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Background:Interstitial Lung Diseases (ILD) may present features suggesting an underlying autoimmune process, which seem to differentiate them from idiopathic interstitial pneumonias, although without fully meeting the classification criteria (CC) for a specific connective tissue disease. Different terms had been used to describe these conditions and, to reach a consensus, the European Respiratory Society/American Thoracic Society proposed the CC for an entity named Interstitial Pneumonia with Autoimmune Features (IPAF). Clinical evolution and prognosis of this entity are still poorly understood.Objectives:To evaluate clinical evolution and prognosis of a population of patients with IPAF.Methods:Retrospective analysis of clinical files of patients followed by the Pulmonology Department since 02/2012 until 06/2019, who met the CC for IPAF, regarding clinical, functional and radiological evolution. Patients were considered to have a progressive phenotype in 24±3 months from their 1stevaluation if they fulfil 1 of the 4 criteria: relative decline in FVC ≥10% predicted; relative decline in FVC ≥5–Results:22 (7.4%) of 296 ILD patients met IPAF CC. 59.0% were female with an age at the 1stevaluation of 66.7±12.4 years. They were all non-smokers (63.6%) or ex-smokers (36.4%). Serologic and morphologic criteria were both present in 21 (95.4%) and clinical criteria in 5 patients (22.7%). Antinuclear antibodies (ANA) were identified in 19, rheumatoid factor in 4, SSA in 3 and anti-Jo-1 in 1 patient. HRCT patterns were identified in 21 patients: 15 nonspecific interstitial pneumonia (NSIP), 5 organizing pneumonia (OP) and 2 lymphocytic interstitial pneumonia (LIP). One NSIP and 1 LIP identified on HRCT were confirmed by histopathology. Three patients had inflammatory arthritis and 2 had Raynaud’s phenomenon. Immunosuppressive therapy was introduced in most cases (18 patients, including systemic corticotherapy in 17, azathioprine in 4, mycophenolate mofetil in 1), azithromycin was prescribed in 2 patients and 3 remained without therapy. Regarding the follow up at 24±3 months from the 1stevaluation (3 patients were excluded due to too recent follow-up), 4 patients (18.2%) had progressive phenotype, 7 (31.8%) had a favourable evolution and 3 (13.6%) patients had died. During a follow-up of 31.1±19.8 months, this number rose to 6 patients (27.3%), all of them died by respiratory cause and had NSIP pattern. No differences were found in age, last FVC, therapy and time of disease evolution between those who died and the others.Conclusion:Our study showed that a small proportion of IPAF patients had a progressive phenotype and the NSIP pattern seemed to be a poor prognosis factor for survival.References:[1]Ito Y, Arita M, Kumagai S, et al. Serological and morphological prognostic factors in patients with interstitial pneumonia with autoimmune features. BMC Pulm Med 2017; 17:111 10.1186/s12890-017-0453-zDisclosure of Interests:None declared

Background:The proportion of elderly patients is increasing in the rheumatoid arthritis (RA) population. However, data on drug effectiveness and safety in these patients is scarce.Objectives:To assess effectiveness and safety of biologic Disease-Modifying Antirheumatic Drugs (bDMARD) in elderly and very elderly RA patients.Methods:Prospective cohort-study of RA patients registered at Reuma.pt starting a 1st bDMARD. Treatment persistence, EULAR response at 6 and 12 months, and adverse events (AE) were compared between adults (Results:2401 patients were included, of which 379 were elderly and 83 very elderly. Elderly and very elderly had higher disease activity at baseline and more comorbidities. Elderly patients started bDMARD later in the course of RA (table 1). Crude and adjusted bDMARD treatment persistence was similar in the 3 groups (p=0.07, Graph). At 6/12 months, EULAR response was achieved by 81.6%/83.3%, 75.2%/68.5% and 82.6%/84.2% of adults, elderly and very elderly, respectively (table 2). Except for a lower response rate at 12 months in the elderly group, the EULAR response was comparable in the 3 groups. The same results were observed after adjustment for baseline characteristics, namely the chance of achieving EULAR response was not different in adults and very elderly (OR 0.78, 95% CI 0.19 to 3.2). Also, the variation of DAS, CDAI and SDAI at 6 months and 12 months were comparable in the 3 groups. AE were reported in 21%/22.5%/22.9% of adult/elderly/very elderly patients, respectively. The rate of AE per 100 patient-years was lower in adults when compared to elderly and very elderly (6.4, 13.5 and 14.7, respectively) (table 2). Also the rate of severe AE (SAE) was higher in very elderly (4.29 per 100 patient-years) when comparing to adults and elderly (1.03 and 1.94 respectively).Table 1.Baseline characteristics. no:number; IQR:interquartile range; SD:standard desviation; DAS28-disease activity score 28 joints ESR; CV: cardiovascular; RF:Rheumatoid Factor; ACPA:anti-citrullinated protein antibodiesAdultsElderlyVery elderlyP valueHypertension – no (%)373 (26.7)108 (42.4)29 (47.5)Diabetes – no (%)95 (6.8)40 (15.7)10 (16.4)CV disease – no (%)93 (6.7)24 (9.4)10 (16.4)RF and/or ACPA positive – no (%)1642 (73)252 (72.8)60 (74)0.97Years since diagnosis to 1stbDMARD -median (IQR)7.4 (3.7-14)9.9 (5-18)5.2 (3-12.6)Baseline DAS28 mean ± SD5.5 ± 1.35.7 ± 1.36 ± 1.40.02Table 2.Efficacy of biologics at 6 (T6) and 12 month (T12) and safetyAdultsElderlyVery elderlyP valueΔ DAS T6 mean ± SD-2 ± 1.4-2 ± 1.9-2.1 ± 1.40.9EULAR responders T6 %618 (81.6)108 (75.2)18 (81.8)0.19Δ DAS T12 mean ± SD-2.1 ± 1.5-1.8 ± 1.6-2.6 ± 1.90.1EULAR responders T12 – no (%)538 (83.3)84 (68.3)16 (84.2)Patients with AE – no (%)396 (21)80 (22.5)19 (22.9)0.76AE/ 100 patient-years6.413.514.7Conclusion:The persistence on 1st bDMARD was similar in adults, elderly and very elderly RA patients. Though older patients have more comorbidities and more active disease at baseline, treatment with biologics was effective and with an acceptable safety profile. However, it is important to take into account the higher risk of AE and SAE in older patients. In conclusion, this study supports the use of bDMARD treatment in elderly and very elderly RA patients.Graph – Persistence in bDMARDDisclosure of Interests:Raquel Freitas: None declared, Nathalie Madeira: None declared, Bruno Miguel Fernandes: None declared, Flavio Costa: None declared, Mariana Santiago: None declared, Agna Neto: None declared, Soraia Azevedo: None declared, João Madruga Dias: None declared, Maura Couto: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Luís Cunha Miranda: None declared, Joaquim Polido-Pereira: None declared, Joao Eurico Fonseca: None declared, Maria Jose Santos Speakers bureau: Novartis and Pfizer

