scholarly journals AB0236 WHAT FACTORS ARE ASSOCIATED WITH THE EVOLUTION TOWARDS RHEUMATOID ARTHRITIS, USE OF BIOLOGICAL THERAPY AND DEVELOPMENT OF CARDIOVASCULAR EVENTS IN A COHORT OF PATIENTS WITH UNDIFFERENTIATED ARTHRITIS?

2019 ◽  
Author(s):  
Jerusalem Calvo Gutierrez ◽  
Rafaela Ortega Castro ◽  
Clementina López-Medina ◽  
Ladehesa Pineda Lourdes ◽  
María del Carmen Castro Villegas ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Events ◽  
Biological Therapy ◽  
Undifferentiated Arthritis

Impact of a new coronavirus infection on the clinical course of immunoinflammatory rheumatic diseases

2021 ◽  
Vol 13 (2) ◽  
pp. 39-47
Author(s):  
Vadim I. Mazurov ◽  
Irina B. Belyaeva ◽  
Lubov E. Sarantseva ◽  
Anton L. Chudinov ◽  
Roman A. Bashkinov ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Viral Infection ◽  
Rheumatic Diseases ◽  
Biological Therapy ◽  
Clinical Course ◽  
Underlying Disease ◽  
Clinical Rheumatology ◽  
Undifferentiated Arthritis ◽  
Saint Petersburg ◽  
Coronavirus Infection

BACKGROUND: The COVID-19 pandemic poses a particular threat to patients suffering from immunoinflammatory rheumatic diseases. New coronavirus infection has been found to be accompanied by the development of a wide range of extrapulmonary clinical and laboratory manifestations, which are characteristic of a number of immunoinflammatory rheumatic diseases. AIM: To evaluate the features of the clinical course of immunoinflammatory rheumatic diseases in patients who underwent new coronavirus infection. MATERIALS AND METHODS: The clinical course of immunoinflammatory rheumatic diseases was analyzed in 324 patients who underwent new coronavirus infection from March 2020 to February 2021 and were treated at the Clinical Rheumatology Hospital No. 25, Saint Petersburg, for exacerbation of the underlying disease. RESULTS: Analysis showed that the risk factors for severe new coronavirus infection in patients with immunoinflammatory rheumatic diseases were: age over 60, comorbidities, use of prednisolone in a dose greater than 12,5 mg, and ESR values 40 mm/hour before the development of new coronavirus infection. There was no effect of immunosuppressive and biological therapy on the severity of the course of viral infection. There was no effect of immunosuppressive therapy and biological therapy on the severity of the course of viral infection in patients with immunoinflammatory rheumatic diseases. The development of the postinfectious syndrome was observed in 1/4 of patients, which was characterized by the formation of postinfectious arthritis in 3,6% of patients, transformation of undifferentiated arthritis into various rheumatic diseases in 49% of patients (more often into early rheumatoid arthritis), as well as exacerbation of the underlying disease in 83,4% of patients with an advanced stage of rheumatoid arthritis. In patients with mixed connective tissue disease, there was a significant increase in immunologic activity due to antinuclear factor (up to a maximum of 1:163 840). Clinical cases of the development of arthritis associated with viral infection and the debut of rheumatoid arthritis after an new coronavirus infection are presented. CONCLUSIONS: New coronavirus infection in the cohort of patients with immunoinflammatory rheumatic diseases observed in the Clinical Rheumatology Hospital No. 25, Saint Petersburg, proceeded in the variant of medium severity in half of patients, initiated the development of lung lesions in 68,6% of patients, arthritis associated with viral infection in 3,6% of patients, immunoinflammatory rheumatic diseases which transformed from undifferentiated arthritis in 49% of cases and exacerbation of the main disease in an overwhelming number of patients. Patients with immunoinflammatory rheumatic diseases have a high risk of adverse outcome of new coronavirus infection, especially in cases of unstable course of the disease or exacerbation of this group of diseases.

