The aim of this study was to systematically review the literature available about the benefit of health education by a training nurse in patients with axial and/or peripheral psoriatic arthritis in the framework of the drawing up of the axial spondyloarthritis and psoriatic arthritis guidelines of the "Spanish Society of Rheumatology". Electronic databases (Cochrane Central Register of Controlled Trials, EMBASE, Medline/PubMed, CINAHL) were systematically searched from inception to 2014 using medical subject headings and keywords. Only articles in English, Spanish and French were included. The patients studied had to be diagnosed of psoriatic arthritis (all ages, both sexes) with axial involvement and/or peripheral arthritis who had received health education by a specialized nurse. We included in the search randomized clinical trials, cohort observational studies, descriptive studies and case series and qualitative research studies. Measured outcomes were those related to the education provided in a nursing consultation such as increased adherence to biological therapy, conducting exercises, smoking cessation and patient satisfaction. Eight studies were included, five randomized clinical trials with moderate level of quality and three intervention studies with no control group with low level of quality. Meta-analyses were not undertaken due to clinical heterogeneity. According to our results, it can be concluded that although there is little evidence on the role of a trained nurse in patients with psoriatic arthritis, this role can be beneficial to the patients because it can increase the rate of adherence to treatment prescribed by a rheumatologist, promotes patient self-management of their disease and increases patient satisfaction.

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Background:With the arrival of biosimilar drugs and savings policies to make the health system sustainable, hospital managers have chosen to make changes from original molecules to biosimilar drugs.Objectives:This work aims to reflect what happens when making these switchings.Methods:We reviewed 235 patients who started Etanercept original in Rheumatology at Navarra Hospital Complex and Henares University Hospital and their switch to Etanercept biosimilar with a follow-up of 6 months.Results:The switch was performed in 174 patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis, SAPHO and spondyloarthritis.9.8% discontinued treatment: 6 RA (8.1%), 5 PsA (9.8 %) and 6 AS (20.7%); all of them in the injection presentation. 12 patient stopped treatment due to ineffecacy, 2 due to reaction at the injection site, 2 due to diarrhea and 1 due to headache. Among 88.2% of patients who returned to Etanercept original, 28.6% did not achieve good response and had to change of treatment. The median time from Etanercept original beginning until the moment of switching was 54 (40-87) months.Conclusion:In our series, approximately 10% of switching patients failed after a 6-month of follow-up; when trying to return to Etanercept original 28.6% did not achieve response.The median persistence time in the original molecule and the percentage of failures observed in AS could be two conditions to consider before switching.A longer-term follow-up and a greater number of patients are necessary to ratify these data.Table 1DISEASESTOPPED CAUSEBACK TO Etanercept originalCONTINUE Etanercept originalTIME UNTIL SWITCH (meses)ASReaction at the injection siteYesYes28ASHeadacheYesYes54ASIneffecacyYesYes126RAIneffecacyYesNo25ASDiarrheaYesYes87RAIneffecacyYesYes37PsAIneffecacyNoNo43RAIneffecacyYesYes54PsAIneffecacyYesNo93PsAIneffecacyNoNo132PsAIneffecacyYesYes62RAIneffecacyYesYes142RAReaction at the injection siteYesYes51RAIneffecacyYesNo56PsAIneffecacyYesNo40ASIneffecacyYesYes26ASDiarrheaYesYes48Disclosure of Interests:Vicente Aldasoro Speakers bureau: Roche, Abbvie, MSD, UCB, Pfizer, Menarini, Grunenthal, Gebro, Novartis, Janssen, Javier Mendizabal: None declared, Sara Perez Garcia: None declared, Guillen Sada Urmeneta: None declared, Juliana Restrepo Vélez: None declared, Natividad del Val del Amo: None declared, Inmaculada Paniagua Zudaire: None declared, Ricardo Gutiérrez Polo: None declared, Loreto Horcada: None declared, Laura Garrido Courel: None declared, C. Fito-Manteca: None declared

Background:Several studies in Rheumatoid arthritis (RA) have suggested that a greater number of comorbidities is associated with worse functional status and disease activity measures. However, it is useful to use a composite comorbidity index, such as Rheumatic Disease Comorbidity Index (RDCI) that is validated for the use in patients with rheumatic diseases, to better understand the overall role of comorbidities in treatment outcomes.Objectives:To evaluate the impact of comorbidities on 12-month clinical response in a cohort of patients with RA treated with a first-line biologic disease-modifying antirheumatic drug (bDMARD), by using the RDCI.Methods:Observational retrospective study was performed including consecutive patients with the diagnosis of RA followed at our Rheumatology Department. The prevalence of comorbidities was computed, and patients were stratified according to RDCI for evaluating its role in clinical response disease activity at baseline and follow up (6 and 12 months). Correlations between variables were studied using Spearman correlation analysis, comparison between groups was performed using Kruskal-Wallis and Chi-square. A multivariate logistic regression model was developed to examine the role of RDCI along with other baseline factors as potential predictor of achieving remission, low disease activity (LDA), and EULAR good/moderate response. Statistical analyses were performed using SPSS statistical software, version 23.0.Results:A total of 251 patients were included: 83.7% (n=210) females, mean age of 58 (± 11.10) years old, with a median disease duration of 16.11 years [10.79 - 23.04]. The majority exhibited a very high or high disease activity at baseline (median DAS28 3V 5.48 [4.70 – 6.19]) and 90% (n=226) of them were concomitantly using corticosteroids and/or other disease-modifying anti-rheumatic drugs (129 with methotrexate (MTX), 96 with leflunomide and 35 with sulfasalazine). The most frequently reported comorbidities were cardiovascular disorders (37.5%), osteoporosis (7.6%) and depression (6.8%). The median RDCI score was 1.0 [0.0 – 2.0] and the majority of patients (63.6%) carried at least one comorbidity. When comparing baseline demographic and clinical characteristics of the 4 subgroups, stratified according to RDCI score (RDCI=0, 1, 2, or ≥3), we found statistically significant differences in age, age at diagnosis, sex and the prescribed anti-TNF agent (p<0.05). There was a progressive increase in the mean age as the RDCI score increased between the subgroups.RDCI strongly correlates with the number of comorbidities (NC) (r=0.764, p<0.01). NC was weakly correlated with patient and physician global assessment of disease activity (pVAS and phVAS) (r=0.183, p<0.01 and r=0.196, p=0.019, respectively), DAS28 3V (r=0.192, p=0.046) and HAQ-DI (r=0.301, p<0.01) at 6 months. Moreover, RDCI poorly correlated with CRP (r=0.192, p=0.01), pVAS (r=0.183, p=0.02) and HAQ-DI (r=0.202, p<0.01). Weaker correlations were also found at 12 months: NC with pVAS (r= 0.196, p=0.02), DAS28 3V (r=0.216, p=0.01) and HAQ-DI (r=0.187, p=0.04); RDCI with phVAS (r= 0.196, p=0.04).The 12-month DAS28 remission rate was 37.8% (n=95); 6.7% (n=17) achieved EULAR good response and 54.4% (n=137) a moderate EULAR response. RDCI was not an independent predictor of DAS remission (OR 0.794, 95% CI 0.561- 1.125,p =0.194) nor it was of EULAR good/moderate response (OR 0,720, 95% CI 0.430- 1.206, p= 0.212).Conclusion:Although our data point to a weak association between morbidities, assessed by the RDCI, and response to a first bDMARD, it is important to consider this simple and useful tool in future prospective and broader studies, since information bias regarding comorbidities may have been responsible for our results.Disclosure of Interests:Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Georgina Terroso: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared