (mean), DE9.30 (9.7)LH, n (%)168/177 (94.5%)High levels 108/177 (61%)Low levels 60/177 (33%)Conclusion:In this study the prevalence of LH was high >90%, mainly in mild levels. Dysfunctionality seems to be the factor most associated with the presence of depression and LH.Rheumatologist should consider the high levels of LH, to assess patients in order to obtain a better outcome.Table 2.Correlation between learned helplessness and clinical variables LH Learned Helplessness HAQ-DI Health Assessment Questionnaire RAI Rheumatology Attitude Index DAS28-PCR Disease Activity Score CDAI Clinical Disease Activity Index BDI Beck Depression InventoryrhopLH –HAQ-DI0.338<0.001LH-CDAI0.2350.002LH-DAS28PCR0.1660.027LH-BDI0.278<0.001[1]Margaretten M, Julian L, Katz P, Yelin E. Depression in patients with rheumatoid arthritis: description, causes and mechanisms. Int J Clin Rheumtol. 2011;6(6):617-23.[2]Moyano S, Scolnik M, Vergara F, Garcia MV, Sabelli MR, Rosa JE, et al. Evaluation of Learned Helplessness, Perceived Self-efficacy, and Functional Capacity in Patients With Fibromyalgia and Rheumatoid Arthritis. J Clin Rheumatol. 2019;25(2):65-8.Disclosure of Interests:None declared

Background:There has been seen a low adherence to treatment in patients with rheumatic diseases, which can have important consequences in disease prognosis. Although literature in Latin-American population is scarce, a previous study evaluating medication adherence in this population reported a 16.4% prevalence of adherence in Rheumatoid Arthritis (RA) and 45.9% in Systemic Lupus Erythematosus (SLE) patients (1). It has been demonstrated better outcomes in patients with rheumatic conditions who have good adherence to treatment therapies (2).Objectives:To describe the adherence to synthetic Disease-Modifying Antirheumatic Drugs (DMARDs) in patients with rheumatic diseases from a Mexican outpatient rheumatology clinic.Methods:This study was conducted in the outpatient rheumatology clinic of University Hospital in Monterrey, México, cross-sectional, descriptive, self-report adherence study. Consecutive patients with RA, SLE, Inflammatory Myopathies, Psoriatic arthritis (PsA), Systemic Sclerosis (SSc) were approached during their normal routine rheumatology appointments, in the March 2018 to December 2018 period. They were asked how many days of the last month they forgot or took their DMARDs. We classified the adherence rate in 4 categories based on the days of the last month it took the indicated medication; good: 75%-100% (> 21 days), regular 50-74% (21-15 days), bad 25-49% (14-8 days) and null: <25% (< 7 days). When adherence was not good we interrogated about the cause. Data was obtained from REPAIR ® (internal electronic patient record) and analyzed with the statistical package SPSS version 24.Table 1 Adherence for Rheumatic Disease Group n (DMARDs) Good n (%) Regular n (%) Bad n (%) Null n (%) Rheumatoid Arthritis1,6861442(85.5)105(6.2)47(2.8)92(5.5)Systemic Lupus Erythematosus440393(89.3)16(3.6)12(2.7)19(4.3)Inflammatory Myopathies9183(92.1)2(2.2)0(0)6(6.6)Psoriatic arthritis8476(90.5)1(1.2)3(3.6)4(4.8)Systemic Sclerosis9180(87.9)6(6.6)1(1.1)4(4.4)N2,392Table 2 Reasons for Bad or Null adherence Rheumatoid Arthritis % Systemic Lupus Erythematosus % Inflammatory Myopathies % Psoriatic arthritis % Systemic Sclerosis % Economic30.133.337.53720Own decision27.933.312.52540Side effects11.511.112.512.50Lack of availability1513.312.512.540forgetfulness of dose11.94.42512.50Other3.54.4000Conclusion:Adherence in this group of patients was good, for the definition used in our study.The method used (self-report) is very sensitive to detect non-adherence, but it overestimate good adherence, therefore the potential bias of results must be considered and confirmed whit objective measurement.The main reason for poor or no adherence was the economic, with the exception of the Ssc group it was their own decision and the patients with SLE that had the same percentage for economic and self-decision.References[1] - Resende Prudente L, Souza Diniz J, Matteucci Ferreira TXA, Marçal Lima D, Antônio Silva N, Saraiva G, et al. Medication adherence in patients in treatment for rheumatoid arthritis and systemic lupus erythematosus...