CP-078 Optimisation of biological therapy in established rheumatoid arthritis patients in real life clinical practice

2016 ◽  
Vol 23 (Suppl 1) ◽  
pp. A34.2-A34
Author(s):  
M Cárdenas ◽  
P Font ◽  
S De la Fuente ◽  
MC Castro-Villegas ◽  
M Romero-Gómez ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Biological Therapy ◽  
Real Life ◽  
Established Rheumatoid Arthritis

scholarly journals AB1176 UTILITY OF REDOSER TOOL IN DOSE OPTIMIZATION OF BIOLOGICAL THERAPY IN PATIENTS WITH RHEUMATOID ARTHRITIS IN CLINICAL PRACTICE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1879.2-1879
Author(s):  
A. M. Cabezas-Lucena ◽  
M. Morales-Águila ◽  
S. Manrique Arija ◽  
C. Fuego-Varela ◽  
L. Cano Garcia ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Dose Reduction ◽  
Biological Therapy ◽  
Activity Index ◽  
Standard Dose ◽  
Disease Evolution ◽  
Independent Variables ◽  
Outpatient Unit ◽  
Baseline Activity

Background:Objectives:To describe the characteristics of patients with rheumatoid arthritis (RA) in dose reduction of biological therapy (BT) in clinical practice and identify possible factors associated with the time in dose reduction and verify the utility of REDOSER tool.Methods:Design:A retrospective, observational longitudinal study under conditions of clinical practice.Patients:RA in BT dose reduction between 2007- 2019 were selected. Inclusion criteria: RA according to ACR 2010 criteria which have been initiated BT dose reduction. Patients with BT are followed prospectively every 3-4 months in a specialized outpatient unit of BT dose reduction with a pre-established protocol for data collection and registered in a database.Variables: Primary:Time in reduction: was defined as the time in which patients maintained the BT optimization andRelapse at 12 and 24 months: percentage of patients who, after starting BT optimization, return to the previous or standard dose.Secondary variables:REDOSER:Appropriate, Doubtful and Inappropriate (If dose reduction was adequate according to the REDOSER tool applied retrospectively were evaluated). Other variables: Demographic, clinical-analytical: time of disease evolution, RF, anti CCP antibodies, Number of Tender Joints, Number of swollen joints, erosions, activity index (DAS28, SDAI, CDAI) and physical function (HAQ). Previous treatments.Statistical Analysis:descriptive, bivariate using x2 and T-Student among patients with and without relapse at 24 months and multivariate linear regression to identify independent variables associated with the time in BT dose reduction (DV: time in reduction).Results:59 patients with RA were included. Table 1 shows the main characteristics of the subjects. The average (SD) of optimization in months was 17.9 (17.7). Ten patients (16.9%) relapsed at 12 months and 16 (27.1%) at 24 months. The mean (SD) of DAS28 and SDAI of patients who relapsed at 24 months was higher compared to baseline DAS28 (2.3 [0.9] vs. 1.5 [0.8]; p = 0.015) and SDAI (7.8 [6.3] versus 3.3 [1.6]; p 0.05). These patients who relapsed at 24 months compared to patients who did not have more erosions at the start of BT (p = 0.004), longer duration of disease (p = 0.072) and greater baseline activity of DAS28 (p = 0.017), of SDAI (p = 0.030) and CDAI (p = 0.036). After simulating the REDOSER tool to all patients at the beginning of the OBT, 28 patients (56%) were “Appropriate”, 20 (40%) “Doubtful” and 2 (4%) “Inappropriate” of which they continue in OBT at the conclusion of study 22, 10 and 0, respectively (p = 0.020). In the multivariant analysis, the independent variables that are associated with time in dose reduction of BT were baseline DAS28 (β = -0.660, 95% CI[2.7-14.0]; p=0.014) and age (β=-0.800, 95% CI [0.8-0.0]; p=0.038).Conclusion:The majority of the patients with RA who initiate BT dose reduction maintain the optimization after 24 months. REDOSER can be useful in clinical practice to assess the BT optimization in patients with RA. A longer time in BT dose reduction was associated with lower values of DAS28 at the beginning and younger age of the patients.Figure 1:Disclosure of Interests:None declared

scholarly journals AB0182 EVALUATION OF THE SOCIO-PROFESSIONAL IMPACT OF ANKYLOSING SPONDYLITIS AND RHEUMATOID ARTHRITIS IN TUNISIA: DATA FROM THE BINAR REGISTRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1390.2-1391
Author(s):  
H. Hachfi ◽  
N. Ben Chekaya ◽  
D. Khalifa ◽  
M. Brahem ◽  
H. Themri ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Ankylosing Spondylitis ◽  
Marital Status ◽  
Biological Therapy ◽  
Total Duration ◽  
National Registry ◽  
Inflammatory Rheumatic Diseases ◽  
Physically Active ◽  
Absence From Work ◽  
Professional Impact

