AB0887-HPR CHARLSON COMORBIDITY INDEX (CCI) IN RHEUMATOID ARTHRITIS: CLASSIFICATION AND CORRELATIONS

Background:

Charlson Comorbidity Index[1] is a tool including age and chronic diseases assessing the comorbidity burden. The age and the comorbidity burden in RA patients determine the morbidity and mortality.

Objectives:

To assess and classification of CCI in RA patients with usage of the health-care system (outpatient clinics) in a real-world setting.

Methods:

327 patients with RA from a large outpatient service of a central hospital were retrospectively reviewed. Demographic characteristics, treatment for RA and comorbidities were recorded. Charlson Comorbidity Index (CCI) was measured and classified as low, intermediate and high score for 1-2, 3-4 and >=5 points, respectively. Its correlation with polypharmacy and necessity of biologic DMARDs was studied. Univariable and multivariable analyses were performed.

Results:

Data from 327 RA patients (75,8% females, 24,2%males) with a mean±SD age of 63±11,8 years and disease duration 113±63 months, were recorded.

CCI was 3±1,2 points (mean±SD) and maximum score was observed at 7 points. High score (>=5points) was observed at 9,2% and in the majority the score was intermediate (3-4points) at 55%. All the RA patients with high score fulfilled the criteria of polypharmacy. Patients with high score had 9,7 times more probability of polypharmacy than the patients with low score (p=0.09, 1.4-2.5 95%CI).

70 patients were treated with biologic-DMARDs (21,7%), in the majority with TNFa inhibitors (16,5%). In RA patients receiving biologic-DMARDs was observed low or intermediate score of CCI. Τhe most likely explanation is the severity of the disease that predominated, its complications and the possible overlap with other conditions.

Conclusion:

The majority of RA patients had intermediate score of CCI. In patients with high score-meaning more comorbidities- polypharmacy was observed completely. Patients receiving biologic-DMARDs characterized with less comorbidities.

References:

[1]Charlson E M et al. A new method of classifying prognostic comorbidity in longitudinal studies:development and validation. J Chronic Dis. 1987;40(5):373-83.

Disclosure of Interests:

None declared

The challenge of implementing Less is More medicine: A European perspective

The concept of Less is More medicine emerged in North America in 2010. It aims to serve as an invitation to recognize the potential risks of overuse of medical care that may result in harm rather than in better health, tackling the erroneous assumption that more care is always better. In response, several medical societies across the world launched quality-driven campaigns ("Choosing Wisely") and published "top-five lists" of low-value medical interventions that should be used to help make wise decisions in each clinical domain, by engaging patients in conversations about unnecessary tests, treatments and procedures. However, barriers and challenges for the implementation of Less is More medicine have been identified in several European countries, where overuse is rooted in the culture and demanded by a society that requests certainty at almost any cost. Patients' high expectations, physician's behavior, lack of monitoring and pernicious financial incentives have all indirect negative consequences for medical overuse. Multiple interventions and quality-measurement efforts are necessary to widely implement Less is More recommendations. These also consist of a top-five list of actions: (1) a novel cultural approach starting from medical graduation courses, up to (2) patient and society education, (3) physician behavior change with data feedback, (4) communication training and (5) policy maker interventions. In contrast with the prevailing maximization of care, the optimization of care promoted by Less is More medicine can be an intellectual challenge but also a real opportunity to promote sustainable medicine. This project will constitute part of the future agenda of the European Federation of Internal Medicine.

Subacute cutaneous lupus erythematosus inducing unilateral sensorimotor neuropathy

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Sweet syndrome on a patient with autoimmune hepatitis on azathioprine and CMV infection

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Serum leptin and erythropoietin during menstruation

OBJECTIVE

The potential influence of leptin and erythropoietin on the angiogenesis and bleeding of the endometrium during normal menstrual cycles and possible correlations between them.

STUDY DESIGN

Serum concentrations of leptin and erythopoietin were measured at menstrual days 20, 1 and 3 or 4 in healthy, non-obese, normal menstruating women.

RESULTS

Mean leptin and erythropoietin concentrations showed no significant alteration over time (F = 0.588, p = 0.563 and F = 0.654, p = 0.528, respectively). There was, however, a strong negative linear relationship between the concentration of the two substances on days 1 and 3 or 4 (p = 0.018 and p = 0.028, respectively).

CONCLUSIONS

If the two substances affect endometrial angiogenesis, they may do this in a locally limited way, so that peripheral concentration changes cannot be observed. Their inverse correlation prompts further study with receptor determination.