Background: In the last years, there has been an increase interest in using Patient Reported Outcomes (PROs) in clinical trials and daily clinical practice in Rheumatology to provide patient-centered care. The most frequently reported PROs are patient’s pain, patient’s global assessment (PGA) of disease activity and reports of functional capacity, fatigue, anxiety and depression. To date, studies that explore patient adherence to rheumatic medications are scarce. Objectives: To study the level of adherence to biologic therapy of Rheumatoid Arthritis (RA) patients, followed at a day care hospital of Rheumatology. Methods: Observational and cross-sectional study which took place in two months of consultation of day care hospital (5 periods per week). Patients with a diagnosis of RA according to 1987 American College of Rheumatology (ACR) and/or 2010 ACR/European League Against Rheumatism criteria, on biologic therapy, able to complete a questionnaire autonomously and who agreed to participate were included. Demographic and clinical data (DAS28, CDAI and SDAI to assess RA disease activity, HADS-A for anxiety, HADS-D for depression, FACIT-F for fatigue) were collected. To assess adherence, a Portuguese version of the Morisky Medication Adherence Scale (MMAS-8) was used and the patients were asked to apply it only to biologic therapy. Three levels of adherence were considered based on the following scores: 0 to Results: In total, 61 patients were included, 91.8% female, 82.0% on anti-Tumor Necrosis Factor (anti-TNF), the others on Tocilizumab (16.4%) or Abatacept (1.6%). Table 1 reports the means and medians of demographic and clinical variables included. The mean MMAS-8 score was 7.0±1.2, the median 7.0 (6.8–8.0), with a minimum of 2.5 and a maximum of 8. The adherence was medium in 50.8%, high in 36.1% and low in 13.1% patients. The median of current age was significantly higher for patients with high and medium levels of adherence compared to those with low levels (p=0.030). The time on treatment with the current biologic therapy was significantly different between the levels of adherence (p=0.028); the median of time on treatment for patients with medium levels of adherence was significantly higher comparatively to the other patients (p=0.009). No other significant difference was found among the levels of adherence for the studied variables. Conclusions: The adherence to biologic therapy was at least medium for 86.9% of patients. Differences between levels of adherence were found only for current age and time on treatment. Disease activity of RA does not seem to influence the levels of adherence. Disclosure of Interest: None declared

The aim of this paper was to assess the validity and reliability of the touch-screen standard Portuguese version of the following patient-reported outcomes (PROs), compared with paper format, in patients with rheumatoid arthritis (RA) and spondyloarthritis: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life scale (ASQoL), Short-Form 36 (SF-36), Health Assessment Questionnaire (HAQ) and visual analogue scales (VAS) measuring pain and burden of disease. Adult patients with RA and spondyloarthritis attending the Portuguese Institute of Rheumatology were recruited from March 2013 to January 2014. Patients filled the paper and touch-screen formats of the standard Portuguese versions of the PROs. Two groups of VAS were used, RA and psoriatic arthritis (Global VAS) and another specific for spondyloarthrites (Spa-VAS). Paper questionnaires were filled 15 min before touch-screen formats. Agreement between formats (validity) was assessed by intraclass correlation coefficient (ICC), while internal consistency of scales (reliability) was assessed by Cronbach's alpha. Overall, 134 patients were included with a mean age of 51 years, 74.6 % female and 57.5 % presenting RA. BASDAI, BASFI, HAQ and ASQoL showed high ICC between paper and touch-screen formats (0.977, 0.958, 0.974 and 0.940, respectively). ICC for Global VAS ranged from 0.906 to 0.921, while Spa-VAS ranged from 0.867 to 0.943. The mean ICC for all SF-36 domains was 0.889 (ICC for each domain ranged from 0.781 to 0.944). Touch-screen standard Portuguese formats of these PROs may be valid and reliable tools for PRO measurement in rheumatology.

Background PROs are especially useful in the management of rheumatic diseases in complement to physician evaluation. However they are time consuming and used in a limited manner in the daily clinical practice. Reuma.pt is the Portuguese national rheumatic diseases register and one of the few registries in Europe that allows the patient to do at home the PROs before the appointment. In our institute we have complemented that with the creation of a paper free day hospital with the use of touch screen computers that also allows the patient to do the PROs before the clinical evaluation by the rheumatologist. Objectives to compare the impact of the use off Reuma.pt at home PROs completion platform before and after the utilization of touch screen computers in the day hospital. Methods We determined the number of patients and appointments with the use at home of the PROs platform one year prior to the introduction of the touch screen computer at our day hospital (October 2014 –October 2015) and one year after the paper free day hospital was installed (November 2015-November 2016). To determine any change of pattern of the use at home of the platform and the relations between that and patients characteristics. Results When we analyse the available variables between the patients that performed the PROs at home we found for both periods considered that they were younger (45,2/49,8 vs 53,4/55,1 p Conclusions The use of technology could have a consider impact on the way we collected data from our patients. With the use of a touchscreen computer we have improved not only the overall completion of PROs but also increased the familiarity of patient to the online questionnaires. Number of appoitments with previous at home completion of the questionnaires more than double. This has a clear impact on patient participation, quality of data in the registry but even more impact on time and human resources at a day hospital. Disclosure of Interest None declared

Background Depression, anxiety and fatigue are common symptoms in rheumatoid arthritis (RA) patients, and seem to influence disease activity, pain, quality of life (QoL) and treatment response. Objectives To assess disease activity, function and QoL in RA patients with symptoms of anxiety/depression. Methods Observational, cross-sectional study including RA patients on bDMARD followed at our centre, registered at Reuma.pt with ≥1 evaluation from 2015/11 to 2016/07. Clinical data including DAS28, CDAI, SDAI, TJC, SJC, patients9 and physicians9 pain/global assessments (VAS), ESR, CRP, HAQ, EQ5D, HADS score (anxiety and depression domains, cutoff ≥8) and FACIT-F were collected. Data were analyzed using Mann-Whitney, Qui-Squared and Spearman correlation, p Results 182 patients enrolled, 84.6% female, mean: age at 1st bDMARD 53.8±11.1; time since diagnosis 16.2±9.3 years; DAS28 3.54±1.3; CDAI 10.2±9.6; SDAI 11.2±10.4; HAQ 0.97±0.6; HADS-Anxiety 7.13±4.5; HADS-Depression 6.62±4.54, FACIT-F 35.1±9.2, EQ-5D 0.36±0.2. 77 (44.5%) patients scored ≥8 in the HADS-Anxiety domain and 71 (41.0%) scored ≥8 in the HADS-Depression domain. Comparison of depressive vs non-depressive and anxious vs non-anxious groups appears on table 1. There was a correlation of HADS-Anxiety with DAS28 (r=0.391, p Conclusions Anxious or depressive patients showed higher disease activity, especially in measures with some subjectivity (such as TJC and PGA) but not regarding ESR or CRP and worse function and QoL. This fact must be taken into account when evaluating therapeutic efficacy. Disclosure of Interest None declared

Background Patient reported outcomes PRO are a key element in the global evaluation of patients, especially those followed in a day hospital. The use of touchscreen computers is one of the new features in the day hospital of Instituto Portugues de Reumatologia. Objectives to evaluate the transition from paper to touchscreen computers technology of the PRO in use in Reuma.pt Methods We considered a step up model of comparison with 2 months intervals one before the use of the touchscreen computers, one two months after the introduction of touchscreen computers and a third after an intermediate evaluation (comparison between interval 0 and 1) of the results.A specific formation to physicians and nurses to be aware of missing data from non-total completion of the questionnaires was introduced between the first and second evaluation. The percentage of questionnaires totally completed by number of patients were obtained for every period and diagnosis Results 631 day hospital appointments were evaluated according to diagnosis and interval and the percentage was obtained (Table 1) Only HADS had a significative (p On our intermediate evaluation comparing paper to tablet we saw a lower percentage of questionnaires fully completed (although not statistical significative) and a formal awareness formation addressing the causes was made with all the physicians and nurses of the day hospital. The PRO from Reuma.pt was not developed for tablets and some issues regarding missing data associated with that was found Conclusions The use of technology can contribute for better data in Reuma.pt and other national registries by saving time (medical and nurse) for clinical evaluation, by integrating patients in their evaluations and by cost reduction, and carbon footprint. Issues regarding the adaptability of software to tablet technology have to be addressed to insure an overall improvement. Disclosure of Interest None declared

Despite the widespread availability of biologics across Europe, rheumatoid arthritis (RA) patients’ access to these drugs differs significantly among countries. To compare the proportion of RA patients treated with biologics across Europe and investigate the factors that most influence it, with focus on the Portuguese case, reportedly with low access rates to biologics. The biologics’ market was characterized for 15 selected European countries. Variables potentially influencing patients’ access to biologics (PAB) in RA were also collected, including demographic, disease, economic, funding and biologics’ market-related data. A multivariable regression model identified the factors that best explain PAB. Based on these determinants, a cluster analysis was performed to group the countries with most similar behaviour regarding PAB allowing the evaluation of Portugal’s relative position among these countries. The regression model (R 2 = 0.953) indicated that PAB in selected countries is explained mostly by its gross domestic product (GDP) per capita, the usage of methotrexate (MTX) and the biologics’ distribution channel. Current MTX usage in Portugal shows similarity with practice from UK, France, Germany or Spain 5 years before, explaining why PAB in Portugal stood at 7 % in 2010, 12 percentage points below the average of selected countries. Variations in RA PAB were found across selected countries with Portugal showing the lowest proportion. GDP per capita, biologics distribution channel and consumption of MTX appear to be the best explanatory factors for these fluctuations in European countries.

Background: Although the survival rate has considerably improved, many patients with systemic lupus erythematosus (SLE) develop irreversible organ damage. Objectives: The objectives of this paper are to characterize cumulative damage in SLE patients and identify variables associated with its presence and severity. Methods: A cross-sectional analysis of SLE patients from the Portuguese Lupus register Reuma.pt/SLE in whom damage assessment using the SLICC/ACR-Disability Index (SDI) was available was performed. Predictor factors for damage, defined as SDI ≥ 1, were determined by logistic regression analyses. A sub-analysis of patients with severe damage (SDI ≥ 3) was also performed. Results: In total, 976 patients were included. SDI was ≥1 in 365 patients, of whom 89 had severe damage. Musculoskeletal (24.4%), neuropsychiatric (24.1%) and ocular (17.2%) domains were the most commonly affected. Older age, longer disease duration, renal involvement, presence of antiphospholipid antibodies and current therapy with steroids were independently associated with SDI ≥ 1. The subpopulation with severe damage had, in addition, a greater interval between the first manifestation attributable to SLE and the clinical diagnosis as well as and more frequently early retirement due to SLE. Conclusions: This large lupus cohort confirmed that demographic and clinical characteristics as well as medication are independently associated with damage. Additionally, premature retirement occurs more often in patients with SDI ≥ 3. Diagnosis delay might contribute to damage accrual.

Joint Bone Spine - In Press.Proof corrected by the author Available online since vendredi 24 avril 2015

Background Treatment of Paget9s Disease of Bone (PDB) has been revolutionized by the use of zolendronic acid (ZA). Patients usually have a dramatic response to treatment with normalization serum alkaline phosphataise (ALP) levels and a longer period of clinical remission, compared with other class agents. Data from long-term use are scarse. Objectives Evaluate the effectiveness and safety of ZA in PDB patients, as well as remission, re-treatment rates and side effects in our outpatient population since 2005. Methods A retrospective study of PDB patients treated with 5 mg ZA intravenous infusion at our day-care center. Follow up time, demographic and clinical characteristics, previous therapeutic agents, rate of response, number and reasons of re-treatment(s) and rates of adverse events were collected. A descriptive statistic analysis was made. Results 48 patients, 60% female, mean age of 75 years, with a median time since the diagnosis of 12.3 years. The disease was poliostotic in 73% of the patients and pelvis (65%), skull (29%) and spine (27%) were the most common pagetic localizations. Deafness was present in 12.5% and 65% had hip involvement. 44% patients had been treated with another biphosphonate agent previously. Response rates were 97.9% at 1 year, 87.2% after 2 years and 95.1% after 3 years. The mean ALP levels before ZA infusion was 290 UI/L and after 112 UI/L. Sixteen patients needed a re-treatment in the period of follow up, minimum of 1 year after the ZA infusion and maximum of 8 years after. 56.3% due to raised of ALP levels and 43.8% due pain/ hip involvement. Four patients needed a third infusion due to hip involvement, and 2 of them a forth infusion due to the same reason. All of the patients re-treated due to hip involvement had severe hip involvement at time of diagnosis. In our population, 2 patients achieved 10 years remission, 5 patients 9 years remission and 10 patients 8 years remission with a single ZA infusion. Recording adverse effects were: 14.6% Flu like symptoms (7 patients), 2% assintomatic hypocalcemia (1 patient) and no reports of osteonecrosis or fractures. All of these effects were reported after the first ZA infusion. Conclusions In our population, we find high long-term sustained remission rate. Only sixteen patients needed re-treatment. Patients maintained sustained remission up to 10 years of a single ZA infusion. Incidence of adverse events was similar to the reported in the literature. References Reid IR, Miller P, Lyles K et al. Comparison of a Single Infusion of Zolendronic Acid with Risendronate for Paget9s Disease. N Eng J Med. 2005 Set:353(9):898–908 Reid IR, Brown JP, Levitt N et al. Re-treatment of relapse Paget9s disease of bone with zolendronic acid: results from an open-label study. Natur BoneKEy Report 2. 2013 Nov: 442: 1–3 Reid IR, Lyles K, Brown JP et al. A Single Infusion of Zolendronic Acid Produces Sustained Remissions in Paget Disease: Data from 6.5 years, JBMR. 2011 Sep 26 (9):2261–70 Devogelaer JP, Geusen P, Daci E et al. Remission over 3 years in patients with Paget disease of bone treated with a single intravenous infusion of 5 mg zolendronic acid. Calcif Tissue Int. 2014 Mar:94(3):311–8 Disclosure of Interest None declared

Background The quality of medical care and the implementation of measures to improve it are crucial steps for the development of Rheumatology in Europe. Quality indicators were obtained through a four-step rand-modified Delphi methodology. A final set of 26 quality indicators was defined within Donabedian framework dimensions: 9 “structure”, 11 “processes” and 6 “outcomes” indicators. Herein we describe the second implementation phase of a national program, Rheuma Space (RS), aiming at quality improvement in Rheumatology. Objectives To develop a quality improvement plan for care provided by Rheumatology Departments (RD). In this second phase we present the results of the RD evaluation. Methods A measurement scale on quality/excellence thresholds was developed for each of the 26 criteria. Eight RD participated in the project and each one set up an Investigation Team of 2–3 members for field criteria measurement and evaluation that required the use of different data sources and focused on the period: 2014 – 1st semester of 2015. After data analysis an individual report was delivered and discussed with each of the 8 RD. Afterwards public presentation and discussion of the results took place. Results “Structure” was evaluated in terms of personal, training, facilities, equipment and budgeting: RD lack Rheumatology specialists and need fully dedicated nurses Training plans exist in all RD, but physicians allocate few time to research Equipment is appropriate, nonetheless microscopes and computers could be updated Internal contracting is well established and professionals are committed to targets “Processes” were evaluated in terms of access and medical care, clinical records, physician-patient communication and multidisciplinary patient management: Triage criteria for first appointments should be standardized, despite compliance for “High Priority” patients Follow up could be more frequent, but direct access in emergencies is guaranteed Reuma.pt registry is mainly used for patients under biologics and data completion could improve Multidisciplinary care is provided, but patient coverage and specialty diversity can increase. “Outcomes” were evaluated in terms of clinical outcomes, patient and personal satisfaction: Average working absence is Almost 1/3 of patients requested early retirement at a median age >50years Patients are satisfied with provided care and physicians9 attitude, but less with RD facilities Professionals are satisfied with working environment, however criticize career related aspects. Conclusions The 26 quality indicators set the basis of this quality management tool that was applied to 8 Portuguese RD. Strengths and weakness were identified and an individual Department report was elaborated and discussed. Interventions are now being planned based on these results in order to ensure quality standards of structure and process criteria for a patient oriented clinical practice, favouring desirable continuous quality improvement on health outcomes. Acknowledgements Investigation Teams from the eight Rheumatology Departments that participated in the Rheuma Space Project. Disclosure of Interest None declared

Rheumatic patients with chronic pain describe in a vivid way the influence of climate on pain and disease activity. Several studies seem to confirm this association.To evaluate and compare in a population of rheumatic patients the perceived influence of weather changes on pain and disease activityThis is a retrospective cross-sectional study. For three weeks an assisted self-reported questionnaire with nine dimensions and a VAS pain scale was performed on consecutive out-patients in our clinic.955 patients 787 female 168 male mean age 57.9 years with several rheumatologic diagnosis were evaluated. Overall 70 of the patients believed that the weather influenced their disease and 40 believed that the influence was high. Morning stiffness was influenced in 54 high influenced in 34 . Autumn and Winter were the most influential periods as well as humidity 67 and low temperatures 59 .In our study as well as in literature we found that a high percentage of patients 70 perceived that weather conditions influenced their pain and disease. Fibromyalgia patients seemed to be strongly influenced by weather changes. Our study confirms that patients perception on the influence of climate on pain and therefore their disease is an important clinical factor and it should be considered when evaluating rheumatic patients.

Background VAS scales are very useful and easy to perform scales that rheumatologists use on a daily basis. There are several ways to perform this evaluation, on paper through a ruler that includes a slider indicator among others. With the use of more electronic patient9s records it is useful to determine if the use of a computer assisted VAS could perform the same as the paper. Objectives To evaluate and validate an electronic based VAS in a touch-screen platform. Methods Patients followed in our biologic clinic were evaluated with a paper version of several visual analogue scale (disease activity, pain intensity, back pain in the night, back pain anytime and how the disease disturbs) and after with the electronic version according to their diagnosis. The touch-screen was specially developed for our patients, integrating software that recognized the patient by disease through a bar code and presented the questionnaires according to the disease. Concordance between paper rand touch-screen questionnaire was done through Intraclass Correlation Coefficients. Internal consistency was evaluated by Cronbach9s alpha coefficient. Results A total of 88 patients were included in the global disease scale (80.7% rheumatoid arthritis and 19,3% psoriatic arthritis) 85.2% were female, mean age was 54.34±11.05 years and mean disease duration was 11.83±9.32 years. Several other VAS used in spondyloarthropathies was compared in a group of 56 patients the majority were man (58.9%) , 30.4% had psoriatic arthritis, 69,6% had ankylosing spondylitis mean age was 46.69±11.78 years and mean disease duration was 10.4±8.77years. Conclusions We found no relevant difference between paper and touch-screen version of all the used VAS scales, with high correlation coefficients validating this platform. This is a useful instrument in our clinical practice, and could be a valid alternative to VAS on paper or rulers. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5384

Background Systemic lupus erythematosus (SLE) affects predominantly women of reproductive age. However, in about 15% of patients SLE begins before the age of 18 years (early-onset) and in 10-20% of patients SLE is first diagnosed after the age of 50 years (late-onset). The age at disease onset significantly impacts on clinical presentation, disease course, response to treatment and prognosis. Objectives To compare demographic, clinical features and disease outcome between patients with early-onset and those with late-onset SLE and to determine whether patients9 age affects the time interval until diagnosis. Methods All SLE patients from the Portuguese registry Reuma.pt/LES with disease onset at age≤18 years-old or at age≥50 years-old were included. Patients9 data were cross-sectionally analyzed upon records from the last visit. The differences between groups with early and late onset were determined by Student t-tests, chi-square or Fisher9s exact tests. Results 313 SLE patients were included (157 early-onset; 156 late-onset). In the early-onset group, 88% were women, mean disease duration 16.8±10.5y and mean age of diagnosis 17±5.9y. Higher education level was noted in the younger group. 81.6% of patients with late-onset SLE were women, mean disease duration 9.37±5.2y and mean age of diagnosis 60.5±7.5y. Photosensitivity, arthritis and neurological disorder were statistically more prevalent in the late-onset group. Anti-Sm positivity was observed more frequently in early-onset SLE. Co-morbidities were also more common in this age group. Disease activity evaluated using the SLEDAI-2K was higher in the early-onset (3.0±3.3 vs 2.0±2.8; p=0.01) while accumulated damage was higher in the older age group (1.0±1.3 vs 0.69±1.4; p Conclusions Patients with late-onset SLE have more co-morbid conditions and greater accumulated damage despite shorter disease duration and lower disease activity. Age of onset has a significant impact not only on the clinical characteristics and disease outcome, but also on time until diagnosis. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5306

Background Regardless of epidemiologic evidence suggesting a positive impact of protein dietary intake over bone health, the connection between dietary protein and bone metabolism remains controversial. A hyperproteic diet is linked to increased renal calcium excretion but there is no clear evidence of its relevance in the development of osteoporosis (OP). In the elderly, it is often found a low dietary protein intake and association between low serum albumin levels, femoral neck fracture and post-fracture mortality. A correlation between body composition and fall occurrence is under discussion. Objectives To study the relation between nutritional/biochemical variables and occurrence of falls and fractures. Methods A questionnaire on dietary protein intake was applied to patients at a Rheumatology clinic during 4 non-consecutive weeks from July to September 2013. Nutritional evaluation included body composition (InBody 720). Clinical data collected included: fall occurrence; history of clinical and/or radiologic vertebral fractures; total serum protein, albumin, inorganic phosphate, calcium, parathyroid hormone, vitamin D and calcium urinary excretion levels and neck/lumbar densitometry. Descriptive statistics, Mann-Whitney, Kruskal-Wallis, Qui-Square and Spearman correlation were applied for a significance of p Results 196 subjects were included, 88% female, mean age 58 years. The most prevalent rheumatic diseases were: rheumatoid arthritis (RA), osteoarthritis (OA), Sjogren9s syndrome, undifferentiated connective tissue disease, spondyloarthritis, systemic lupus erythematosus (SLE) and fibromyalgia. The average body mass index (BMI) was 27,5 kg/m2, higher in patients diagnosed with SLE, OA and RA. 20 subjects (10,2%) had previous history of fall occurrence, 24 (12,2%) had history of fractures (7 vertebral, 2 femoral neck, 4 wrist). We found correlation between the occurrence of fractures and female gender (25 vs. 0 patients, p=0,046); lower T-score at femoral neck (r=-0,521, p=0,046) and lower total serum protein levels (6,39 vs. 6,69, p=0,018). These variables were also correlated with the number of fractures. Fall occurrence was higher in older subjects (64,8 vs. 57,4 years, p=0,017), and in those with higher T-score at lumbar spine (r=0,663, p=0,014). In subjects over 58 years, we found an association with body percentage and BMI, independent of muscle mass (p Conclusions In this population, in a rheumatologic setting, fractures were commoner in women, with lower bone mineral density and lower serum protein levels. Higher BMI and body fat percentage may be risk factors for fall occurrence in the elderly, eventually related to a shift in the centre of gravity. Nutritional advice in OP patients should consider these notions. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4357

Background Patient reported outcomes are a relevant aspect in the follow-up of our patients. The use of computer assisted platforms is being introduced rapidly in our daily clinical practice. We should be comfortable in using new technologies as long as they are validated and reflect the same outcome as older forms of patient reported outcomes. Objectives To evaluate and validate an electronic based SF-36 questionnaire in a touch-screen platform Methods Patients followed in our biologic clinic were evaluated with a paper version of SF-36 and after with the electronic version. The touch-screen was specially developed for our patients, integrating software that recognized the patient by disease through a bar code and presented the questionnaires according to the disease. Concordance between paper rand touch-screen questionnaire was done through Intraclass Correlation Coefficients. Internal consistency was evaluated by Cronbach9s alpha coefficient. For categorical variables Cohen Kappa concordance coeficent was used. Results A total of 120 patients were included 75.8% were female, mean age was 50.78±11.88 and mean disease duration was 11.43±9.02, 69.9% had less than the complete secondary school level. 14.2% had psoriatic arthritis, 30% ankylosing spondylitis, and 55.8% had rheumatoid arthritis. The ICC: Intraclass correlation coefficients between touch-screen versus paper were respectively for the different dimensions of SF-36 Physical function – 0.928, Physical role – 0.870, Pain – 0.858, General health – 0.925, Vitality – 0.905, Social function – 0.899, Emotional role – 0.781, Mental health – 0.944, Cronbach9s Alpha (8 domains) for touchscreen – 0.891 and for paper – 0.907. Conclusions We found no relevant difference between paper and touch-screen version of the SF-36, with high correlation coefficients validating this platform. This is a useful instrument in our clinical practice, helping clinicians to have more data on their patient9s with less time expended. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5094

Background Work capacity is primarily assessed by absenteeism and rheumatic patients may experience decreased productivity as well as presenteeism due to their health problems as well as its costs consequences. Objectives To evaluate the relation between work disability, productivity and disease activity, quality of life and functional disability. Methods 242 rheumatic patients were recruited, 33.3% employed (N=81) completed the questionnaires of work disability and productivity: WALS (Workplace Activity Limitations Scale), SPS 6 (Stanford Presenteeism Scale) and WPAI (Work Productivity and Activity Impairment) 4 scores - absenteeism, presenteeism, work and activity impairment. Patient-reported parameters included pain, fatigue, sleep quality and disease activity (VAS). Functional disability and quality of life outcomes were assessed by HAQ-DI, FACIT and SF-12. Data were collected during a 4-week period. The analysis included descriptive statistics, Mann-Whitney test and Spearman correlation, p Results 81 gainfully employed patients (85% female) had 48±11 years old, with 10±4 schooling years. Mean VAS were: pain 47±32, fatigue 57±33, sleep quality 46±33 and disease activity 43±30; HAQ-DI: 1.76±0.9, FACIT:17±11 and SF-12: 39±13 in PCS and 43±18 in MCS. Productivity assessment revealed limitations in all measured scores: WALS 8±6 [0-25], SPS 6 12±3 [3-15], WPAI work impairment 29±32%, activity impairment 29±29%, absenteeism 2.1±12.3% and presenteeism 28±32%. WALS was positively correlated to HAQ (r=.657, p .517, p .296, p Conclusions These findings suggest the significant impact of rheumatic disease in productivity losses, and that unemployed patients present worst quality of life and higher levels of pain, fatigue and disability. We found good correlations between the productivity assessment and the SF12, HAQ, FACIT, pain, fatigue, sleep quality and disease activity. This provides information about trend of work restrictions, useful in cost-effectiveness analysis for example of new treatment therapies. Moreover, these issues are particularly important because absenteeism and presenteeism have strong links to health related costs. Prevention of work disability and job changes/adaptations to the individual capabilities would be most effective in reducing socioeconomic and work related impact. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5488

Background The relationship between protein dietary intake and Bone Mass Index (BMI) is controversial. Hyperproteic diet increases urinary calcium excretion but without obvious impact in Osteoporosis (OP). Sarcopenia in the elderly may be associated with low protein diet. High BMI and with high fat content was considered a protective factor for OP but it may be related to vitamin D deficiency and subclinical hyperparathyroidism. Objectives This study aims to evaluate the relationship between protein diet intake, BMI and and parathyroid hormone (PTH) levels. Methods A questionnaire on dietary protein intake was applied to patients at a Rheumatology clinic during 4 non-consecutive weeks from July to September 2013. Nutritional evaluation included body composition (InBody 720). Clinical data collected included: fall occurrence; history of clinical and/or radiologic vertebral fractures; total serum protein, albumin, inorganic phosphate, calcium, PTH, vitamin D and calcium urinary excretion levels and neck/lumbar densitometry. Descriptive statistics, Mann-Whitney, Kruskal-Wallis, Qui-Square and Spearman correlation were applied for a significance of p Results 189 subjects were enrolled, 88% female, mean age 58 years, mean BMI 27kg/m2 (low weight in 1,7%, normal in 33,1%, overweight in 37,7% and obesity in 27,6%). Regarding protein intake, 66,7% drunk milk >5 times/week and 22,2% >2 glasses/day; 61,3% of the patients consumed yogurt 1-3 times/day and 20,6% 0,142;p Conclusions Patients that had a lower BMI and reduced body fat content consumed more lean fish, also those with lower body fat content showed a higher intake of milk. Red meat was associated with higher muscle mass and protein content. High PTH levels were correlated with higher BMI, which is in concordance with new evidence suggesting that overweight and obesity do not protect against OP. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5279

Background Rheumatic diseases have a tremendous impact on workability and on employability. Pain, joint limitation: oedema and disability are very common in patients with rheumatic diseases with clear implications in the way patients perform their jobs. Additional impact of these diseases is linked to early retirement, absenteeism and unemployment. Objectives To determine the impact of rheumatic diseases in terms of early retirement, sick leave and unemployment due to Rheumatic diseases. To compare RD with other chronic diseases. Methods Study included a representative sample of Portuguese population of 10661 subjects, using a random-rout selection method. Interviews were applied in peoples9 home to the adult with birth date closer to interview9s date. Data concerning demographic, clinical and work situation were collected; quality of life and general health status questionnaires were applied. Data were analyzed considering descriptive statistics and comparison between groups using Chi-square test and Mann-Whitney test (p value Results 10,661 subjects, 61.5% female, mean age 53±18 years old. Considering as having an auto-reported rheumatic disease (RD) those who affirmed having Rheumatoid arthritis and/or Ankylosing spondylitis/Spondiloarthropaty/Spondyloarthritis and/or Psoriatic arthritis and/or Osteoarthrosis and/or Osteoporosis and/or Gout and/or Rheumatic polymyalgia and/or Lupus and/or Fibromyalgia and/or Periarticular rheumatism/Tendinitis/Bursitis, Considering the group of patients reporting a RD 19.3% of retired subjects who reported a RD affirmed they were retired due to their disease (n=234/1213), 14.3% were unemployed due to RD (n=16/112 RD patients unemployed) and 73.8% had temporary work incapacity (n=31/42 RD patients who were with temporary work incapacity).The percentage of people with a RD retired due to was similar to those with a cardiac disease and, slightly higher than those with an oncological disease. 36.4% of RD patients affirmed that they couldn9t work at least a day in the last 12 months due to a RD. RD had more impact in patients9 ability to work than other chronic diseases, like cardiac, digestive and neurological diseases, as data show that subjects who referred a RD presented a higher percentage of absenteeism due to their disease than the subjects with other diseases. Subjects with reported fibromyalgia presented a higher number of days with temporary work incapacity due to RD, in the past 12 months, when compared with those who did not referred that disease (107.24±128.45 days vs. 40.43±125.32 days; p Conclusions This nationwide study would determine a significant relationship between the presence of self-reported RD and retirement, unemployment and sick leave with more than 70% of patients showed work incapacity due to the RD. RD seems to have a higher impact on work status than other chronic diseases. No difference was found between different rheumatic diseases regarding the works status, except for fibromyalgia, that has a higher number of absenteeism from work in the previous year. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6023