Background:Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are disabling and common chronic inflammatory rheumatic diseases.Objectives:The aim of our study was to evaluate the socio-professional impact of RA and AS.Methods:Using the Biological National Registry (BINAR) data, which includes ten tunisian rheumatology centers,we identified patients≥18 years with AS and RA according to the ACR and EULAR 2010 criteria(RA) and ASAS 2009 (AS), receiving biotherapy for less than two years.Results:298 patients were included in the study. The percentage of patients with RA was 58.7 % and those with AS 41.3%. The sex ratio was 0.6. The average age of the onset of the disease was 49.1 years ± 14.1 years [18–79]. For marital status, 72% were married, single (25%), widowed (2.6%) and divorced (0.4%). 22.4% of patients were illiterate, 32.7 % (primary), 28.3% (secondary) and 16.6% had an university level. For the RA population, a high disease activity (DAS28-ESR >5.1) was detected in 36% of patients, an erosive arthritis in 73.1% and 7.2% had a coxitis. In the AS group, an elevate BASDAI (BASDAI≥4) was detected in 56.9% of patients and 39% had coxitis. All patients have received Biological therapy concomitant with corticosteroids (59.1%), methotrexate (42.6%), salazopirine (20.8%) and leflunomide (4.7%). 54% of patients had a comorbidity, of which 1.7% was depression. More than half of our patients (54.3%) were unemployed, 40 % were professionally active, and 5.7% were retired due to the rheumatic condition. Absence from work was observed in 15.1% of cases with a total duration exceeding three months in 55.5% of cases. 37.9 % of patients were physically active: regularly (9.8%), irregularly (28.1%) and (62.1%) were sedentary. For the functional impact, HAQ score was 1.31± 0.7 for RA and BASFI was 5.2 ± 4.8 for AS. The working abandonment is significantly associated to: marital status (p=0.039), low level of education (p=0.04),depression (p<0.001), high activity of AS (p=0.004) and BASFI>4 (p=0,001).Conclusion:RA or AS requiring biotherapy have a high socio-economic impact and are responsible for absenteeism at work and even for early working abandonment. Early therapeutic management and a global assessment are essential in order to improve quality of life and working conditions. Longitudinal studies are needed to assess the effect of biological therapy on the socio-professional impact of these chronic inflammatory rheumatic disease.Disclosure of Interests:None declared

scholarly journals AB0237 INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH RITUXIMAB AND ANTI-TNF INHIBITOR

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1144.2-1144
Author(s):  
N. Zehraoui ◽  
R. Benaziez.Boutaleb ◽  
H. Hafirassou ◽  
F. Mechid ◽  
N. Bahaz ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Best Practice ◽  
Biological Therapy ◽  
Patient Characteristics ◽  
Inadequate Response ◽  
Tnf Inhibitor ◽  
Clinical Rheumatology ◽  
Number Of Patients ◽  
Serious Infections ◽  
Comparative Risk

Background:Biological therapies have significantly improved the management of rheumatoid arthritis (RA). These molecules are very effective, but are known for their specific risks, especially infectious. It depends on several factors including the type of molecule used.Objectives:The objective of our study is to compare the rate of infection in RA patients treated with rituximab and anti-TNFα.Methods:Prospective, observational, monocentric study. Were included RA patients (ACR / EULAR 2010 criteria) treated with rituximab and anti-TNFα (adalimumab, infliximab and Etanercept) after inadequate response to DMARDs.Demographic characteristics, comorbidities, association with methotrexate and corticosteroids were collected and compared for each group.The number, type and severity of the infections in both cases were noted.SPSS (Statistical Package for Social Science) was used for data analysis.Results:40 RA patients treated with rituximab and 31 patients who received anti-TNFα were included.Patient characteristics and Comparison of rate of infection in RA patients between the two groups are summarized in Table 1Table 1.ParametersRituximabAnti-TNFαpNumber of patients4031Average age (years)56,2846,060,01Sexratio0,140,110,7Average duration of evolution (years)15,8313,740,3Patients under corticosteroid (%)97,587,10,08Average corticosteroid dose6,415,480,3patients under methotrexate (%)37,545,20,5Diabetes (%)2016,10,7Patients with infection (%)32,551,60,1Number of infections18240,4Number of serious infections500,04Conclusion:The rate of infections in patients with RA treated with rituximab or anti-TNF was similar. However, the infections observed were more serious in patients with RA treated with rituximabReferences:[1]Fabiola Atzeni MD PhD and al. Infections and Biological Therapy in Patients with Rheumatic Diseases. IMAJ . VOL 18. march-APRIL 2016.[2]Huifeng Yun and al. Comparative Risk of Hospitalized Infection Associated with Biologic Agents in Rheumatoid Arthritis Patients Enrolled in Medicare. ARTHRITIS & RHEUMATOLOGY. Vol. 68, No. 1, January 2016, pp 56–66.[3]Manjari Lahiri and al. Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis. Best Practice & Research Clinical Rheumatology (2015) 1-16.Disclosure of Interests:None declared

