Objectives: To assess patients’, carers’, nurses’ and physicians’ perspectives and experiences regarding patient education (PE) and support of Methotrexate (MTX) treatment in Europe. Methods: An international team of researchers and clinicians, including rheumatology nurses, a pharmacist, a rheumatologist, and three patient representatives, developed a survey. Common and sample-specific questions were conceived for adult patients or carers (≥18 years) of children/young people with RMDs, nurses, and physicians working in rheumatology practice in Europe. The survey was available in English and, for patients/carers, in eight additional languages, disseminated between May 2022 and May 2023. Ethics committee approval was obtained (116_CEIPC/2022_IPC). Results: A total of 1526 patients, 145 carers, 354 nurses, and 291 physicians (96% rheumatologists), from 26 European countries participated. Only 28% of patients had a PE with nurse when starting oral MTX, with a slight increase to 42% for the subcutaneous form, with variations across Europe (Northern=69%, Eastern=52%, Western=50%, Southern=23%). Patients’ perspectives align with physicians, whereas nurses reported higher access rates. Around 77% of patients had/have concerns about side effects, which were discussed with health professionals in 69% of the cases, though 46% of these concerns remained unresolved. The priority ranking of topics to be addressed in PE was similar overall for the three subgroups. Conclusion: PE and support regarding MTX are unequal across Europe and can be improved by offering opportunities to clarify concerns through more access to nursing consultations. There is an overall agreement between patients and clinicians regarding key areas of education, although a tailored approach is required.

Introduction: Still's Disease (SD), encompassing both systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still's disease (AOSD) is a rare condition, therefore posing unique challenges in diagnosis and management, which can lead to delayed treatment and increased morbidity. The current state of practice regarding SD management varies widely across different countries. Very recently, a EULAR/PReS taskforce published new recommendations for the diagnosis and management of SD, providing tools to accelerate its diagnosis, including new biomarkers such as IL-18 and S100 proteins and recommending early initiation of IL-1 or IL-6 inhibition to avoid prolonged systemic glucocorticoid exposure. Methods: Cross-sectional, descriptive, and observational study utilizing a structured questionnaire to collect data from healthcare professionals involved in the diagnosis and treatment of SD in Portugal. Results: We obtained 52 responses from Portuguese clinicians. Only 10% use IL-18 levels and 25% use S100 proteins to aid in the diagnosis of SD. Half of the responders expect to achieve clinically inactive disease (CID) with low-dose glucocorticoids after 3 months, but only 39% aim to achieve CID without glucocorticoids at month 6. For 95% of responders the use of glucocorticoids is part of the first line of therapy. Less than half (37%) did not include IL-1 or IL-6 inhibitors in their first line of treatment. Conclusion: The results of the questionnaire applied show that there is still a gap between clinical practice and the recent recommendations, as demonstrated by the underuse of recent biomarkers and biologic therapies, which should be bridged in order to improve health outcomes for individuals affected by SD.