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Funding Information: The study had no funding. Reuma.pt is a database that has diverse funding entities, mentioned in the online site. Disclosure statement: The authors have declared no conflicts of interest Publisher Copyright: © 2022. Acta Reumatologica Portuguesa.All Rights Reserved. Introduction: Hand osteoarthritis (HOA) is a prevalent rheumatic disease that may cause significant disability. The Functional index for HOA (FIHOA) is a validated questionnaire to evaluate loss of function in patients with HOA. Objective: To undertake a cross-cultural adaptation and validation of FIHOA into Portuguese. Patients and methods: First, the original French version of FIHOA had been forward-backward translated into Portuguese, according to the guidelines for cross-cultural adaptation. Secondly, patients with primary HOA were consecutively recruited in three Portuguese rheumatology outpatient clinics between May 2016 and April 2018. The final consensual Portuguese version of FIHOA was administered to 52 patients. A numerical rating scale (NRS – 0 to 100mm) for hand pain and for perceived hand dysfunction was also registered. Ten randomly selected patients were re-administered the same tools 5 to 15 days later. Internal consistency, test-retest reliability, internal construct validity and external validity related to dysfunction NRS were evaluated. Results: Fifty-two patients were evaluated: all right-handed, 96% women, mean age of 63 (10) years and 8 (6) years of disease duration. Mean (SD) pain and dysfunction were 47 (25) and 46 (25), respectively, with 68% patients being symptomatic. Mean (SD) FIHOA was 7 (5). Cronbach’s alpha for internal consistency was high and adequate (0.87) and corrected item-total correlation revealed adequate performance. For reliability, Spearman’s rho coefficient was 0.88 and total intraclass correlation coefficient (ICC) between test and retest was 0.87, showing good reliability. Factor analysis revealed three factors accounting for 71% of the variance of the score, with the first one (including questions 1, 2, 3 and 10) being responsible for 47% of the variance. Spearman’s rho between FIHOA and dysfunction NRS was 0.5, showing a moderate but significant correlation and moderate external validity. Conclusion: The Portuguese version of FIHOA is a consistent, reliable, and valid instrument to measure loss of function in HOA Portuguese patients publishersversion published

Objective: To update the recommendations for the treatment of rheumatoid arthritis (RA) with biological therapies, endorsed by the Portuguese Society of Rheu -matology (SPR). Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on litera -ture evidence and consensus opinion. At a national meeting the 11 recommendations were discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the recommendations. Results: These recommendations cover general aspects as shared decision, prospective registry in Reuma.pt, asses sment of activity and RA impact and treatment objec tive. Consensus was also achieved regarding specific aspects as initiation of biologic therapy, assessment of res pon se, switching and definition of persistent remission. Conclusion: These recommendations may be used for guidance of treatment with biological therapies in patients with RA. As more evidence becomes available and more therapies are licensed, these recommendations will be updated. publishersversion published

Pain is the predominant symptom for people with inflammatory arthritis (IA) and osteoarthritis (OA) mandating the development of evidence-based recommendations for the health professional's approach to pain management. A multidisciplinary task force including professionals and patient representatives conducted a systematic literature review of systematic reviews to evaluate evidence regarding effects on pain of multiple treatment modalities. Overarching principles and recommendations regarding assessment and pain treatment were specified on the basis of reviewed evidence and expert opinion. From 2914 review studies initially identified, 186 met inclusion criteria. The task force emphasised the importance for the health professional to adopt a patient-centred framework within a biopsychosocial perspective, to have sufficient knowledge of IA and OA pathogenesis, and to be able to differentiate localised and generalised pain. Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; pain characteristics; previous and ongoing pain treatments; inflammation and joint damage; and psychological and other pain-related factors. Pain treatment options typically include education complemented by physical activity and exercise, orthotics, psychological and social interventions, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management. Effects on pain were most uniformly positive for physical activity and exercise interventions, and for psychological interventions. Effects on pain for educational interventions, orthotics, weight management and multidisciplinary treatment were shown for particular disease groups. Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA. ispartof: ANNALS OF THE RHEUMATIC DISEASES vol:77 issue:6 pages:797-807 ispartof: location:England status: published

