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Objective To describe the development of an Environmental contextual factors (EF) Item Set (EFIS) accompanying the disease specific Assessment of SpondyloArthritis international Society Health Index (ASAS HI). Method First, a candidate item pool was developed by linking items from existing questionnaires to 13 EF previously selected for the International Classification of Functioning, Disability and Health (ICF) /ASAS Core Set. Second, using data from two international surveys, which contained the EF item pool as well as the items from the ASAS HI, the number of EF items was reduced based on the correlation between the item and the ASAS HI sum score combined with expert opinion. Third, the final English EFIS was translated into 15 languages and cross-culturally validated. Results The initial item pool contained 53 EF addressing four ICF EF chapters: products and technology (e1), support and relationship (e3), attitudes (e4) and health services (e5). Based on 1754 responses of axial spondyloarthritis patients in an international survey, 44 of 53 initial items were removed based on low correlations to the ASAS HI or redundancy combined with expert opinion. Nine items of the initial item pool (range correlation 0.21–0.49) form the final EFIS. The EFIS was translated into 15 languages and field tested in 24 countries. Conclusions An EFIS is available complementing the ASAS HI and helps to interpret the ASAS HI results by gaining an understanding of the interaction between a health condition and contextual factors. The EFIS emphasizes the importance of support and relationships, as well as attitudes of the patient and health services in relation to self-reported health.

Objective: Biobanks for research (BBR) have enormous value for research, including those specifically oriented to chronic diseases. Knowing public attitudes and perceptions is key to design and implement patient-centered BBR. We assessed patient awareness, perception and choices among rheumatology outpatients regarding aging biobanking activities. Methods: We conducted a cross-sectional survey of patients, aged 50 or older, attending an outpatient rheumatology tertiary department. Demographic data and perceptions about biobanking were collected and statistical analysis was performed. Results: 132 valid questionnaires were obtained (mean age: 63,4; 68,2% female; mean education years: 8,35). 61,7% of respondents did not know the specific term “biobank”, 57,7% knew they could donate biological material for BBR, 89,9% agreed with these infrastructures and 88,3% would consider participation Those participants with more years of education were more knowledgeable and prone to biobank participation. Willingness to participate in BBR was mainly related (86,4%) to the advancement of scientific knowledge and not individual gain. Scientific research institutes were indicated as the most adequate institutions to manage BBR. Informed consent, anonymity and confidentiality ranked as top requisites for biobank participation. 61,3% of respondents expressed their agreement with aging biobanks, considering these as a sign of respect for specific problems of people of older ages such as higher disease burdens. Conclusion: Knowledge of biobanks was found to be limited. Participants were positive toward the setting up of biobanks in general and patient-centered aging biobanks in particular. Knowledge about biobanks and acceptance were higher among participants with higher education years.

Methotrexate (MTX) is an anti-folate drug with anti-proliferative and anti-inflammatory effects. MTX proved to be the most highly effective, fast-acting disease modifying anti-rheumatic drug (DMARD), being widely used for the treatment of rheumatoid arthritis (RA). This review aims to describe the main genetic variants identified concerning proteins that play a role in methotrexate's kinetics and efficiency profile.A literature review was conducted since January of 2000 until December 2020, by searching the PubMed and Embase bibliographic databases, employing the following MeSH terms: methotrexate, pharmacogenetics, pharmacokinetics, and rheumatoid arthritis. The search was limited to articles in English language. Two independent reviewers screened the titles and abstracts followed by a full-text review to assess papers regarding their eligibility. A total of 48 articles matched the research criteria and were analyzed.Reduced folate carrier 1 (RFC1), a constitutively expressed folate transport protein that has high affinity for MTX is responsible, almost exclusively, for the transport of folate and MTX into the cell. The most studied variant of the gene is the 80Ggt;A variant, mapped within exon 2, on chromosome 21. It seems to improve RA responses to MTX, clinical efficacy with long disease remission. ABC transporters are involved in the efflux of MTX from cells. An increased expression and function of these transporters should decrease MTX concentrations in target cells, resulting in lack of therapeutic response. ABCB1 3435 C/T is a high frequency polymorphism, significantly associated with RA good responses, symptom remission and reduced adverse events, due to MTX treatment. Thymidylate synthase (TYMS) is involved in thymidine synthesis. MTX decreases TYMS activity by inhibition and decreasing the access to tetrahydrofolate (THF) cofactors. The most common genetic variant of the TYMS gene consists of a 28 bp tandem repeat, with double and triple number of repeats (2R and 3R). The 3R allele genotype was associated with decreased efficacy and increased toxicity. The 5,10-methylenetetrahydrofolate reductase (MTHFR) enzyme is indirectly inhibited by MTX. The most common SNPs of the MTHFR gene are C677T and A1298C. Both are associated with a decreased efficacy and an increased toxicity of MTX.MTX response is affected by many gene variants; the effect of each variant separately is likely to be small. Additionally, gene-gene interaction seems to enhance the potential role of linkage disequilibrium. This shows the emerging need for a better gene characterization and to improve the knowledge about variants distribution according to ethnicity, to explain different responses to MTX at an individual level.

© International League of Associations for Rheumatology (ILAR) 2020., This paper is to assess the efficacy of different biologic DMARDs (bDMARDs) on several patient-reported outcomes (PROs) in randomized controlled trials (RCT) in axial spondyloarthritis (axSpA). A systematic literature review (SLR) was performed. MEDLINE (May 1, 2018) was used with the filters "published in the last 10 years" and "humans." The PICO criteria used were Patients: adults with radiographic axSpA (r-axSpA) or non-radiographic axSpA (nr-axSpA); Intervention: any bDMARD; Compararator: placebo (PBO)/any different drug; Outcome: the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Ankylosing Spondylitis Quality of Life (ASQoL), the EuroQol-5D (EQ-5D), the Short Form 36 Health Survey physical component summary (SF36-PCS), the Short Form 36 Health Survey mental component summary (SF36-MCS), and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). After screening 84 initial references and manually selecting other 9, 24 publications, assessing TNF inhibitors (TNFi) or IL17A inhibitors (IL17Ai) were selected. Four RCTs quantified the minimal clinical important difference (MCID) between treatment arms. Most of the RCTs compared the mean difference of PROs between different timepoints. Overall, the treatment arm was superior to the comparator. PROs were often underreported or highly heterogeneously presented. MCID was seldom mentioned. There is a need to raise the standard of care on SpA by aiming at remission and PRO associated improvements. In order to achieve this goal, the target must be clearly defined, reported, and tested.

Funding Information: We thank Cláudia Andrade for technical support and Juliana Gonçalves for testing samples for SARS-CoV-2 exposure. We are extremely grateful to all the participants of the study and to the whole rheumatology department at Hospital Egas Moniz that made this study possible. This work was supported by Fundação para a Ciência e Tecnologia (FCT) PTDC/MEC-REU/29520/2017, by iNOVA4Health UID/Multi/04462 and by Portuguese Society for Rheumatology (SPR) grants to H.S. H.S. is supported by FCT through IF/01722/2013 and CEECIND/01049/2020, DAS and RCT were supported by FCT through PD/BD/137409/2018 and UID/Multi/04462, respectively. Publisher Copyright: © 2021, The Author(s). CD4+ T cells mediate rheumatoid arthritis (RA) pathogenesis through both antibody-dependent and independent mechanisms. It remains unclear how synovial microenvironment impinges on CD4+ T cells pathogenic functions. Here, we identified a TLR4+ follicular helper T (Tfh) cell-like population present in the blood and expanded in synovial fluid. TLR4+ T cells possess a two-pronged pathogenic activity whereby direct TLR4+ engagement by endogenous ligands in the arthritic joint reprograms them from an IL-21 response, known to sponsor antibody production towards an IL-17 inflammatory program recognized to fuel tissue damage. Ex vivo, synovial fluid TLR4+ T cells produced IL-17, but not IL-21. Blocking TLR4 signaling with a specific inhibitor impaired IL-17 production in response to synovial fluid recognition. Mechanistically, we unveiled that T-cell HLA-DR regulates their TLR4 expression. TLR4+ T cells appear to uniquely reconcile an ability to promote systemic antibody production with a local synovial driven tissue damage program. publishersversion published

CD4+ T cells mediate rheumatoid arthritis (RA) pathogenesis through both antibody-dependent and independent mechanisms. It remains unclear how synovial microenvironment impinges on CD4+ T cells pathogenic functions. Here, we identified a TLR4+ follicular helper T (Tfh) cell-like population present in the blood and expanded in synovial fluid. Mechanistically, we unveiled that homotypic T-T cell interactions through non-cognate HLA-DR:TCR contacts regulate TLR4 expression on T cells. TLR4+ T cells possess a two-pronged pathogenic activity. Upon TCR and ICOS engagement, TLR4+ T cells produce IL-21, a cytokine known to sponsor antibody production. However, direct TLR4+ engagement on T cells, by endogenous ligands in the arthritic joint, reprograms them towards an IL-17 inflammatory profile compatible with tissue damage program. Blocking TLR4 signaling with a specific inhibitor impaired IL-17 production in response to synovial fluid recognition. Ex vivo, synovial fluid TLR4+ T cells produced IL-17, but not IL-21. TLR4+ T cells appear to uniquely reconcile an ability to promote systemic antibody production with a local synovial driven tissue damage program. TLR4+ T cells could constitute an attractive cellular target and predictive biomarker for erosive arthritis.