Background:Pharmacovigilance is the science and activities related to detection, evaluation, understanding and prevention of adverse effects of medications or any other health problem related to them. (1)Within the scope of the pharmacovigilance study, following domains are included: adverse drug reaction, interaction between medications, counterfeit or inferior quality medications, lack of efficacy of medications, misuse or abuse of medications and medication errors (ME). (2)ME is any preventable incident that can cause harm to the patient or lead to improper use of medications when they are under the control of healthcare professionals or the patient. (3)Objectives:To determine the frequency of ME in the prescriptions among rheumatology outpatient’s clinic.Methods:Prospective observational study.Frequency of ME was sought by a randomized review of the prescriptions from rheumatology outpatient’s clinic of the University Hospital “Dr. José Eleuterio González” before and after the implementation of an electronic medical prescription system (REPAIR®) (January 2018-December 2019)REPAIR® displays an automated menu with the stages of the medical prescription: Name, presentation and dosage of the medicine and duration of the treatment. Figure 1. Once the review began, semiannual reports were made to the doctors involved in which frequency of errors and the stage of medical prescription with highest incidence of ME were reported.Figure 1Example image displayed by REPAIR®Descriptive statistics were performed, reporting frequencies and percentages.Results:A total of 1599 medical prescriptions were evaluated. The number of prescriptions with ME was 196 (12.2%). Table 1Table 1General description about errors in medical prescriptionsPrescriptions evaluated1599Prescription with ME n (%)196 (12.2%)Medications evaluated n10 413Medications with ME n (%)907(8.7%)Average medications per prescription6.4Average medications with ME per prescription0.78Prescription Stage Name of the drug n (%)2/10 413 (0.01%) Medication presentation n (%)77/ 10 413 (0.7%) Dose of the drug n (%)0/10 413 (0%) Duration of prescription n (%)725/10 413 (6.9%)The incidence of ME decreased, at beginning of the study incidence was reported 31.6%, and at the end were 1.5%. Graph 1The percentage of medications with ME also decreased from 17.2% to 0.8% at the end of the study. Table 2Table 2Errors in prescriptions per semesterJanuary-June 2018July-December 2018January-June 2019July-December 2019Prescriptions evaluated n321411407460Prescriptions with ME n (%)73 (31.6%)93 (22.6%)23 (5.6%)7 (1.5%)Medications evaluated n2126278426802823Medications with ME n (%)367 (17.2%)469 (16.8%)36 (1.7%)35 (0.8%)Average medications per prescription evaluated6.66.76.26.4Average medications per prescription evaluated1.1461.1430.0820.081Prescription Stage n (%) Name1/367(0.2%)1/469 (0.2%)00 Presentation37/367 (10%)37/469 (7.8%)1/36 (2.7%)2/35 (5.7%) Dose0000 Duration290/367 (89%)367/469 (88.2%)35/36 (97.2%)33/35 (94.2%)Conclusion:Decrease in the incidence of ME in rheumatology consultation is important because outcome of the patients depends significantly on treatment adherence. This study results shows that through the application of an electronic prescription system, it is possible to reduce the incidence of ME in rheumatology consultation.References:[1]Jeetu G, Anusha G. Pharmacovigilance: a worldwide master key for drug safety monitoring. J Young Pharm. 2010;2(3):315-20.[2]Organization WH. WHO pharmacovigilance indicators: a practical manual for the assessment of pharmacovigilance systems. 2015.[3]Elden NM, Ismail A. The Importance of Medication Errors Reporting in Improving the Quality of Clinical Care Services. Glob J Health Sci. 2016;8(8):54510.Graph 1Disclosure of Interests:None declared

Background:Medication error can be defined as a failure in the treatment process that leads to or has the potential to lead to harm to the patient, this fault can happen in two different phases: prescribing and prescription.Prescribing is the process of deciding what to prescribe and naming it. Various types of faults can occur in the decision-making process: underprescribing, overprescribing, irrational, inappropriate and ineffective prescribing. All these covers one type of errors, but these are different kind of errors that those that occur in the act of writing a prescription. This leads to the distinct concepts of ‘prescribing faults’ and ‘prescription errors’A prescription is ‘a written order, which includes detailed instructions of what medicine should be given, to whom, in what formulation and dose, by what route, when, how frequently, and for how long’. Thus, a prescription error can be defined as ‘a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription’. The ‘normal features’ include the identity of the patient, the identity of the drug, the formulation and dose, and the route, timing, frequency, and duration of administration. (1)It is not