Background: Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and the most commonly prescribed disease modifying antirheumatic drug. Moreover, it is also used as an adjuvant drug in patients under biologic therapies, enhancing the efficacy of biologic agents. Objectives: To review the literature and update the Portuguese recommendations for the use of MTX in rheumatic diseases first published in 2009. Methods: The first Portuguese guidelines for the use of MTX in rheumatic diseases were published in 2009 and were integrated in the multinational 3E Initiative (Evi - dence Expertise Exchange) project. The Portuguese rheumatologists based on literature evidence and consensus opinion formulated 13 recommendations. At a national meeting, the recommendations included in this document were further discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the updated recommendations. Results: Results presented in this article are mainly in accordance with previous guidelines, with some new information regarding hepatitis B infection during MTX treatment, pulmonary toxicity monitoring, hepatotoxi - city management, association with hematologic neoplasms, combination therapy and tuberculosis scree - ning during treatment. Conclusion: The present recommendations combine scientific evidence with expert opinion and attained desirable agreement among Portuguese rheumatologists. The regular update of these recommendations is essen - tial in order to keep them a valid and useful tool in daily practice. publishersversion published

The authors present the imaging study of a case of severe vertical atlanto-axial subluxation in a 60-year-old male with long-term rheumatoid arthritis with severe polyarticular involvement (Class IV of Steinbrocker functional classification).

To characterize systemic lupus erythematosus (SLE) in Portuguese patients and to identify differences in diseases expression related to sex and ethnicity.Retrospective cohort analysis of patients with SLE followed at five Rheumatology Departments between 1976 and 2006. Demographic data, diseases manifestations, medications used, co morbidity and damage scores were recorded.Five hundred forty four patients were studied, 93% female, 89% Caucasians, with an average age at disease diagnosis of 35 years. The most frequent clinical features were musculoskeletal (91%), cutaneous and mucous membrane (90%) and the hematological involvement (58%). Renal diseases and serositis occurred more often in males while myositis was more common in black patients. Immunological features included the presence of anti-nuclear antibodies in 99% of the patients, anti-DNA (76%) anti-SSA (33%), anti-SSB (20%), anti-RNP (26%), anti-Sm (22%), anticardiolipine (31%) and lupus anticoagulant (21%). Anti-SSA, anti-RNP, and anti-Sm antibodies were significantly more prevalent among black patients. The presence and severity of damage measured by SLICC/ACR was similar between sexes and ethnicities. In multivariate analyses diseases duration and the presence of hypertension showed a positive association, while educational and antimalarials were negatively associated with the presence of damage.In this cohort of Portuguese patients SLE present clinical features similar to those observed in other predominantly Caucasian populations, albeit a higher prevalence of anti-RNP and anti-Sm antibodies was observed. Some particular features were associated with male sex and African ethnicity. Some socio-demographic and clinical variables were associated with damage accrual.

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This chapter concerns the oxygen transfer provided by aerators in biological processes. First of all, the criteria that characterise oxygen transfer efficiency in biological treatment processes are presented: (i) in clean water in standard conditions and (ii) under process conditions. Principal methods utilised to measure oxygen transfer are then presented and illustrated. Finally, the main aeration systems installed in activated sludge processes are described, their performances are commentated and analysed. Optimisation parameters of these performances are specified and their prediction is examined. Injection of pure oxygen and oxygen transfer in biofilters are tackled at the end of the chapter., Ce chapitre est consacré au transfert de l`oxygène dans les procédés biologiques par l`intermédiaire d`aérateurs. Tout d`abord sont définis les critères pris en compte pour exprimer l`efficacité du transfert d`oxygène dans les procédés d`épuration biologique en eau claire dans les conditions standard d`une part, et en boues d`autre part, lorsque les installations sont en service. Les principales méthodes de mesures du transfert d`oxygène sont ensuite présentées et illustrées. Enfin, les principaux systèmes d`aération des boues activées (aérateurs de surface et systèmes d`insufflation d`air) sont décrits, leurs performances commentées et analysées. Les paramètres d`optimisation des performances sont précisés et la prévision des performances d`oxygénation est examinée. L`injection d`oxygène pur et le transfert d`oxygène en biofiltration sont abordés en fin de chapitre.

[Departement_IRSTEA]GMA [TR1_IRSTEA]21 - TECHNEAU / EPURE; The effect on oxygen transfer of two surfactant substances, characteristic from household detergents, was analyzed as a function of water depth in a pilot column and on 3 full scale treatment plants. Oxygen transfer is affected by the type and concentration of the surfactant and by the contact time of the air bubbles. The non-ionic surfactant (Polyethoxylated Lauric Alcohol - PLA) proved to have a negative effect on oxygen transfer, contrary to the anionic surfactant (Sodium Laurylsulfate - SLS). For a concentration of PLA of 1 mg.L-1, the alpha factor decreases as a function of water depth according to the equation : a = 0.945 H -0.349 [n = 9, r2 = 0.88, 1.5; L'effet de deux substances tensioactives issues de formulations lessivielles sur le transfert d'oxygène a été examiné à différentes hauteurs d'eau, en colonne pilote et sur sites réels. La nature, la concentration du tensioactif et le temps de passage des bulles influencent le transfert d'oxygène. Le tensioactif non ionique testé (Alcool Laurique Polyethoxylé - ALP) s'avère pénalisant vis à vis du transfert d'oxygène contrairement au tensioactif anionique (Lauryl Sulfate de Sodium - FAS). Pour l'ALP à une concentration de 1 mg/L, le facteur alpha décroît en fonction de la hauteur d'eau selon l'expression : a = 0,945 H -0,349 [n = 9, r2 = 0,880, 1,5

This paper outlines 4 methods for measuring oxygen transfer under process conditions. The off gas method, two non steady-state methods (absorption method and desorption method using hydrogen peroxide) and the steady-state method (measurement of in situ oxygen uptake rate) are compared, under perfectly controlled process conditions in a pilot column, and in an oxidation ditch equipped with fine bubble diffusers and a banana blade mixer. The off gas method and the non steady-state method using hydrogen peroxide give similar results: the differences of k(L)a(f) are less than 6%. On the contrary, the absorption method gives more random results (differences from k(L)a(f) measured by the off gas method are ranged between -5% to -20%). The steady-state method by measuring the in situ oxygen uptake rate results in an underestimation of the oxygen transfer coefficient k(L)a(f) of the order of 10 to 15%.; Cet article présente 4 méthodes pour mesurer le transfert d'oxygène sur station en fonctionnement. La méthode des bilans gazeux, deux méthodes non-stationnaires (réoxygénation et désorption après ajout de peroxyde d'hydrogène) et la méthode stationnaire (mesure in situ de la respiration) sont comparées, en pilote sous des conditions de fonctionnement strictement contrôlées, et dans un chenal d'aération équipé de diffuseurs fines bulles et d'un agitateur à pale banane. La méthode des bilans gazeux et la méthode non-stationnaire avec ajout de peroxyde donnent des résultats comparables : les différences de k(L)a(f) sont inférieures à 6%. A l'inverse, la réoxygénation donne des résultats plus aléatoires (les différences de k(L)a(f) mesurées par la méthode des bilans gazeux se situent entre -5% et -20%). La méthode stationnaire par la mesure de respiration conduit à une sous-estimation des coefficients de transfert d'oxygène k(L)a(f) de l'ordre de 10 à 15%.

This paper outlines 4 methods for measuring oxygen transfer under process conditions. The off gas method, two nonsteady-state methods (absorption method and desorption method using hydrogen peroxide) and the steady-state method (measurement of the in situ oxygen uptake rate) are compared, under perfectly controlled process conditions in a pilot column, and in an oxidation ditch equipped with fine bubble diffusers and a banana blade mixer. The off gas method and the nonsteady-state method using hydrogen peroxide give very similar results (differences between kLaf less than 5%). On the contrary, the absorption method gives more random results (differences from -5 to -43% in comparison to the value obtained with the off gas method) and the oxygen uptake rate measurement results in an underestimation of the oxygen transfer coefficient kLaf in the order of 10 to 15%.; 4 méthodes de mesure du transfert d'oxygène en boues activées sont présentées. La méthode des bilans gazeux, 2 méthodes non stationnaires (réoxygénation des boues et désorption au peroxyde d'hydrogène) et la mesure de respiration des boues en régime stationnaire ont été comparées, dans des conditions parfaitement contrôlées en colonne pilote et sur un chenal d'aération équipé de diffuseurs fines bulles. La méthode des bilans gazeux et la méthode au peroxyde d'hydrogène donnent des résultats très proches (différences inférieures à 5%). En revanche, la méthode de réoxygénation des boues donne des résultats plus aléatoires (écarts de -5 à -43% par rapport à la valeur obtenue par bilans gazeux) et la mesure de respiration conduit à une sous estimation du coefficient de transfert kLaf de l'ordre de 10 à 15%.

The objective of this work was to analyze, interpret and evaluate the influence of different design factors and operating conditions of activated sludge processes on oxygen transfer.First, two relationships have been developed using dimensional analysis and from 88 clean water tests performed in 31 full-scale plants, in relation with the major process parameters of fine-bubble diffused air systems (air flow rate, diffusers density, horizontal velocity, water depth).A further approach, from a theoretical and experimental analysis, has been carried out in order to optimize the interpretation of the results obtained by the developed relationships. An efficiency criterion of oxygen transfer, the transfer number (NT) has been defined which can take into account the impact of vertical liquid circulation movements on oxygen transfer. It can be stated that these vertical velocities of the liquid were essentially generated by the diffuser layout.The second objective was to better understand oxygen transfer in activated sludge processes under actual conditions, by acquiring and evaluating data on pilot plants and on sites, in clean water with surfactants (anionic and non ionic agents) at a concentration of 1 mg.L-1 equivalent to that measured in activated sludge process. Finally, the oxygen transfer coefficients under process conditions obtained by the off gas method, two nonsteady-state methods (absorption method and desorption method using hydrogen peroxide) and the steady-state method (measurement of the in situ oxygen uptake rate) were compared. A critical analysis on the limitations and the conditions of implementation of these methods has been performed.; L'objectif du travail présenté était d'étudier, d'interpréter et de modéliser l'influence sur le transfert d'oxygène de différents facteurs de conception et de conditions de fonctionnement des stations d'épuration à boues activées.Dans une première partie, à partir de 88 mesures de réoxygénation d'eau claire réalisées sur 31 stations et à l'aide de l'analyse dimensionnelle, deux relations permettant de prédire le transfert d'oxygène ont été développées en fonction des paramètres du système (débit d'air, densité de diffuseurs, hauteur d'eau, avec ou sans vitesse horizontale du liquide). Une approche complémentaire, théorique et expérimentale, a ensuite permis d'optimiser l'interprétation des résultats obtenus par ces relations, en définissant un nombre de transfert adimensionnel (NT). NT permet de rendre compte de l'effet sur le transfert d'oxygène des mouvements de circulation liquide, induits notamment par la disposition des diffuseurs.Le deuxième objectif a été de progresser dans la compréhension des phénomènes du transfert d'oxygène en conditions réelles de fonctionnement des stations d'épuration, par l'acquisition et l'interprétation de données sur pilotes et sur sites, en eau additionnée de tensioactifs (anionique et non ionique) à une concentration de 1 mg.L-1, concentration voisine de celle mesurée en sortie de stations.Enfin, en présence de boues activées, les coefficients de transfert d'oxygène déterminés par la méthode des bilans gazeux, par deux méthodes non stationnaires (réoxygénation et désorption au peroxyde d'hydrogène) et par la mesure de respiration des boues in situ ont été comparés. Une analyse critique sur les limites et les conditions d'application de chaque méthode présentée a été effectuée.

Applying a horizontal flow to clean water in a shallow annular oxidation ditch (water depth lower than 5 meters) equipped with fine bubble diffusers improves the oxygen transfer efficiency, the increase generally lying in the range 30% to 50%. Under process conditions, this increase is lower. The value of the alpha factor thus decreases when a horizontal velocity is applied to the liquid. On the site of Milly la Forêt (low loaded oxidation ditch), the alpha factor value is about 0.75 without mixing and about 0.62 for a horizontal velocity comprised between 0.17 and 0.45 m.s(-1).

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 des pite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regi -mens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, defined by a DAS28 lower than 3.2,without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of at least 0.6 in the DAS28 score. After 6 months of treatment res ponse criteria is defined as a decrease greater than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opi -nion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituxi mab or tocilizumab). publishersversion published