ObjectivesTo characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world.MethodsCross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated.ResultsA total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%).ConclusionThese results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.

© The Author(s). 2020 Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visithttp://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data., Background: To investigate whether the reason to discontinue the first TNF inhibitor (TNFi) affects the response to the second TNFi in axial spondyloarthritis (axSpA). Methods: Patients with axSpA from the Rheumatic Diseases Portuguese Register (ReumaPt), who discontinued their first TNFi and started the second TNFi between June 2008 and May 2018, were included. Response was assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS) clinically important improvement (ASDAS-CII), major important improvement (ASDAS-MI), low disease activity (ASDAS-LDA), and inactive disease (ASDAS-ID). The reason for discontinuation of the first TNFi was defined, according to ASDAS-CII as primary failure (no response ≤ 6 months), secondary failure (response ≤ 6 months but lost thereafter), adverse events, and others. The association between the reason for discontinuation of the first TNFi and response to the second TNFi over time was assessed in multivariable generalized equation (GEE) models. Results: In total, 193 patients were included. The reason for discontinuation of the first TNFi did not influence the response to the second TNFi, according to the ASDAS-CII. However, a difference was found with more stringent outcomes, e.g., there was a higher likelihood to achieve ASDAS-ID with the second TNFi for patients discontinuing the first TNFi due to secondary failure (OR 7.3 [95%CI 1.9; 27.7]), adverse events (OR 9.1 [2.5; 33.3]), or other reasons (OR 7.7 [1.6; 37.9]) compared to primary failure. Conclusion: Patients with axSpA with secondary failure to their first TNFi, compared to those with primary failure, have a better response to the second TNFi according to stringent outcomes., This work was supported by a research grant from Merck Sharp & Dohme Corp., a division of Merck & Co., Inc., Kenilworth, NJ, USA [IIS# 57763]. AS is supported by a doctoral grant from “Fundação para a Ciência e Tecnologia”(SFRH/BD/108246/2015)

Congenital disorders of glycosylation (CDG) are rare diseases with variable phenotypes and severity. Immunological involvement remains a largely uncharted topic in CDG, mainly due to lack of robust data. To better characterize immune-related manifestations&rsquo, prevalence, relevance, and quality-of-life (QoL) impact, we developed electronic questionnaires targeting (1) CDG patients and (2) the general &ldquo, healthy&rdquo, population. Two-hundred and nine CDG patients/caregivers and 349 healthy participants were included in this study. PMM2-CDG was the most represented CDG (n = 122/209). About half of these participants (n = 65/122) described relevant infections with a noteworthy prevalence of those affecting the gastrointestinal tract (GI) (63.1%, n = 41/65). Infection burden and QoL impact were shown as infections correlated with more severe clinical phenotypes and with a set of relevant non-immune PMM2-CDG signs. Autoimmune diseases had only a marginal presence in PMM2-CDG (2.5%, n = 3/122), all being GI-related. Allergy prevalence was also low in PMM2-CDG (33%, n = 41/122) except for food allergies (26.8%, n = 11/41, of PMM2-CDG and 10.8%, n = 17/158, of controls). High vaccination compliance with greater perceived ineffectiveness (28.3%, n = 17/60) and more severe adverse reactions were described in PMM2-CDG. This people-centric approach not only confirmed literature findings, but created new insights into immunological involvement in CDG, namely by highlighting the possible link between the immune and GI systems in PMM2-CDG. Finally, our results emphasized the importance of patient/caregiver knowledge and raised several red flags about immunological management.

© author(s) (or their employer(s)) 2020. Re-use permitted under CC BY- nC. no commercial re-use. see rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-­NC 4.0) license., Objectives: To assess the efficacy of golimumab in combination with methotrexate (MTX) versus MTX monotherapy in psoriatic arthritis (PsA) dactylitis. Methods: Multicentre, investigator-initiated, randomised, double-blind, placebo-controlled, parallel-design phase 3b trial in 11 Portuguese rheumatology centres. Patients with PsA along with active dactylitis and naive to MTX and biologic disease-modifying antirheumatic drugs (bDMARDs) were randomly assigned to golimumab or placebo, both in combination with MTX. The primary endpoint was Dactylitis Severity Score (DSS) change from baseline to week 24. Key secondary endpoints included DSS and Leeds Dactylitis Index (LDI) response, and changes from baseline in the LDI and MRI dactylitis score. Analysis was by intention-to-treat for the primary endpoint. Results: Twenty-one patients received golimumab plus MTX and 23 MTX monotherapy for 24 weeks. One patient from each arm discontinued. Patient inclusion was halted at 50% planned recruitment due to a favourable interim analysis. Median baseline DSS was 6 in both arms. By week 24, patients treated with golimumab plus MTX exhibited significantly greater improvements in DSS relative to MTX monotherapy (median change of 5 vs 2 points, respectively; p=0.026). In the golimumab plus MTX arm, significantly higher proportions of patients achieved at least 50% or 70% improvement in DSS and 20%, 50% or 70% improvement in LDI in comparison to MTX monotherapy. Conclusions: The combination of golimumab and MTX as first-line bDMARD therapy is superior to MTX monotherapy for the treatment of PsA dactylitis.

Background Thrombocytopenia is a frequent hematological manifestation in patients with systemic lupus erythematosus (SLE), usually treated with glucocorticoids, immunosuppressants (such as azathioprine and cyclophosphamide), intravenous immunoglobulin (IVIG) or splenectomy. Case report A 44-year-old woman diagnosed with SLE and secondary antiphospholipid antibody syndrome was admitted in our hospital, in July 2018, presenting severe renal and haematological involvement. She underwent treatment with methylprednisolone, followed by prednisolone, and mycophenolate mofetil, with no response. In August 2018, the patient started haemodialysis, human immunoglobulin (transient response) and plasmapheresis due to evidence of secondary thrombotic microangiopathy. The refractory severe thrombocytopaenia and lupus nephritis, justify two cycles of rituximab - platelet count rising lasted for five months. Seven months later, the patient presented pancytopenia and due to high hemorrhagic risk, there was a switch from warfarin to LMWH (prophylactic dosing). One month later, anti-coagulation was suspended due to spontaneous intracranial bleeding. In August 2019, the patient had an ischemic stroke of the right occipital lobe, secondary to APS, under prednisolone and hydroxychloroquine, and with platelet count of 24.000/uL. Because of the bleeding risk, no anti-aggregation was instituted, and she started tacrolimus - the initial good response disappeared two weeks later. After consulting a rheumatology board, tacrolimus was kept and rituximab repeated, regardless of the hypogammaglobulinemia and no lymphocytes CD19+ count. Conclusion We experienced a severe case of secondary thrombocytopenia, that was refractory to multiple therapeutic agents. A reasonable response was obtained under rituximab. Tacrolimus is kept due to the reported cases of late effect. Ischaemic stroke is a challenging condition in patients thrombocytopenic and further clinical guidance is warranted.

Aging often results in the appearance of sarcopenia, which is characterized by loss of muscle mass and strength. The incidence of sarcopenia in the elderly is a quite common and leads to weakness and disability, as well as a lower quality of life, also assuming a high social and economic impact. One previous study has shown an independent negative association between arterial stiffness and skeletal muscle mass decline [1], which suggest its relationship with sarcopenia. This work aims to evaluate the relation between sarcopenia and the arterial stiffness, in Portuguese elderly population A cohort of 38 elderly volunteers between 67 and 95 years, with and without Sarcopenia, were selected from nursing homes and day centers of Portuguese charity institution - Santa Casa da Misericórdia de Almada. All volunteers have the same living condition, meals and lifestyle routine, excepting the medications. The diagnosis and degree (severe or moderate) of sarcopenia were performed according to the European consensus on definition and diagnosis of sarcopenia [2] at the same day with arterial stiffnesses measurements assessed by carotid-femoral Pulse Wave Velocity (cfPWV). Our data show a positive correlation for cfPWV with the sarcopenia severity degree, which represents an increasing in arterial stiffness and might be explained by the fact that the loss of muscle mass is often associated with chronic inflammation [3]. Despite of the small cohort size, the male gender held a bigger mean value of cfPWV, with significant p-value (0.014), in comparison to the female gender, which estimates a higher CV risk for the male elders of the region of Almada and Greater Lisbon compared to the female gender. Further investigations would be desirable in order to obtain larger samples and ascertain the estimates for the respective groups.

SAICT-POL/23439/2016| LISBOA-01-0145-FEDER-023439). This Grant covers all the planned activities for this study including, the design of the study, data collection, data analysis and interpretation and the writing of this manuscript.The funder did not play any role in the study design, data collection and analysis, decision to publish, or preparation of this manuscript Background Non-specific low back pain (NSLBP) is the most prevalent musculoskeletal condition in western countries and is associated with persistent disability and high consumption of health care resources. NSLBP patients first seek primary health care services but the outcomes are often uncertain. This study aimed to examine the clinical course of the outcomes and to identify prognostic indicators for poor outcomes in NSLBP patients who consulted primary care. Methods A prospective cohort study of 115 patients seeking treatment for NSLBP in primary care was conducted. Participants were consecutively recruited by their General Practitioners (GPs) and then assessed at baseline and 2 and 6 months later. Baseline assessment included socio-demographic and clinical data, psychosocial factors, pain, disability, and health related quality of life (HRQoL). Pain, disability, HRQoL and global perception of change were also assessed at 2 and 6-months’ follow-up. In addition, information regarding the GP’ practice was collected. Poor outcomes were determined according to the cut-off point used to define a persistent disabling condition and the minimal important change established for disability, pain and for global perception of change. The relationship between variables on baseline and poor outcomes was modulated through binary logistic regression analysis. The significance of associations was evaluated at ≤ 0.05 p-value with 95% confidence intervals (CI) and adjusted odds ratios (AOR). Results 110 (94.8%) and 104 (89.7%) participants completed the follow-up assessment at 2 and 6 months, respectively. The mean age (±SD) was 48.06 ± 11.41, with 53.9%, (N = 62) reporting an acute presentation of NSLBP. Six months after GP consultation, 53.8% (N = 56) of the participants reported a persistent disabling condition. An “LBP episode of less than 12 weeks” [AOR: 0.26; 95% CI (0.10, 0.65); AOR: 0.34; 95% CI (0.14, 0.81); AOR: 0.21; 95% CI (0.09, 0.53)],”maladaptive psychosocial factors” [AOR: 2.06; 95% CI (1.40, 3.04); AOR: 1.82; 95% CI (1.27, 2.59); AOR: 1.72; 95% CI (1.20, 2.47)] were significantly associated with poor outcomes on disability, pain and global perception of change, respectively. Besides these factors, being employed reduces the chances of poor outcomes on disability [AOR 0.31; 95% CI (0.11, 0.92)]. Conclusions A large proportion of LBP patients seeking primary health care reported poor outcomes 6 months after GP consultation. Patients who report chronic LBP, maladaptive psychosocial factors and are unemployed have a significant increase in the risk of poor outcome. These findings suggest the need of implementing effective models of care able to provide early screening and appropriate treatment to those at greatest risk of a poor outcome. publishersversion published

Maintaining a stable upright position and body orientation are fundamental tasks to perform everyday activities and ensure the quality of life. The ability to maintain these can be damaged by various pathologies/disfunctions, such as stroke and aging. Therefore, it is important to quantify how the postural control reacts to different situation and how is affected by different pathologies, which could bring a big contribution in a clinical context, by helping to diagnose pathologies that can bring postural impairments. An experimental protocol was developed that combines both electromyography and posturography. To help validate this protocol, 53 patients (43 healthy and 10 stroke patients) performed it twice within a two-week period. By comparing the results from the two runs, it was possible to assess that these were not statistical different, and thus prove that the protocol is viable tool to build a normative database.

Osteoarthritis (OA) is the most prevalent rheumatic disease and is a leading cause of decreased quality of life (QoL). The OA Quality of Life questionnaire (OAQoL) is an OA-specific patient-reported outcome measures. The aim of this study was to translate and validate the original UK English version of the Osteoarthritis Quality of Life (OAQoL) questionnaire into European Portuguese. The translation of the questionnaire was carried out according to a dual panel methodology (bilingual panel followed by lay panel). This was followed by cognitive debriefing interviews (CDIs) with OA patients to assess comprehension and relevance of the translated questionnaire. Finally, a validation survey was conducted to assess its psychometric properties. The Portuguese OAQoL, a comparator scale (the Nottingham Health Profile-NHP) as well as questions relating to demographic and disease information were administered to OA patients. A sub-sample of patients also completed the Portuguese OAQoL two weeks later, to assess test-retest reliability. The internal consistency, construct validity and known group validity (according to perceived OA severity) of the scale was also assessed. Both the bilingual and lay panels consisted of five individuals and no major difficulties relating to the translation process were identified. A total of ten patients with OA participated in the CDIs. The mean time to complete the questionnaire was 5 min. These interviews revealed that the Portuguese version of the OAQoL was clear, relevant and easy to complete. Finally, 53 OA patients (44 females; mean age of 67.6 years) completed the validation survey. Cronbach's alpha coefficient was 0.87, demonstrating high internal consistency. Test-retest reliability, assessed by Spearman's rank correlation coefficient, was 0.86. Moderate correlations were found with the majority of the NHP sections, providing evidence of construct validity. Significant differences in OAQoL scores were found between patients who differed according to their perceived OA severity, providing evidence of known group validity. The Portuguese version of the OAQoL is a valid and reliable questionnaire that can be used to assess QoL in OA, both in clinical practice and for research purposes.

Objectives: Fibromyalgia (FM), a chronic pain condition, is associated with abnormalities in pain modulation. A growing body of evidence has shown that social distress modulates pain sensitivity. The current study aimed to assess the effects of social distress manipulation on pain in FM patients compared with positive (rheumatoid arthritis, RA) and negative (pain-free) controls. Materials and Methods: FM, RA patients and pain-free controls (PFC) were recruited. Demographic, medical, and psychological data were collected. Each participant was exposed to 3 study conditions in a random order: the inclusion (positive social effects) and exclusion (negative social effects) conditions of Cyberball, a game that manipulates social distress, and a control condition. Pain sensitivity in response to nociceptive electrical and thermal (cold) stimuli was assessed before and during each study condition. Results: In response to electrical stimuli, pain decreased in both the inclusion and exclusion conditions in PFC and RA groups, whereas inclusion conditions significantly increased pain in the FM group. Social manipulation (inclusion or exclusion) did not affect pain sensitivity as measured in response to thermal stimulation. Discussion: These results are in line with previous studies demonstrating altered pain inhibition in FM patients, and suggest that unlike PFC or other non-"stress-related" chronic pain conditions, being socially included may increase pain perception in FM patients. Possible underlying mechanisms and clinical relevance are discussed.

Background: In 2010 the latest ASAS-EULAR recommendations for ankylosing spondylitis and the ASAS recommendations for the use of TNF-inhibitors (TNFi) have been published. Since then new treatments for axial Spondyloarthritis (axSpA) have become available. Aim: To update and integrate the two sets[for full text, please go to the a.m. URL], 44. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh); 30. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh); 26. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)

Introduction Les patients avec un diagnostic clinique de spondyloarthrite (SpA) (en incluant le rhumatisme psoriasique – Rhpso) peuvent avoir des symptomes principalement peripheriques ou principalement axiaux. Cependant, des chevauchements entre ces symptomes sont frequents et ils n’existent pas de sous-groupes clairement definis. L’objectif de cette etude a ete d’identifier des groupes des manifestations musculosquelettiques peripheriques selon leur localisation anatomique dans le spectre des SpA (en incluant le Rhpso). Patients et methodes Etude transversale et internationale avec 24 pays participants. Des patients consecutifs avec un diagnostic de SpA axiale (axSpA), SpA peripherique (pSpA), rhumatisme psoriasique (Rhpso), SpA associe a maladie inflammatoire de l’intestin (SpA-MICI), arthrite reactive (ReA) et SpA juvenile ont ete eligibles. Une analyse de cluster pour chaque manifestation peripherique musculosquelettique (affection articulaire peripherique, enthesite et dactylite) a ete realisee en utilisant des donnees sur la localisation anatomique de ces symptomes observes a n’importe quel moment de la maladie. La distribution de ces manifestations peripheriques et les caracteristiques cliniques ont ete comparees entre les differents clusters. Resultats Un total de 4465 patients ont ete inclus. Trois clusters ont ete trouves selon la localisation de l’affection articulaire, nommes « arthrite rare (a) », « principalement membres inferieurs (b) » et « principalement mains (c) ». Les patients du groupe « a » avaient, en comparaison avec les groupes « b » et « c », une prevalence plus importante d’hommes (63,9 % vs 51,3 % vs 41,5 %), de HLA-B27 (79,8 % vs 48,2 % vs 34,8 %) et de diagnostic de axSpA (67,2 % vs 20,9 % vs 23,7 %), mais une prevalence plus basse de psoriasis (23,2 % vs 67,8 % vs 59,6 %) et de diagnostic de Rhpso (17,2 % vs 61,7 % vs 58,5 %). Entre les clusters « b » et « c », l’uveite etait plus frequente chez le premier (15,7 % vs 8,7 %), tandis que la maladie inflammatoire de l’intestin etait plus frequente chez le deuxieme (3,5 % vs 6,7 %). Concernant la localisation de l’enthesite, nous avons trouve aussi 3 clusters, nommes « enthesite du talon (d) », « enthesite axiale (e) » et « polyenthesite (f) ». Les patients du cluster « f » avaient une frequence plus eleve de fibromyalgie concomitante (41,3 % vs 17,4 % vs 31,3 %), de psoriasis (48,3 % vs 28,4 % vs 23,4 %) et de Rhpso (40,8 % vs 22,7 % vs 21,5 %) en comparaison avec les groupes « d » et « e », mais une prevalence moindre d’hommes (40 % vs 61,9 % vs 56,2 %) et de diagnostic d’axSpA (37,5 % vs 61,4 % vs 64,1 %). Finalement, nous avons trouve 3 clusters selon la localisation des dactylites : « absence de dactylite (g) », « principalement orteils (h) » et « principalement doigts (i) ». Le groupe « g » a montre, en comparaison avec les groupes « h » et « i », la plus grande prevalence d’hommes (61,4 % vs 51,4 % vs 52,9 %), de HLA-B27 (66,6 % vs 52,5 % vs 50,0 %) et de diagnostic d’axSpA (62,6 % vs 20 % vs 11,8 %), mais la plus basse frequence de psoriasis (26,9 % vs 68,6 % vs 79,4 %) et de diagnostic de Rhpso (21,5 % vs 65,7 % vs 52,9 %). Conclusion Cette etude suggere la presence de groupes heterogenes d’affection peripherique chez des patients atteints de SpA (et Rhpso) sans groupes clairement definis, ce qui confirme un clair chevauchement entre les differents sous-types de SpA.

Objective: The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain (CNP). Design: Randomized controlled trial. Setting: Outpatient care units. Subjects: Sixty-four non-specific CNP patients were randomly allocated to MET ( n = 32) or UC ( n = 32) groups. Interventions: Participants in the MET group received 12 sessions of mobilization and exercise, whereas the UC group received 15 sessions of usual care in physiotherapy. Main measures: The primary outcome was disability (Neck Disability Index). The secondary outcomes were pain intensity (Numeric Pain Rating Scale) and global perceived recovery (Patient Global Impression Change). Patients were assessed at baseline, three weeks, six weeks (end of treatment) and at a three-month follow-up. Results: Fifty-eight participants completed the study. No significant between-group difference was observed on disability and pain intensity at baseline. A significant between-group difference was observed on disability at three-week, six-week and three-month follow-up (median (P25–P75): 6 (3.25–9.81) vs. 15.5 (11.28–20.75); P < 0.001), favouring the MET group. Regarding pain intensity, a significant between-group difference was observed at six-week and three-month follow-up (median (P25–P75): 2 (1–2.51) vs. 5 (3.33–6); P < 0.001), with superiority of effect in MET group. Concerning the global perceived recovery, a significant between-group difference was observed only at the three-month follow-up ( P = 0.001), favouring the MET group. Conclusion: This study’s findings suggest that a combination of manual therapy and exercise is more effective than usual care on disability, pain intensity and global perceived recovery.

Objective To evaluate whether use of comedication with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA). Methods Patients with SpA from the Rheumatic Diseases Portuguese Register who started treatment with their first TNFi between 2001 and 2014 were included in this study. Cox regression analysis was used to estimate the effect of comedication with csDMARDs on TNFi retention in 2 types of models: a model in which baseline (time-fixed) variables were included, and a second model incorporating time-varying variables, including sociodemographic features, measures of disease activity, measures of physical function, and cotreatment with other drugs (nonsteroidal antiinflammatory drugs and oral steroids). To control for possible confounding by indication, the effect of csDMARD comedication on TNFi retention was also tested after adjustment for the treatment propensity score. Results In total, 954 patients were included in the study, of whom 289 (30.3%) discontinued treatment with their first TNFi after a median follow-up time of 2.5 years (range 0.08–13 years). Inefficacy was the most common reason for TNFi discontinuation (55.7% of patients). In the multivariable analyses, comedication with csDMARDs had no measurable effect on TNFi retention, neither in the baseline model (hazard ratio [HR] 0.83, 95% confidence interval [95% CI] 0.59–1.16) nor during follow-up in the model adjusted for time-varying covariates (HR 1.07, 95% CI 0.68–1.68). The effect of csDMARD comedication remained nonsignificant after propensity score adjustment. Conclusion Comedication with csDMARDs does not prolong TNFi retention in patients with SpA in clinical practice, suggesting that there is no benefit conferred by the concomitant use of these drugs.

Introduction La distribution des manifestations peripheriques musculosquelettiques chez tous les sous-types de spondyloarthrite (SpA) et leurs caracteristiques ont ete peu etudiees. De plus, tres peu d’etudes ont evalue la distribution des manifestations peripheriques selon la region geographique. L’objectif de cette etude a ete de comparer la prevalence, les caracteristiques et les traitements des manifestations musculosquelettiques peripheriques chez les patients atteints de tous sous-types possibles de SpA ainsi que leur distribution selon la region geographique. Patients et methodes Etude transversale avec 24 pays participants. Des patients consecutifs avec un diagnostic de SpA axiale (axSpA), SpA peripherique (pSpA), rhumatisme psoriasique (Rhpso), SpA associe a maladie inflammatoire de l’intestin (SpA-MICI), arthrite reactive (ReA) et SpA juvenile etaient eligibles pour l’etude. La prevalence des manifestations peripheriques (affection articulaire peripherique, enthesite, dactylite, tarsite et affection des articulations racines) leur localisation et leur traitement ont ete evalues, ainsi que leur distribution dans les differentes regions du monde. Resultats Un total de 4465 patients (61 % hommes, âge moyenne 45 ans) ont ete inclus appartenant a quatre regions : Amerique Latine (n = 538), Europe et Amerique du Nord (n = 1677), Asie (n = 975), Moyen-Orient et Afrique du Nord (n = 1275). La prevalence des diagnostics etait axSpA (60,9 %), Rhpso (23,1 %), pSpA (9,7 %), SpA-MICI (2,5 %), ReA (1,3 %), et Juv-SpA (1,3 %). Parmi la totalite des patients, 78,3 % avaient eu au moins une manifestation peripherique ; 56,9 % au moins une affection articulaire peripherique, 44,3 % une enthesite, 33,7 % une affection des articulations racines, 15,3 % une dactylite et 7,7 % une tarsite. Les patients d’Amerique Latine avaient la prevalence la plus haute d’affection articulaire peripherique (79,9 %), d’enthesite (68,8 %), de dactylite (25,5 %) et de tarsite (23,6 %), tandis que la prevalence d’affection des articulations des racines des membres etait plus elevee chez les patients d’Asie (57,4 %). L’affection articulaire peripherique etait plus frequente chez les patients avec pSpA (94,7 %) et moins souvent chez les patients avec axSpA (36,0 %). Les patients atteints de Rhpso avaient plus souvent une atteinte polyarticulaire (58,9 %) tandis que les axSpA avaient une atteinte surtout mono-articulaire (20,1 %). L’atteinte des petites articulations des membres superieurs etait plus souvent observee chez les patients avec Rhpso (52,0 %) tandis que l’atteinte des grosses articulations des membres inferieurs etait plus souvent chez les MICI-SpA (55,9 %) et pSpA (51,2 %). Parmi les patients avec atteinte des articulations proximales, la hanche etait surtout observee dans les axSpA (86 %) tandis que l’epaule etait plus frequente au cours du Rhpso (60,9 %). Les patients atteints de axSpA avaient la prevalence la plus basse d’enthesite (40,9 %) et de dactylite (6,0 %) ; cependant, les dactylites etaient plus souvent localises aux pieds au cours de la axSpA et aux mains au cours des ReA et SpA-MICI. Conclusion Cette etude suggere que toutes ces manifestations musculosquelettiques peripheriques peuvent etre trouvees dans tous les sous-types de SpA (en incluant le Rhpso), avec seulement des differences quantitatives. Ces resultats confirment le chevauchement entre les differentes entites et suggerent que la probabilite de trouver ces manifestations depend de la maladie sous-jacente. En plus, ces resultats confirment la grande variabilite dans l’expression de la maladie entre pays.

Background Psychological disturbances, frequently observed in inflammatory rheumatic diseases, seem to negatively influence patient’s clinical status and treatment response. Objectives The aim of this study was to examine the longitudinal impact of depression (D)/anxiety (A) in treatment response, disease activity, physical disability and quality of life in patients with Ankylosing Spondylitis (AS). Methods Data from patients who fulfilled the modified New York criteria for AS were collected at baseline, weeks 2 and 14 post-treatment with Adalimumab. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate D/A symptoms severity. The primary outcomes were AS disease activity score – C reactive protein (ASDAS-CRP), Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI) and AS Quality of Life (ASQoL) Scale. Secondary outcomes were patient and physician global assessment by Visual Analogue Scale (VAS), erythrocyte sedimentation rate (ESR), CRP and BASDAI question 1 (fatigue). Difference-in-differences estimation took into account the covariates gender, age at baseline and disease duration. Results Data from 54 patients were included. At baseline, D/A symptoms significantly influenced the mean value of BASFI (p=0.006; p=0.003) and ASQoL (p Conclusions Psychological status does not seem to affect response to treatment with Adalimumab, even if the overall characteristics of the population are different at baseline between patients with/without D/A symptoms. Disclosure of Interest None declared

Background The ASAS-EULAR recommendations for the continuation of biological Disease-Modifying Anti-rheumatic Drugs (DMARD) suggest the evaluation of patients after at least 12 weeks of treatment by either the Ankylosing Spondylitis (AS) Disease Activity Score – C reactive protein (ASDAS-CRP) or by the Bath AS Disease Activity Index (BASDAI). For ASDAS-CRP, a Minimal Clinical Important Difference (MCID) ≥1.1 is necessary, while for the total BASDAI score a 50% reduction or a change of ≥2.0 points is considered clinically relevant. In clinical trials, the Assessment in Ankylosing Spondyloarthritis (ASAS) response criteria – ASAS 20, ASAS 40 and ASAS 70 – are still the most frequent primary outcome measures to evaluate improvement in treatment response. However, in clinical practice the BASDAI is still routinely used. Objectives The aim of this work was to assess the concordance/agreement between different therapeutic outcome measures, such as the ASAS response criteria, ΔASDAS-CRP and BASDAI 50. Methods Data from 54 patients who fulfilled the modified New York criteria for AS were collected at baseline, weeks 2 and 14 post-treatment with Adalimumab. Pearson’s correlation (PCCs) and the Cohen’s Kappa coefficients were calculated for the three scores. Results A strong correlation was found between the three scores throughout the visits: rho=−0.676 for ASDAS/ASAS, rho=−0.807 for ASAS/BASDAI, and rho=0.786 for BASDAI/ASDAS (all PCCs with p The individuals categorised as responders, by eitheir BASDAI50 or ΔASDAS ≥1.1, have shown similar clinical characteristics (Erythrocyte Sedimentation Rate, CRP, AS Quality of Life Scale and Bath AS Functional Index). Importantly, when more stringent measures of ASAS response criteria and ASDAS were used (i.e. ASAS 70 and ASDAS≥2.1) the agreement with BASDAI values decreased. Conclusions Our results suggest that the ASAS response criteria, ΔASDAS-CRP and BASDAI 50 report the same clinical information. Hence, the clinician’s decision should still be consistent independently of the score adopted. However, this study also highlights the importance of establishing a new and more stringent BASDAI cut-off, in alignment with ASDAS-CRP’≥2.1 and ASAS 70. Disclosure of Interest None declared

Background A BASDAI ≥4 has been often required to start TNFi therapy in patients with axSpA. However, this cut-off of high disease activity (HDA) is largely arbitrary. Unlike BASDAI, ASDAS incorporates objective measures (e.g. CRP) and has a validated definition of HDA (≥2.1). It has thus been suggested that ASDAS could also be used to guide treatment decisions, but evidence to support this is still scarce. Objectives To compare the impact of applying the ASDAS and BASDAI definitions of HDA in selecting patients for TNFi-treatment in daily clinical practice Methods Patients from Reuma.pt (Rheumatic Diseases Portuguese Register), with diagnosis of axSpA according to their rheumatologists (both treated and not treated with their first TNFi), with complete baseline BASDAI and ASDAS data, and complete 6 month of follow-up (i.e. baseline, 3 and 6 months visits available) were included. Four subgroups [cross-tabulation between ASDAS (≥2.1) and BASDAI (≥4) definitions of HDA], were compared according to baseline demographic and clinical characteristics in the ‘eligible population’ (i.e. irrespective of TNFi-treatment). In addition, for patients starting TNFi and with complete follow-up BASDAI/ASDAS data (‘efficacy population’), the subgroups were also compared according to different response criteria (see table 1), at 3 and 6 months. Results In total, 466 patients were included (59% males and 66% HLA-B27 positive). The large majority (n=382; 82%) fulfilled the definition of HDA according to both BASDAI and ASDAS at baseline (i.e. BASDAI≥4 and ASDAS≥2.1). The frequency of ASDAS≥2.1, if BASDAI Conclusions Our results show that the ASDAS-HDA definition (ASDAS≥2.1) is more inclusive than the BASDAI-HDA definition (≥4) in selecting axSpA patients for TNFi treatment. Importantly, the additionally ‘captured’ patients respond better and have higher likelihood of predictors thereof. These results support the use of ASDAS≥2.1 as a selection criterion for treatment decisions. Acknowledgements Supported in part by a research Grant from Investigator-Initiated Studies program of MSD Disclosure of Interest J. Marona Grant/research support from: MSD, A. Sepriano Grant/research support from: MSD, S. Rodrigues-Manica Grant/research support from: MSD, F. Pimentel-Santos Grant/research support from: MSD, A. Mourao Grant/research support from: MSD, N. Gouveia Grant/research support from: MSD, J. Branco Grant/research support from: MSD, F. Vinagre Grant/research support from: MSD, R. Roque Grant/research support from: MSD, J. Rovisco Grant/research support from: MSD, M. Marques Grant/research support from: MSD, J. Tavares-Costa Grant/research support from: MSD, J. Silva Grant/research support from: MSD, H. Santos Grant/research support from: MSD, N. Madeira Grant/research support from: MSD, E. Vieira-Sousa Grant/research support from: MSD, R. Machado Grant/research support from: MSD, M. Bernardes Grant/research support from: MSD, R. Ferreira Grant/research support from: MSD, S. Ramiro Grant/research support from: MSD

Background The treat-to-target concept is currently recommended in axSpA management and remission is the main objective of treatment. Although consensual definitions of remission are lacking, most authors assume remission as a state of inactive disease or, alternatively, of low disease activity, as a near concept. In current practice, ASAS-Partial Remission (ASAS-PR) and ASDAS-Inactive Disease (ASDAS-ID) scores have gained wide acceptance as clinical remission-like definitions. Objectives In this review we assessed the efficacy of different biologic disease-modifying anti-rheumatic drugs (bDMARD) in achieving ASAS-PR or/and ASDAS-ID as remission-like primary outcomes. Data from randomised controlled trials (RCT) conducted in radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA) patients were included. Methods A systematic literature review was performed using the MEDLINE database (August 17 2017) with the filters “published in the last 10 years” and “humans”. The PICO (P, population; I, intervention; C, comparison; O, outcome) concept was used to perform the analysis according to: Patients – adults (>18 years old) with r-axSpA or nr-axSpA; Intervention – any bDMARD regardless of formulation or duration; Comparison – placebo and/or any different drug; Outcomes: ASAS-PR and ASDAS-ID. Results After screening 557 references (after de-duplication), 7 RCTs fulfilled the inclusion criteria, all concerning tumour necrosis factor inhibitors (TNFi) bDMARDs – table 1. ASAS-PR was the most commonly used remission-like definition- in 6 of the 7 trials, 1 of those as a composed measure with a magnetic resonance score. Despite different baseline populations (including r-axSpA and nr-axSpA), all these trials provide evidence of TNFi efficacy in achieving remission. The proportion of patients achieving ASAS-PR and ASDAS-ID varied between 33%–61.9% and 27.3%–55%, respectively, with a minimum and maximum follow-up periods of 28 to 254 weeks for ASAS-PR and 24 weeks to 5 years for ASDAS-ID. Conclusions Clinical trials addressing remission-like concepts as primary outcomes are scarce. ASAS-PR score was the most commonly used remission outcome. Depending on the studies, between one third to one half of patients treated with TNFi achieved ASAS-PR or ASDAS-ID. Considering nowadays aimed treatment targets, these data raise the unmet need for improved treatment options and strategies, that favour optimised remissions rates in axSpA patients. References [1] Braun2008. [2] Davis2008. [3] Sieper2011. [4] Sieper2012. [5] Song2012. [6] Sieper2013. [7] van Heijde2014. [8] van Heijde2016. [9] Smolen2017. Disclosure of Interest None declared

Background Patient reported outcomes (PROs) have gained relevance in the evaluation of several diseases such as axial spondyloarthritis (axSpA). They allow the clinician to have a quantitative measurement of several aspects of the disease, according to the patient perspective. Objectives In this review we intended to evaluate the efficacy of different biologic disease-modifying anti-rheumatic drugs (bDMARD) in achieving the minimum clinically important difference (MCID) in several PROS’s. Data from randomised controlled trials (RCT) conducted in radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-AxSpA) patients were included. Methods A systematic literature review (SLR) was performed using the MEDLINE database (August 17 2017) with the filters “published in the last 10 years” and “humans”. Abstracts from the EULAR 2017 were also considered. The PICO (P, population; I, intervention; C, comparison; O, outcome) concept was used to perform the analysis according to: Patients: adults (>18 years old) with r-axSpA or nr-axSpA; Intervention: any bDMARD regardless of formulation or duration; Comparison: placebo and/or any different drug; Outcomes: The Bath Ankylosing Spondylitis Functional Index (BASFI), the Ankylosing Spondylitis Quality of Life (ASQoL), the EuroQol-5D (EQ-5D), the Short Form 36 Health Survey physical component summary (SF36-PCS), the Short Form 36 Health Survey mental component summary (SF36-MCS), and the Functional Assessment of Chronic Illness Therapy – Facit (FACIT-F). For each outcome we assessed whether the treatment group was superior, equal or inferior to the placebo (PBO) group regarding the achievement of the MCID of the assessed PRO over time. Results After screening 557 references (after de-duplication), 16 RCTs were included, studying interleukin 17 inhibitors (IL17i) and tumour necrosis factor inhibitors (TNFi). In r-axSpA, the treatment group (for both TNFi and IL17i) reached the MCID for all the assessed PROs, except for a single study in which both the treatment and PBO groups reached the MCID for the SF36-PCS. For nr-axSpA the results were more heterogeneous (table 1). Conclusions The assessment of PROs in RCT is scarce. The profile of PROs response seems to be different between r-axSpA and nr-axSpA patients; these differences must be further validated in future trials. This study launches a call for action in PROs reporting standardisation. References [1] -Deodhar 2016; van der Heijde2009; Sieper 2013; Haibel 2008; Maksymowych 2008; Dougados 2014; Maksymowych 2016; Dougados 2015; van der Heijde 2014; Deodhar Abstract THU0348. EULAR 2017; Reveille JD EULAR 2017; Park W 2016; Sieper 2014; Deodhar 2016; Marzo-Ortega 2017; Kvien TK Abstract THU0393 EULAR 2017; Sieper 2015. Acknowledgements Novartis Pharma for the logistic support. Disclosure of Interest S. Rodrigues-Manica: None declared, J. Leite Silva: None declared, A. R. Machado: None declared, C. Coelho Employee of: Novartis Pharma Portugal, J. Duarte Employee of: Novartis Pharma Portugal, E. Vieira-Sousa: None declared, J. Tavares-Costa: None declared, F. M. Pimentel-Santos: None declared

Background Chronic nonspecific neck pain (CNP) is a common health problem worldwide. The physiotherapy approach is the second line of treatment and a large variety of modalities are frequently used. However, the mean effect of interventions is small and it is unknown if the patients achieving clinically important change. Individual responder analyses provide researchers with complementary information about the patterns of recovery and the proportion of patients achieving clinically important treatment responses. Objectives The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on pain intensity and global perceived recovery. Methods A randomised controlled trial was conducted on 62 participants with CNP lasting ≥3 months, assigned to MET and UC groups. Participants in the MET group (n=31) received 12 sessions of passive articular mobilisation and exercise (coordination, strength, endurance), whereas the UC group (n=31) received 15 sessions of usual physiotherapy care, combining electrotherapy, massage and stretching exercises. Patients were assessed at baseline, and then at 3 and 6 weeks (final of intervention). The Minimal Clinically Important Difference (MCID) in treatment response for pain intensity was defined as a decrease of >2 point in the Numeric Rating Scale of Pain compared to the baseline score and for global perceived recovery a value of ≥5 in Patient‘s Global Impression of Change Scale. Results A significant difference between-groups was observed at 6 weeks on pain intensity (p≤0.001), favouring the MET group. No significant differences were found between-groups in pain intensity at the baseline (p≥0.626) and at 3 weeks (p≥0.777). At patient-level response, in the MET group, 58% of the participants experienced an MCID in the first 3 weeks of treatment and this proportion was increased to 94% at 6 weeks on pain intensity, and rose from 68% to 81% on global perceived recovery. In the UC group the proportion of patients that experienced an MCID rose from 55% to 61% on pain intensity, at 3 and 6 weeks, respectively, and 68% in global perceived recovery in both moments. The patients in MET group were 10% (RR=1,1) and 50% (RR=1,5) more likely to achieve the MCID on pain intensity than the UC group, at 3 and 6 weeks, respectively. In global perceived recovery, the MET group were 20% (RR=1,2) more likely to achieve an MCID response at the 6 weeks. No differences were found in chances of recovery at 3 weeks. Conclusions These findings suggest that participants of MET group had a pattern of recovery over 6 weeks and achieved a higher response rate to treatment, on pain intensity and a better global perceived recovery, compared to those receiving UC. Disclosure of Interest None declared

Background Axial Spondyloarthritis (axSpA) usually starts in early adulthood and the lifetime impact of the disease can be considerable. Pain, stiffness, sleep disturbances contribute to health-related quality of life reduction with significant impact in work productivity. Absenteeism and presenteeism are still responsible for high costs associated with the disease. Objectives Assess absenteeism, presenteeism, work and daily-activities impairment and their related associated factors in patients with axSpA. Methods Cross-sectional postal, unicenter, non-interventional study. Patients fulfilling the Assessment of Spa International Society Classification criteria for axSpA under working age were included. Two groups were defined: A) patients under current anti-TNF; B) patients under conventional therapy. Quantitative and qualitative surveys were performed: Work Productivity and Activity Impairment Questionnaire in SpA (WPAI); participants’ experiences of working and their perceptions of how their condition had affected their work capacity and workplace relationships were recorded. The questionnaires were applied through a telephone call, after consent of the participant and respecting anonymity. Results 60 patients were included (table 1). No significant differences were found between the two groups. They worked on average 42±14.7 hours per week (h/w) and missed 2.3±4.1 h/w due to axSpA. Mean absenteeism, presenteeism, work and activities impairment due to axSpA were 6.8%, 32%, 35% and 41%, respectively. The univariable analysis showed correlations between absenteeism and Visual Analogue Scale physician (phVAS) (p=0.027); presenteeism and Anquilosing Spondylitis disease activity score – C reactive protein (ASDAS-CRP) (p=0.002), Bath AS Disease Activity Index (BASDAI) (p=0.03), Bath AS Functional Index (BASFI) (p=0.02), VAS patient (pVAS) and phVAS (p=0.01, p=0.006), erythrocyte sedimentation rate (ESR) (p=0.03), CRP (p=0.024); percent overall work impairment and ASDAS-CRP (p=0.002), BASDAI (p=0.019), BASFI (p=0.026), pVAS and phVAS (p=0.016, p=0.01), ESR (p=0.03) and CRP (p=0.03); percent activity impairment and BASDAI (p=0.006), BASFI (p=0.004), pVAS (p=0.0004) and phVAS (p=0.007). No correlation was found between work productivity and anti-TNF medication, education or marital status. Regression analysis revealed that BASDAI, BASFI, phVAS, pVAS and CRP accounted for 63% of the variance of presenteeism, with 10 points increase in phVAS resulted in an increase of 17% in presenteeism (p=0.046). Over time, 95% had already gone to work sick: economic reasons (60%), not liking staying at home even sick (43%) and importance of work (35%) were the major reasons to presenteeism. Overall, 63% considered that the disease can limit their projects or career progression; 56% had already cancelled or postponed work; 20% had already changed jobs and 15% stated that had already felt discriminated. Conclusions Presenteeism, impairment of work productivity and activity were correlated with disease activity and physical functioning, with the increase of VAS physician resulting in increase in presenteeism. Economic reasons were the major factors to presenteeism and the majority of patients considered that the disease can limit their projects or career progression. Disclosure of Interest None declared

Objectives Ankylosing spondylitis (AS) is the most prevalent form of spondyloarthritis, with a known genetic association with the HLA-B27 molecule. The aim of this study was to assess the contribution of the HLA-G, HLA-E and HLA-F to AS susceptibility/protection in Portuguese patients with HLA-B27 AS and HLA-B27 unaffected controls. Methods High-resolution typing of HLA-G, HLA-E and HLA-F was performed in 228 patients with HLA-B27 AS and 244 HLA-B27 unaffected controls. Allelic, genotypic and haplotypic frequencies were compared between cohorts. To replicate the results, single nucleotide polymorphisms (SNPs) in HLA-E and HLA-F genes were typed in Australian cohorts. For further confirmation, a group of European-descent patients with AS and unaffected controls were genotyped for Major Histocompatibility Complex SNPs using the Illumina microarray. Results In the Portuguese population, no significant differences were found in HLA-G. For HLA-E, a significant difference was detected for the genotype HLA-E*01:01:01/01:03:01 (p=0.009; pc=0.009; OR=0.51), with a protection effect. For HLA-F, significant differences were detected in the allele HLA-F*01:01:02 (p=0.0049; pc=0.0098; OR=0.60) and corresponding SNP rs2075682 (p=0.0004; pc=0.0008; OR=0.53), suggesting protection and in the genotype HLA-F*01:01:01/01:03:01 (p=0.011; pc=0.043; OR=2.00), suggesting a susceptibility effect. Three G-E-F haplotypes with significant differences were detected but occur in a very small number of individuals. The only significant differences detected in the replication studies were for HLA-E rs1059510 in the Australians and for HLA-F rs1736924 in the European-descent cohorts. Conclusion Our results reveal suggestive AS protective and susceptibility effects from both HLA-E and HLA-F loci, however with population differences. To our knowledge, this is the first study showing association of HLA-F with AS.

We report on the new microplate horn ultrasonic device as a powerful tool to speed proteomics workflows with unparalleled throughput. 96 complex proteomes were digested at the same time in 4min. Variables such as ultrasonication time, ultrasonication amplitude, and protein to enzyme ratio were optimized. The "classic" method relying on overnight protein digestion (12h) and the sonoreactor-based method were also employed for comparative purposes. We found the protein digestion efficiency homogeneously distributed in the entire microplate horn surface using the following conditions: 4min sonication time and 25% amplitude. Using this approach, patients with lymphoma and myeloma were classified using principal component analysis and a 2D gel-mass spectrometry based approach. Furthermore, we demonstrate the excellent performance by using MALDI-mass spectrometry based profiling as a fast way to classify patients with rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis. Finally, the speed and simplicity of this method were demonstrated by clustering 90 patients with knee osteoarthritis disease (30), with a prosthesis (30, control group) and healthy individuals (30) with no history of joint disease. Overall, the new approach allows profiling a disease in just one week while allows to match the minimalism rules as outlined by Halls.

Background Lower serum vitamin D levels have been shown to be associated with various autoimmune disorders, including Rheumatoid Arthritis (RA). Vitamin D deficiency is common in RA patients, despite profiting from a sunny country. Objectives The aim of the study is to evaluate (1) – the association between vitamin D serum levels and disease activity in patients with RA; (2) – seasonal distribution of vitamin D levels. Methods Patients fulfilling the 2010 EULAR/ACR Rheumatoid Arthritis Classification Criteria, which had serum vitamin D [25(OH)D3] levels measured between January 2013 and December of 2016 were included. Demographic data, disease activity scores, including DAS283v-CRP and DAS283v-ESR, vitamin D supplementation with cholecalciferol and other therapeutic approaches were recorded. Vitamin D insufficiency was considered between 25–75 nmol/L and deficiency if Results A sample composed by 95 patients, 79 females (83.16%), with an average age (SD) of 68.57 (11.92) years within 40–88 years range were included. Average disease duration was 13.46 (11.41) years. The average age at diagnosis was 57.10 (14.25) years. The average vitamin D levels were 78.13 (60.98) nmol/L in a range between 20–400 nmol/L. Vitamin D levels were not significantly different in male vs. females patients. The prevalence of vitamin D insufficiency and deficiency was 53.68% and 8.42% respectively, despite 57.89% of the patients taking supplementation (average 6141 (4800) UI/week). The univariable analysis showed that albeit vitamin D levels presented a negative poor correlation with DAS283v-CRP (rho=-0.348, p-value Conclusions Vitamin D insufficiency/deficiency was frequent among RA patients (62.1%), independently of seasonality or supplementation. An interesting pattern behavior was observed in this study, which indicates that the likelihood of encountering a very narrowband of vitamin D values for patients with high disease activity is very high, and thus, the forecast capability of vitamin D values for patients with increasingly active disease is quite good. Future research will aim at strengthening the statistical parameters of relevance, identifying and characterizing the more specific behaviours of this global pattern. Disclosure of Interest None declared

Background Spondyloarthritis (SpA) carries substantial financial costs, including direct costs (use of medical services and treatments) and indirect costs (loss of work productivity). While disease related factors have been repeatedly shown to be associated with work outcomes, information on the role of educational attainment and the economic wealth of the patients9 country of residence is scarce. Objectives To explore the role of individual and country level socio-economic (SE) factors on employment, absenteeism and presenteeism across 22 countries. Methods Patients with a clinical diagnosis of SpA, fulfilling the ASAS SpA criteria and in working age (≤65 years old) from COMOSPA were included. Outcomes explored were employment-status, absenteeism and presenteeism according to the Work Productivity and Activity Impairment Specific Health Problem (WPAI-SHP) questionnaire. Absenteeism and presenteeism were assessed in employed patients. Multilevel logistic (for work status) and linear (for absenteeism and presenteeism) regression models with random intercept for country were constructed. Independent contribution of individual (education) and country level socio-economic factors (country healthcare expenditures and gross domestic product (GDP) (all low vs medium/high tertiles) were assessed in models adjusted for clinical factors. Results In total 3,114 patients from 22 countries were included (mean (SD) age 40.9 (11.8) years; 66% males; and 63% employed). Of these, 89% had axial SpA and 11% a peripheral SpA. Unadjusted employment rates ranged from 28% (Colombia) to 83% (Canada). After adjustment for relevant socio-demographic and clinical variables, differences between countries in work status persisted (Figure). High healthcare expenditures were associated with higher employment (OR=2.42; 95% CI=1.53;3.81) and lower presenteeism (β=-4.53;CI=-8.90;-0.17). Similarly, higher GDP was associated with higher employment (OR=1.70; 95% CI=1.02;2.83), and in the same direction with presenteeism but without reaching statistical significance (β=-3.42;CI=-13.07;6.23). No significant association between any country SE indicators and absenteeism was found. At individual level, higher education was positively associated with employment-status, presenteeism and absenteeism. Conclusions Individual- and country-level SE factors affect work participation in SpA, and this varies significantly across countries. Better socio-economic welfare seems to support SpA patients to stay employed and productive. Disclosure of Interest None declared

Background The Assessment of SpondyloArthritis international Society Health Index (ASAS HI), is a unidimensional questionnaire, that includes 17 items, measuring functioning and health in patients with spondyloarthritis (SpA) (1). At the beginning of this project, only an English version of the instrument existed. Objectives The aim of this study was to conduct the cross-cultural adaptation of the ASAS-HI into European Portuguese language and investigate its reliability and validity in a sample of Portuguese patients with SpA. Methods The ASAS-HI has a range from 0 (best health state) to 17 (worst health state). The questionnaire was first translated and then back translated following published guidelines. Patients fulfilling ASAS classification criteria for either axial (axSpA) or peripheral SpA (pSpA) were included. Reliability was assessed through internal consistency coefficient, and internal consistency was assessed using Cronbach9s alpha. Construct validity was assessed through Spearman9s correlation analyses between the ASAS-HI and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score-CRP (ASDAS-CRP), and the Short Form (36) Health Survey (SF-36) (physical) SF-36 (physical) for convergent validity and between the ASAS-HI and the HAD-S Anxiety/Depression, and SF-36 (mental) for divergent validity. Discriminative validity was tested comparing the ASAS-HI across ASDAS-CRP disease activity states using the Kruskal–Wallis test. Results In total, 86 patients were included: 65% male, mean (SD) age 47.1 (12.9) years, symptom duration 11.4 (11.0) years, BASDAI 3.1 (2.1), BASFI 2.2 (2.6), ASDAS-CRP 2.2 (0.8). The diagnosis of axSpA was established in 58 patients (AS =45, nr-axSpA =13) and of pSpA in 28 patients. The forward backward translation was successful and qualitative interviews raised no further comments of the patients. The total mean score of the ASAS-HI was 4.6 (3.8). The ASAS- HI showed an excellent test-retest reliability (n=72) (ICC=0.93: 95% CI=0.89;0.96, p Conclusions The findings of this study showed that the Portuguese version of the ASAS –HI is a comprehensible questionnaire that is reliable and valid. Therefore, its use can be recommended, both for clinical practice and research purposes, to assess the state of health and functioning in Portuguese SpA patients. Future research is needed to evaluate the responsiveness of the ASAS-HI in SpA patients. References Kiltz U et al. Ann Rheum Dis. 2015;74(5):830–5. Disclosure of Interest None declared

Background Biobanks for research (BBR) are organized repositories of biological materials and associated health information with enormous potential and value for scientific research. In consonance with increasing attention to healthy aging research, BBR specifically oriented to chronic diseases and aging populations have gathered heightened attention. Public perceptions and patient choices are key to design, develop and implement patient-centered BBR. Public awareness, education and involvement are confidence building and unequivocally lead to higher participation in scientific enterprises. Objectives To assess patient awareness, perception and choices regarding aging biobanking activities. Methods We developed and applied a standard anonymous questionnaire to rheumatology terciary outpatients, aged 50 or older, between March-October 2016. Demographic data and perceptions about biobanking were collected. Data analysis was performed using Stata 14® software. Results We obtained a total of 131 valid responses [age (min-max, 50–93), mean (64); sex ratio (M/F) (40/91, 44%), education years (min-max, 0–20), mean (8.5)]. 69% of respondents did not know the specific term “biobank” but 57% were aware about the possibility of donating their biological material for research purposes. Furthermore, 77% of respondents indicated they were willing to contribute with their biological material to BBR, stating they had no particular preference whether these infrastructures were of private or public nature. However, they expressed a clear preference for these to be based at scientific research institutes (50%), instead of hospitals (23%), universities (16%) or biotechnology companies (7%). Moreover, respondents highlighted diferent requirements for their participation with anonymity (31%) and confidentiality (27%) ranking as top priorities. Most importantly, a majority of respondents (70%) expressed their agreement with a biobank exclusively dedicated to the study of aging, considering that people of older ages have higher disease burdens and that such research infrastructures and practices expressed respect for the particular problems of the elderly (Figure). Conclusions Our study constitutes a comprehensive assessment of public perceptions and patient choices regarding biobanks for aging research purposes among rheumatology outpatients. Although awareness is still suboptimal, BBR are highly regarded health infrastructures with enormous potential for further patient-centered development. Disclosure of Interest None declared