record about the rate of medication errors in rheumatology consultation.Objectives:To evaluate whether there is a relationship between prescribing errors and the number of drugs in the prescription.Methods:A descriptive, observational, and retrospective study was made.It was carried out a random search of medical prescriptions, generated by the electronic records (REPAIR®) of the rheumatology consultation of the Hospital Universitario “Dr. José Eleuterio González” during 2019, in which the prescriptions that contained any error were identifiedT student test was performed to see the difference in the prescription error based on the number of medications. P <0.05 was taken as statistically significant.Results:A review of 867 medical prescriptions was performed, among which 5503 medications were indicated with an average of 6.34 medications per prescription, a total of 30 (6.9%) prescriptions were found with error, where a total of 71 (3.9%) medications had errors. In the prescriptions with medication error, all the errors were prescription type; 68 (95.7%) had a mistake in the duration of administration and 3 (4.22%) in the identity of the drug.In the prescriptions with medical errors the average number of prescription drugs was 7.50, only 2/30 (0.6%) had less than 7 indicated medications (4 and 6), meanwhile the prescriptions in which no error was found had a mean of 6.30 indicated medications. P < 0.001.Conclusion:According to the study findings, it could be established that when the number of prescribed medications is greater than 7, there is an increased risk of making a prescription error. Further studies should carry out to look for other factors that influence medical errors in rheumatology clinics.References:[1]Aronson JK. Medication errors: definitions and classification. Br J Clin Pharmacol. 2009;67(6):599-604.AcknowledgmentsDisclosure of Interests:None declared

BackgroundTreatment adherence in Rheumatoid Arthritis (RA) patients vary from 30 to 80% (1). It is important to identify the associated factors to a low adherence, so clinicians can make interventions to obtain better therapeutic results. Adherence to treatment has been described to be affected by several factors, such as access to healthcare facilities, education, socioeconomic status, quality of communication between physician and patient, among others (2). There are no previous studies that investigate if the number of drugs received in RA patients affects this adherence. REPAIR ® is a program designed with the purpose of improve data collection and medical practice in our outpatient clinic.ObjectivesTo compare the adherence to synthetic Disease-Modifying Antirheumatic Drugs (DMARDs) among RA patients prescribed with monotherapy and combined therapy.MethodsCross sectional, observational, comparative study. This study was conducted in the outpatient rheumatology clinic of University Hospital in Monterrey, México. Consecutive patients with RA, were approached during their normal routine rheumatology appointments, in the March 2018 to December 2018 period. They were asked how many days of the last month they forgot or took their DMARDs (self-report). We classified the adherence rate in 2 categories based on the days of the last month they took the indicated medication; adequate: 75%-100% (> 21 days), inadequate <75% (<21 days). When adherence was inadequate we interrogated about the cause. Data was obtained from REPAIR ® (internal electronic patient record). The Kolmogorov‐Smirnov test was used to determine normal distribution. Categorical variables are expressed as total number and percentage (%), and numerical variables as median and the 25th-75th percentiles (q25-q75). Chi square and Mann‐Whitney U‐test were used to compare groups and considered significant if p<0.05. Data was analyzed with the statistical package SPSS version 24 (New York, USA).ResultsA total of 959 patients were included. When comparing adherence to treatment and gender between groups, no statistically significant difference was found. The main cause of inadequate adherence in the monotherapy group was the economic (30.3%) and own decision in the combined therapy group (29.1%).Table 1 Monotherapy (n=346) Combined therapy (n=613) p Age (years), median (q25-q75) 54 (44-63)53 (43-59) 0.018 Women, n (%)317 (91.6)575 (93.8)0.362Inadequate adherence to treatment, n (%)52 (15)102 (16.6)0.514Adequate adherence to treatment, n (%) 294 (85)511 (83.4)ConclusionPatients with combined therapy had the same percentage of inadequate adherence as patients with monotherapy. These results may indicate that number of drugs prescribed not necessarily affects adherence to treatment. The principal causes for an inadequate adherence to treatment were: economic for monotherapy group and own decision for combined therapy group. However, long-term studies are needed to evaluate the persistence of treatment in these groups of patients.References[1] Van den Bemt BJF, Z...