scholarly journals AB1280-HPR REQUIRED FORCE TO OBTAIN A POSITIVE SQUEEZE TEST AUTOMATIZED IN PATIENTS WITH HAND ARTHRALGIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1931.3-1931
Author(s):  
M. M. Castañeda-Martínez ◽  
G. Figueroa-Parra ◽  
D. Vega-Morales ◽  
B. R. Vázquez Fuentes ◽  
Y. G. Ordoñez Azuara ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Rheumatic Diseases ◽  
Primary Care Physicians ◽  
Clinical Aspects ◽  
Inflammatory Rheumatic Diseases ◽  
Undifferentiated Arthritis ◽  
Left Hand ◽  
Hand Force ◽  
The Uk

Background:Primary care physicians (PCP) are usually the first contact of people with inflammatory rheumatic diseases, and find the early symptoms of Rheumatoid Arthritis (RA) difficult to distinguish from those of other rheumatic diseases. A time-delay in the reference to Rheumatology is a health issue in several countries. The clinical aspects that general practitioner took into account in hand arthralgia patients are important to make the reference. In particular the Squeeze Test (ST) - which is simple to perform and rapidly done, ST is useful for identifying progression to RA in patients with undifferentiated arthritis. The ST has been described as not reliable because is clinician-dependent.Objectives:To identify the required force that needs to be applied in order to obtain a positive Automatized Squeeze Test (AST) in a cohort of patients with hand arthralgia.Methods:Ninety-seven patients were recruited in Family Medicine Consultation and in Rheumatology Consultation of the Hospital Universitario “Dr. José Eleuterio González” in Monterrey, Nuevo León, México. Eligible patients were adults (aged≥18 years) with hand arthralgia (that wasn’t caused by trauma) as their chief complaint. After obtaining informed consent and after a questionnaire application, patients were submitted to AST maneuver, using an automated compressor with different forces already predetermined in the interface of the software used for compression.Results:In this cohort of 98 patients, 79 (80.6%) were women. The mean age was 51.14 years (SD 14.66). Ninety-six (97.9%) patients were right handed. The diagnoses were Osteoarthritis (OA) (16.3%), RA (5.1%), Undifferentiated arthritis (1.2%), Psoriatic arthritis (1.2%) and Fibromyalgia (2%). Force measures according to diagnoses are reported in Table 1.Table 1.Diagnoses and mean forcesDiagnosisn (%)Right hand force mean (kg/s2) (SD)Left hand force mean (kg/s2) (SD)OA16 (16.3)3.53 (2.74)3.18(2.73)RA5 (5.1)3.60 (2.53)3.16(1.36)UA1 (1.2)7.60(0)8.70(0)PsA1 (1.2)7.60(0)7.80(0)FM2 (2.0)4.11(4.40)1.75(1.06)OA, Osteoarthritis;RA, Rheumatoid Arthritis;UA, Undifferentiated Arthritis;PsA, Psoriatic Arthritis;FM, Fibromyalgia;SD, Standard DeviationConclusion:In the cases of RA and OA, the means of force to obtain a positive AST was lower than in the rest of the diagnoses.References:[1]Stack R, Nightingale P, Jinks C, Shaw K, Herron-Marx S, Horne R et al. Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study. BMJ Open. 2019;9(3):e024361.Disclosure of Interests:None declared

scholarly journals AB0780 GENDER FEATURES OF VERIFICATION OF DIAGNOSIS UNDIFFERENTIATED ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1416.1-1416
Author(s):  
O. Malyshenko ◽  
M. Koroleva ◽  
M. Letaeva ◽  
J. Averkieva ◽  
T. Raskina
Keyword(s):  
Rheumatoid Arthritis ◽  
Ankylosing Spondylitis ◽  
Therapeutic Strategy ◽  
Gouty Arthritis ◽  
Social Significance ◽  
Undifferentiated Arthritis ◽  
Early Date ◽  
Working Age ◽  
Bone Tuberculosis ◽  
Gender Characteristics

Background:Undifferentiated arthritis (UDA) is an inflammatory arthritis that does not meet the criteria for any rheumatologic disease. Early verification of UDA is currently one of the main goals of modern rheumatology, since a diagnosis established at an early date allows determining a therapeutic strategy. The high social significance of arthritis lies in the predominant lesion of people of working age, the steady progression of the disease, early disability and a reduction in life expectancy.Objectives:To study the gender characteristics of verification of the diagnosis of undifferentiated arthritis.Methods:A retrospective analysis of 74 case histories of patients diagnosed with UDA was carried out. The study group consisted of 26 men and 48 women, mean age 50.6 ± 4.3 years. All patients underwent a comprehensive laboratory and instrumental examination according to the standard of an articular syndrome of unclear genesis.Results:According to the data obtained, the duration of the articular syndrome averaged 2.53 ± 1.2 years. In 29 patients (21.6% of women and 17.6% of men), on average, after 1.72 ± 0.9 years, the diagnosis of NDA was clarified. Taking into account modern diagnostic criteria, the following diseases were verified: rheumatoid arthritis in 13.5% (12.2% in women and 1.3% in men), ankylosing spondylitis in 10.8% (2.7% in women and 8.1% in men). Osteoarthritis, psoriatic arthritis and APS were diagnosed in 5.4%, 1.4% and 1.4% of women, and gouty arthritis, bone tuberculosis and HIV in 4.1%, 1.4% and 1.4% of men respectively. In 60.8% (43.2% in women and 17.6% in men), the etiology of arthritis was not verified.Conclusion:In a third of patients with UDA, diagnosis verification takes about 2 years on average. In more than half of patients, the diagnosis remains the same. According to the data obtained, rheumatoid arthritis was more often verified in women, while ankylosing spondylitis in men, which is consistent with statistical data.Disclosure of Interests:None declared

scholarly journals Serum Levels of Anticyclic Citrullinated Peptide Antibodies, Interleukin-6, Tumor Necrosis Factor-α, and C-Reactive Protein Are Associated with Increased Carotid Intima-Media Thickness: A Cross-Sectional Analysis of a Cohort of Rheumatoid Arthritis Patients without Cardiovascular Risk Factors

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Mónica Vázquez-Del Mercado ◽  
Lourdes Nuñez-Atahualpa ◽  
Mauricio Figueroa-Sánchez ◽  
Eduardo Gómez-Bañuelos ◽  
Alberto Daniel Rocha-Muñoz ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Tumor Necrosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Citrullinated Peptide ◽  
Necrosis Factor

The main cause of death in rheumatoid arthritis (RA) is cardiovascular events. We evaluated the relationship of anticyclic citrullinated peptide (anti-CCP) antibody levels with increased carotid intima-media thickness (cIMT) in RA patients.Methods. Forty-five anti-CCP positive and 37 anti-CCP negative RA patients, and 62 healthy controls (HC) were studied. All groups were assessed for atherogenic index of plasma (AIP) and cIMT. Anti-CCP, C-reactive protein (CRP), and levels of tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA).Results. The anti-CCP positive RA patients showed increased cIMT compared to HC and anti-CCP negative (P<0.001). Anti-CCP positive versus anti-CCP negative RA patients, had increased AIP, TNFαand IL-6 (P<0.01), and lower levels of high density lipoprotein cholesterol (HDL-c) (P=0.02). The cIMT correlated with levels of anti-CCP (r=0.513,P=0.001), CRP (r=0.799,P<0.001), TNFα(r=0.642,P=0.001), and IL-6 (r=0.751,P<0.001). In multiple regression analysis, cIMT was associated with CRP (P<0.001) and anti-CCP levels (P=0.03).Conclusions. Levels of anti-CCP and CRP are associated with increased cIMT and cardiovascular risk supporting a clinical role of the measurement of cIMT in RA in predicting and preventing cardiovascular events.

scholarly journals OP0088 INITIATING TNF INHIBITORS IN INFLAMMATORY ARTHRITIS DOES NOT DECREASE THE AVERAGE OPIOID ANALGESIC CONSUMPTION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 58.2-59
Author(s):  
O. Palsson ◽  
T. Love ◽  
J. K. Wallman ◽  
M. C. Kapetanovic ◽  
P. S. Gunnarsson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Inflammatory Arthritis ◽  
Opioid Analgesic ◽  
Oral Morphine ◽  
Undifferentiated Arthritis ◽  
First Line ◽  
The Mean ◽  
Oral Morphine Equivalent ◽  
Morphine Equivalent

Background:TNFα-inhibitor (TNFi) therapy is effective in controlling several rheumatic diseases and has been shown to reduce pain in patients with arthritis. Opioids are often prescribed for chronic pain, a common issue in inflammatory joint disease.Objectives:To explore the impact of the initiation of TNFi therapy as a first-line biologic disease-modifying anti-rheumatic drug (DMARD) on the prescription rates of opioids in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and undifferentiated arthritis (UA) in Iceland.Methods:All patients receiving biologic DMARD therapy for rheumatic diseases in Iceland are registered in a nationwide database (ICEBIO). The Icelandic Directorate of Health operates a Prescription Medicines Register that includes over 90% of all drug prescriptions in Iceland. The study group included patients with RA, PsA, AS, and UA registered in ICEBIO and for each of them five randomly selected comparators from the general population matched on age, sex, and calendar time. On February 1st2016 we extracted data on all filled opioid analgesic prescriptions two years before and two years after the date of TNFi initiation.Results:Data from 359 RA, 217 AS, 251 PsA and 113 UA patients and 4700 comparators were collected. In total, 75% of patients compared to 43% of comparators received ≥1 opiate prescription during the study period. The proportion of patients using opioids (regardless of dose) two years prior to TNFi initiation was 41%, increasing to 49% the following year. After TNFi initiation the proportion returned to 40% (Figure 1). Despite this, the mean yearly opiate dose used by the patients followed a rising trajectory throughout the study period (Figure 2). In total, patients were prescribed nearly 6 times more opioids than the comparators, corresponding to a bootstrapped mean (95% CI) dose of 818 (601-1073) mg MED per patient and year compared to 139 (111-171) mg for comparators.Figure 1.Percental distributions of opioid analgesic use by dose (according to dispensed prescriptions) among patients with inflammatory arthritis (A) and matched comparators (B). All doses are oral morphine equivalent dose (MED) in milligrams.Figure 2.Bootstrapped mean oral morphine equivalent dose per person per year for patients with inflammatory arthritis (above) and age and sex matched comparators (below). Box edges represent 25-75thpercentiles and whiskers 95% confidence intervals.Conclusion:Three out of four patients with inflammatory arthritis in Iceland use opioid analgesics in the two years prior to and/or after the initiation of TNFi therapy and the mean doses were significantly higher than in matched comparators. The proportion of patients receiving opioids increased before TNFi therapy and then decreased again to the previous level. The initiation of the first-line TNFi did not reduce opioid consumption by dose at the group level. On the contrary, there was a trend towards increasing doses over time in both patients and comparators, possibly reflecting the development of opiate tolerance.Table 1.Baseline demographic data. Mean ± SD unless specified. * defined from diagnosis to baselAll patientsRheumatoid arthritisPsoriatic arthritisAnkylosing spondylitisUndifferentiated arthritisTotal n (%)940 (100)359 (38)251 (27)217 (23)113 (12)Age (years)49 ± 1453 ± 1449 ± 1343 ± 1344 ± 15Disease duration (years)*7.8 ± 8.58.2 ± 8.27.4 ± 7.88.3 ± 10.26.3 ± 6.6Female58%73%59%34%52%Disclosure of Interests:Olafur Palsson: None declared, Thorvardur Love: None declared, Johan K Wallman Consultant of: Consultant for AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma., Meliha C Kapetanovic: None declared, Petur S Gunnarsson: None declared, Björn Gudbjornsson Speakers bureau: Novartis and Amgen

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