A pragmatic intervention directed at patients and physicians led to substantial improvements in osteoporosis treatment, even when delivered 6-months post-fracture. From the healthcare payer's perspective, the intervention appears to have led to both cost-savings and gains in life expectancy.

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For outpatients with wrist fractures, our multifaceted osteoporosis intervention was cost-effective. Healthcare systems implementing similar interventions should expect to save money, reduce fractures, and gain quality-adjusted life expectancy.

BackgroundJuvenile Idiopathic Arthritis (JIA) is a collective term used to denote clinically discrete subtypes, which include: Enthesitis-related arthritis, Oligoarthritis, Polyarthritis, Psoriatic arthritis, Systemic arthritis and unclassified arthritis. Polyarthritis is further categorized according to rheumatoid factor (RF) status. The International League of Associations for Rheumatology (ILAR) has devised classification criteria of JIA with specific exclusion criteria and its diagnosis is reliant upon clinical symptoms. While laboratory tests like CBC, CRP, ESR, RF, ANA, and anti-CCP add prognostic value, they have limited utility for diagnosis. Thus, markers that can assist in sub-typing JIA at presentation are imperative as this can influence patient management strategy.Objectives14-3-3η is a joint derived, rheumatoid arthritis (RA) specific marker that informs radiographic damage. The purpose of this study was to examine the expression of 14-3-3η in the sub-types of JIA, and to assess whether a relationship existed between 14-3-3η and RF+ polyarthritis.Methods14-3-3η serum levels were measured in 60 JIA patients as shown in Table 1. One-way ANOVA analysis was used to determine if group differences existed. 14-3-3η positivity was defined using the adult RA diagnostic cut-off of ≥0.19 ng/ml. The Fisher's Exact test was employed to assess the relationship between RF and 14-3-3η positivity in polyarthritis patients.ResultsANOVA analysis revealed differences in 14-3-3η serum levels between the groups. Patients with RF positive polyarticular disease had significantly higher serum 14-3-3η levels than the other groups. 14-3-3η positivity analysis revealed that 30% of the oligoarthritis, 53% of RF negative polyarticular, 50% of psoriatic and 57% of patients with systemic arthritis were positive for 14-3-3η. Although there were only four patients in the enthesitis group, none of them were 14-3-3η positive. Fisher's Exact testing returned no significant association between RF and 14-3-3η positive status (p-value =0.35) indicating that the two markers may uniquely inform patient profiles within subtypes of JIA, especially since 53% of RF negative polyarticular JIA patients had positive 14-3-3η tests.Table 1EnthesitisOligoPoly, RF−Poly, RF+PsoriaticSystemic# of Pts42119727Median (QR)0.06 (0.02–0.09)0.10 (0.02–0.23)0.19 (0.02–0.33)1.83 (0.09–10.59)0.20 (0.01–0.38)0.20 (0.01–1.54)Mean (SD)0.06 (0.04)0.23 (0.35)0.29 (0.38)4.69 (6.51)0.20 (0.26)0.55 (0.69)% Positivity (n)0% (0)30% (7)53% (10)71% (5)50% (1)57% (4)ANOVAp=0.0008 Conclusions14-3-3η is a joint-derived mechanistic marker that up-regulates factors that are involved in joint damage pathogenesis. While RF+ polyarthritis patients had higher 14-3-3η levels, in JIA, 14-3-3η expression has no significant association with RF positivity and may provide insights into biochemical processes that uniquely inform JIA sub-typing.Disclosure of InterestA. Rosenberg: None declared, W. Maksymowych Consultant for: Augurex Life Sciences Corp, (Co-inventor of 14-3-3η), Y. Gui Employe...

Childbearing women with rheumatoid (RA) and psoriatic arthritis (PsA) have significant peripartum issues. A retrospective anonymous RedCAP survey of peripartum period in females with RA/PsA in the RAPPORT registry was performed. Completed analyses included descriptive statistics, Chi-square and Fisher's exact test. 162 patients (133 RA/29 PsA) completed the survey (103 women having 234 pregnancies), 164 pregnancies occurring before and 70 pregnancies occurring after diagnosis. Pregnancy outcomes from 103 patients included: 96% live births, 1.9% stillbirths, 23% miscarriages, and 15% therapeutic abortions. A third of patients had fewer children than desired due to disease activity, medications and other reasons. For 63 pregnancies after diagnosis: (1) 49% of pregnancies received pre-conception counseling; (2) 65% described good disease control during pregnancy but 74% flared in the first 3 months postpartum; (3) 79% of pregnancies discontinued IA medications; (4) 35% of pregnancies occurred on biologic therapy at or prior to conception. Gestational age at time of delivery was 37-40 weeks in 58% (33/57) post-arthritis vs 66% (83/126) pre-arthritis pregnancies. No statistically significant differences occurred between pregnancies before or after RA/PsA diagnosis for: pregnancy planning, fertility treatment, pregnancy and labour/delivery complications, birth defect frequency or neonatal complications. Neonatal ICU admissions were significantly lower in pre-compared to postarthritis pregnancies (3.2% vs 14.5%). No pregnancy complications were noted in 24/54 pregnancies on medications compared to 6/9 pregnancies not on medications. The impact of RA/PsA before, during and after pregnancy varied considerably in this cohort emphasizing the importance of informed-decision making at all stages.