Background Targeting humoral immunity has been proved effective in several inflammatory rheumatic diseases (IRD). Though clinical trials have shown some efficacy of B-cell depletion in ankylosing spondylitis (AS), results are less convincing. Other studies have revealed an association between mutations and expression of immune regulatory genes suggesting B-cell dysfunction in the development and progression of AS. Yet, there is still lack of data describing B-cell subsets in AS, how these compare to other IRD and an evaluation of B cell compartment homeostasis in the pathophysiology of this disease. Objectives To assess and compare the immature, naive and antigen differentiated subsets of peripheral B-cell compartment in AS with those in healthy controls (HC) and other IRD Methods Patients (pts) with AS, RA and SLE according to respective classification criteria were included in this study. Pts under biologic DMARDS were not included. Sociodemographic and clinical variables were recorded. Blood samples were collected for quantification of inflammatory markers (ESR and CRP), immunoglobulin serum levels and assessment of B-cell immature transitional stages and mature subsets by flow cytometry (figure). Mann-Whitney and Fisher9s exact test were used for comparison of AS with other groups Results Overall, 60 pts and 12 HC were included (Table). All patient groups presented similar and rather low levels of inflammation, as measured by CRP, ESR and immunoglobulins, in addition to a decreased lymphocyte count by comparison with HC. There were no differences in the B-cell counts between AS pts and HC, with both groups having higher B-cell counts than RA and SLE pts. Regarding B-cell subsets, the immature transitional compartment of AS pts was found in normal range, but not in the RA and SLE groups. In fact, the latter presented a significant decrease in all transitional cell maturity stages (T1-T3). The next step in B-cell differentiation is mature naive cells, also found in normal levels in AS and decreased in RA and in particular in SLE. AS pts presented slightly higher counts of CD27+IgD+ MZ-like and class able to switch memory cells with reference to HC and these cell numbers were found to be low in RA and even lower in SLE pts. Switched memory CD27+IgD- B-cells were reduced in all patient groups, however, only SLE pts presented highly decreased cell levels. Conclusions We found that while a severe dysfunction is present in the homeostasis of the B-cell compartment in RA and in particular SLE pts, which are lymphopenic in both immature and mature B-cell compartments, it appears that AS pts are not affected in the same way. At this stage, functional studies appear to be necessary in order to identify differences in key mechanisms of B cell development and differentiation that may play a role in the aetiology and progression of these inflammatory rheumatic diseases. Our first results, however, establish that pathophysiological mechanisms involving B-cells clearly differentiate AS from RA and SLE Disclosure of Interest None declared

Background and objectiveThe SPLIT project aims to introduce an interdisciplinary stratified model of care for patients with low back pain. This study aimed to explore the acceptability and identify potential barriers and facilitators regarding the upcoming implementation of this project, based on the general practitioners' and physiotherapists' perceptions.MethodsA qualitative study was carried out supported by two focus groups, which were conducted by two researchers. A focus group was carried out with each professional group. One focus group included six general practitioners and the other included six physiotherapists. The focus groups were based on a semi-structured interview schedule, audio-recorded and transcribed verbatim. A thematic analysis was conducted.ResultsThe participants explored aspects related to the acceptability of the SPLIT project, emphasising the satisfactory amount of effort that is expected to be required for its implementation. Potential facilitators to the implementation of the model were identified, such as the participants`motivation. Potential barriers were also explored, with particular emphasis on the challenges related to the change of routine care. Lastly, the need for particular adjustments in the health services was also highlighted.ConclusionsThis study`s participants highlighted the feasibility and acceptability of the SPLIT project. The identification of potential barriers and facilitators to its implementation also attained major relevance to better prepare the upcoming implementation of this project. The generalizability of findings to the larger population of relevant practitioners is limited, since only two focus groups were carried out. Therefore, this study`s findings should be considered in terms of transferability to contexts that may have some similarities to the context where the study was carried out.

Human leukocyte antigen (HLA)-B27 is the mostly known major histocompatibility complex (MHC) gene associated with ankylosing spondylitis (AS). Nonetheless, there is substantial evidence that other MHC genes appear to be associated with the disease, although it has not yet been established whether these associations are driven by direct associations or by linkage disequilibrium (LD) mechanisms. We aimed to investigate the contributions of HLA class I and II alleles and B27-haplotypes for AS in a case-control study. A total of 188 HLA-B27 AS cases and 189 HLA-B27 healthy controls were selected and typed for HLA class I and II by the Luminex polymerase chain reaction-sequence specific oligonucleotide probe (PCR-SSOP) method. Allelic and haplotypic distributions were estimated by maximum likelihood method using Arlequin v3.11 and statistical analysis were performed by Stata10.1. No associations were found between non-HLA-B27 loci and AS susceptibility, but several associations were observed for phenotypic features of the disease. DRB1*08 was identified as a risk factor for uveitis and DQB1*04 seems to provide protection for AS severity (functional, metrological and radiological indexes). A*02/B27/C*02/DRB1*01/DQB1*05 [P

Funding Information: positions on two Pfizer sponsored trials and has directed an educational course supported by Bristol Myers Squibb. He serves as an epidemiology consultant to CORRONA. J.A.P.S. has received honoraria as a speaker or consultant and benefited from research support from several pharmaceutical companies involved in the production of biologic agents (Abbott, Amgen, MSD, Pfizer and Roche), always at sums less than E10 000. All other authors have declared no conflicts of interest. Funding Information: Funding: This work was supported by a grant from Harvard-Portugal Program HMSP-ICS/SAU-ICT/0002/ 2010. Objectives: Adalimumab, etanercept and infliximab are effective TNF inhibitors (TNFis) in the treatment of RA, but no randomized clinical trials have compared the three agents. Prior observational data are not consistent. We compared their effectiveness over 1 year in a prospective cohort.Methods: Analyses were performed on subjects' first episode of TNFi use in the Rheumatic Diseases Portuguese Register, Reuma.pt. The primary outcome was the proportion of patients with European League Against Rheumatism good response sustained at two consecutive observations separated by 3 months during the first year of TNFi use. Comparisons were performed using conventional adjusted logistic regression, as well as matching subjects across the three agents using a propensity score. In addition, baseline predictors of treatment response to TNFi were identified.Results: The study cohort included 617 RA patients, 250 starting etanercept, 206 infliximab and 161 adalimumab. Good response was achieved by 59.6% for adalimumab, 59.2% for etanercept and 51.9% for infliximab (P = 0.21). The modelled probability of good response did not significantly differ across agents (etanercept vs adalimumab OR = 0.97, 95% CI 0.55, 1.71; etanercept vs infliximab OR = 1.25, 95% CI 0.74, 2.12; infliximab vs adalimumab OR = 0.80, 95% CI 0.47, 1.36). Matched propensity score analyses also showed no significant treatment response differences. Greater educational attainment was a predictor of better response, while smoking, presence of ACPA, glucocorticoid use and worse physician assessment of disease activity at baseline each predicted a reduced likelihood of treatment response.Conclusion: Over 1 year, we found no difference in effectiveness between adalimumab, etanercept and infliximab. publishersversion published

Objective.Unconfirmed reports describe association of ankylosing spondylitis (AS) with several candidate genes includingANKH. Cellular export of inorganic pyrophosphate is regulated by the ANK protein, and mutant mice (ank/ank), which have a premature stop codon in the 3’ end of theankgene, develop severe ankylosis. We tested the association between single-nucleotide polymorphisms (SNP) in these genes and susceptibility to AS in a population of patients with AS. We investigated the role of these genes in terms of functional (BASFI) and metrological (BASMI) measures, and the association with radiological severity (mSASSS).Methods.Our study was conducted on 355 patients with AS and 95 ethnically matched healthy controls. AS was defined according to the modified New York criteria. Four SNP inANKH(rs27356, rs26307, rs25957, and rs28006) were genotyped. Association analysis was performed using Cochrane-Armitage and linear regression tests for dichotomous and quantitative variables. Analyses of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BASFI, and mSASSS were controlled for sex and disease duration.Results.None of the 4 markers showed significant single-locus disease associations (p > 0.05), suggesting thatANKHwas not a major determinant of AS susceptibility in our population. No association was observed between these SNP and age at symptom onset, BASDAI, BASFI, BASMI, or mSASSS.Conclusion.These results confirm data in white Europeans thatANKHis probably not a major determinant of susceptibility to AS.ANKHpolymorphisms do not markedly influence AS disease severity, as measured by BASMI and mSASSS.

The Bath Ankylosing Spondylitis Activity Index (BASDAI), Functional Index (BASFI), Metrology Index (BASMI), and Global Score (BASG) are commonly used to assess patients with ankylosing spondylitis (AS). The aim of this study was to cross-culturally adapt and validate these indexes into the Portuguese language. Seventy-eight patients were included in the study. After forward and backward translations, the questionnaires were administered and tested for internal consistency, test-retest reliability, face validity, content validity, and construct validity. The outcome measures HAQ, EQ-5D, and SF-36 were also implemented. Metrological parameters (BASMI components) and chest expansion were evaluated. Correlation coefficients for test-retest were 0.875, 0.937, 0.831, and 0.961 for BASDAI, BASFI, BASMI, and BASG, respectively. Internal consistency coefficients were between 0.747 and 0.953. The adapted and translated questionnaires demonstrated an acceptable comprehensibility by a panel of patients, and face validity was assured by the cognitive debriefing performed. Content validity was assured by comparing the scores obtained by the questionnaires when age and gender, age of symptoms onset, and disease duration were considered. Construct validity was assured by significant correlations established between the Bath scores and generic health status HAQ, EQ-5D and SF-36, morning stiffness duration, chest expansion, and physician disease activity assessment. The Portuguese version of the BASDAI, BASFI, BASG, and BASMI showed adequate reliability and validity in patients with AS. The measurement properties were comparable to versions in other languages, indicating that the indexes can be used for evaluation of Portuguese-speaking AS patients.