Background The social impact of a disease can be related to its mortality but also to the prevalence and disability associated. In osteoarthritis (OA), pain, joint limitation and overall disability are the main components of its social and individual impact. Objectives To evaluate the impact of self-reported OA and to study its correlation with several clinical and socio-demographics factors. Methods Observational, population-based, cross-sectional study was conducted in mainland Portugal by Eurotrials Consultants, between September and October 2011, by random route. Citizens aged ≥45 years who agreed to participate completed a survey in home interviews including socio-demographics and presence of OA. Prevalent cases of OA were characterized regarding treatment, comorbidities, impact of OA (VAS 0-10, none to higher impact), pain of OA (VAS 0-10, no pain to worse pain), patient’s perception of importance of OA given by current physician (VAS 0-10, none to higher importance), disability due to OA (VAS 0-10, none to maximum disability) and health status (SF-12 v2.0®; physical and mental health, 0 no health - 100 better health). Spearman correlation coefficient (r) was calculated Results A representative sample of 1039 participants completed the screening survey. About 54% were female, mean age of 62 years (range: 45-99), average of 7 school-years, 18% obese (body mass index ≥30 kg/m 2 ) and 77% retired (0.8% due to OA). OA was self-reported by 9.9% of participants (95% CI 8.1-11.7%), 92% of those with OA diagnosis confirmed by x-ray (self-reported). In this population, the score for OA impact averaged 6.1. The mean score for mental and physical health was 45.9 and 38.5, respectively. About 30% of OA cases referred previous sick leave or temporarily work stop due to OA (absenteeism varied between 3 days and 3 years). 41.4% of OA participants had to change from job activity, 34.5% had to change the way their occupational tasks were done and 10.3% had to stop working definitely. OA had a higher impact in participants which had already been in sick leave or temporarily had to stop working due to OA (8.1 vs 6.0; p=0.001). Impact of OA showed to be associated with physical (r=-0.582; p Conclusions OA is related in our study to a low psychological but even lower physical outcome in the SF-12. Sick leave was present in almost a third of the cases and work adjustments or change of occupation was even more relevant. One in ten patients had to stop working due to OA. In an ageing population that has to work more years than before, we have to take in to account that disease can influence the work productivity and performance and that OA is a serious issue as an occupational and as an overall economic burden to the society. Disclosure of Interest None Declared

Background In RA, many different clinical and biochemical variables and composite measures reflect the degree of inflammation in the joints. Joint inflammation can lead to joint destruction in most patients. Joint destruction is considered a key outcome in RA and is linked to the worsening of HAQ. One of the claimed breakthroughs of biologic agents is their potential to arrest radiographic progression but is this clinical relevant on the daily practice to consider starting a biologic? Objectives Assess the main reasons for biologic therapy introduction in RA patients and the relevance of radiological progression on the selection of patients for biological therapies. Methods Development and implementation of a questionnaire among Portuguese Hospital-based Rheumatologists in order to collect data regarding the reasons they consider important when starting biological therapies in RA patients. This questionnaire also evaluated the impact of radiological progression on starting biological therapy decision Results 31 rheumatologists answered the questionnaire (about 25-30% of the Portuguese hospital-based rheumatologists); 17 female (55%) with a mean age of 42.7±9.3 years (var: 31-60 years). The mean average time as a specialist was 9.9±7.8 years (var: 1-25 years). The answers to question ``Choose 2 from a total of 6 reasons for prescribing biological therapy99 were: 29 DMARDs failure; 19 maintain disease activity; 3 meets the SPR criteria; 3 radiological progression; 2 physical and psychological disability; 1 young and active patient. When asked about the clinical importance of radiological progression: 11 classified as extremely important; 15 very important, 4 important; 1 less important and 0 answered no importance. Another question included in this questionnaire was ``On the last 100 AR patients observed, in how many times have you assessed the radiological progression through the Total Sharp Score method?99 25 didn9t applied to any patient, 3 applied to 1 patient, 2 applied to 2 patients and 1 applied to 10 patients. So, for a potential number of 3100 patients observed, 17 were evaluated for the radiological damage (0.5%). Conclusions There is scientifically data demonstrating the importance of radiological progression evaluation; but in the clinical practice this isn9t possible. The radiological progression evaluation methods are difficult to apply and time consuming, so they have been losing their relevance in daily clinical practice. The main reasons for the rheumatologist to start biological therapy are increased disease activity and failure of synthetic DMARD9s, that are known to been intimately connect with radiological progression. Alternative methods should be developed, such as risk matrices and therapeutic strategies, in order to evaluate radiological progression, allowing a better and adequate management for RA patients. Disclosure of Interest None Declared

Background The awareness of osteoporosis (OP) symptoms and evolution may impact on patients daily activities. Osteoporosis may cause pain, reduce physical functioning and mobility also resulting in social isolation and depression 1 . Objectives To evaluate Health Related Quality of Life (HRQoL) and pain in subjects with and without self-reported OP, in the general population and in a high risk of fracture (HRF) population. Methods Cross sectional survey including a representative sample of Portuguese population aged ≥50 years (random route method, door to door) and a HRF population (convenience sample, selected randomly from nursing homes and long term facilities from Portugal). Inclusion criteria for HRF population were age ≥50 years, history of femoral neck fracture on the 24 months prior and absence of cognitive limitations. SF12 scale and ECOS were used. Results From the 2007 subjects of the general population (mean age of 65.3±10.4 years; 55.2% female), 62 (3.1; CI: 2.4%>3.9%) self-reported OP. HRF population included 419 subjects (mean age of 78.3±7.8;70.4% were female), 37.5% (n=157; CI: 32.9%>42.2%) self-reported OP. Significant differences were found for SF12 dimensions between subjects in general population with and without self-reported OP (Table 1). In HRF population no significant differences were found (Table 1). Regarding ECOS, significant differences were found between general population and HRF population with self-reported OP (2.74±0.79 vs. 3.15±0.85, p=0.001). No significant differences were found in ECOS pain items between general population and HRF population with self-reported OP (ECOS items 1 to 5: p=0.410; p=0.134; p=0.086; p=0.323; p=0.144, respectively). Conclusions The evidence suggests that the HRQoL on the general population with self-reported OP was significantly lower in comparison with the population without OP, although no significant differences were found between groups in the HRF population. That could be partial explained by the presence of a low hip fracture in this group. References Bianchi ML, Orsini MR, Saraifoger S, Ortolani S, Radaelli G, Betti S. Quality of life in post-menopausal osteoporosis. Health Qual Life Outcomes 2005;3:78. Disclosure of Interest None Declared

Background FRAX tool has been developed by the World Health Organization (WHO) to estimate the 10-year fracture probability in men and women from clinical risk factors, age, sex and body mass index with or without the measurement of femoral neck bone mineral density 1 . Objectives To evaluate the differences in the Portuguese population in the FRAX 10 year probability of fracture and reported risk factors for osteoporosis (OP), comparing the general population and a high risk fracture (HRF) population. Methods Cross sectional survey was performed including subjects representative of the Portuguese population aged ≥50 years(selected by random route method, door to door) and a HRF population (convenience sample, selected from nursing homes and long term facilities in Portugal). Inclusion criteria for HRF population are age ≥50 years, history of femoral neck fracture on the 24 months prior, absence of cognitive limitations. The overall and HRF population included demographics and clinical variables. The FRAX 10 year probabilities of hip and major osteoporotic fractures were calculated, according to the Spanish algorithm and reported risk factors for OP were collected. Descriptive analysis was performed, including relative frequencies for categorical variables and mean ± standard deviation for continuous variables. T-test was performed to validate study hypothesis. Confidence intervals (CI) of 95% will be determined and all calculations were performed assuming a 5% significance level. Results The analyses included 2007 subjects from the general population (mean age of 65.3±10.4 years, 55.2% female). 62 subjects self-reported OP (3.1%; 95% CI: 2.4%>3.9%). The HRF population included 419 subjects (mean age 78.3±7.8, 70.4% female). In general population, the probability of a major osteoporotic fracture was 5.0±5.3 and 2.1±3.7 for hip fracture. This values were statistically higher for subjects in general population with self-reported OP (Major Osteoporotic: 11.0±11.8 vs. 4.8±4.8; p vs. 1.9±3.1; p=0.003). The probability of a major osteoporotic fracture in HRF population was 20.7±11.4. Considering hip fracture, HRF population had a mean probability of 12.1±9.6. No significant differences were found in the HRF population between subjects with and without self-reported OP. Conclusions As expected, subjects in HRF population (that already had suffered a previous fracture) have a higher risk for major osteoporotic and hip fractures when compared with the general population. References Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E. FRAX and its applications to clinical practice. Bone 2009;44(5):734-43. Disclosure of Interest None Declared

Background Over the past 15 years, rheumatologists have developed and witnessed many paradigmatic changes in the treatment of rheumatoid arthritis (RA). In RA, joint damage and physical disability are the major adverse outcomes associated with reduction in quality of life and premature mortality. Some inconsistencies in therapeutic targets and strategies among rheumatologists have been recognised. EULAR published the “EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs”. But what is the real impact on clinician’s daily practice of these guidelines. Objectives To assess Portuguese Rheumatologists’ opinion on the “EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs” published in May 2010. The opinion from 52 experts regarding the 15 recommendations published this year by the EULAR, is presented at table 1. When assessing the potential impact of these recommendations, 62% of the experts considered these recommendations important to their practice, nevertheless 61% of the present rheumatologists said that they wouldn’t change their common daily practice Conclusions Although there is an overall agreement in most of the recommendations, there are some that are not so consensual. Although the Portuguese rheumatologists considered them important, they wouldn’t change their clinical practice after this publication. This may reflect the gap between EULAR recommendations and real life practice. A greater involvement of all countries that constitute the EULAR is needed, so that different sensibilities and expertises are covered. References Smolen JS et al. Ann Rheum Dis 2010;69:631-7. Smolen JS et al. Ann Rheum Dis 2010;69:964-75. Disclosure of Interest None Declared

Background Femoral neck fracture is considered as one of the most severe consequence of osteoporosis (OP) due to its high mortality and morbidity, affecting patients’ Health Related Quality of Life (HRQoL) physically, psychologically and socially1. Objectives To evaluate HRQoL and impact of femoral neck fracture in subjects lives in a high risk of fracture (HRF) population with and without self-reported OP. Methods HRQoL was assessed by SF12 scale and subjects perception on their HRQoL before and after the fracture. Cross-sectional survey including a convenience sample of HRF population selected randomly from nursing homes and long-term care facilities in Portugal. Inclusion criteria for subjects were age ≥50 years, history of a low impact femoral neck fracture on the 24 months prior, absence of cognitive limitations. Confidence intervals (CI) of 95% will be determined and calculations were performed assuming a 5% significance level. Results 419 HRF subjects were included, mean age 78.3±7.8, 70.4% female. From these 37.5% (n=157;CI: 32.9%>42.2%) self-reported OP. Mean age for occurrence of a femoral neck fracture was 77.2±8.1, with no significant differences between subjects with and without self-reported OP (77.3±9.6 vs. 76.9±7.4; p=0.656). In a scale of 1 (worst possible) to 10 (better possible), significant differences were found for subjects’ perception about their HRQoL before and after femoral neck fracture (7.0±2.4 vs. 4.2±2.3; p Conclusions Subject’s perceptions of their HRQoL change after a femoral fracture. Lower HRQoL levels are reported by individuals after experiencing a femoral neck fracture. Fracture is a life altering event on people’s lives diminishing their QoL. References Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA. Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 2000;11(5):460-6 Disclosure of Interest None Declared

Background Sexual satisfaction is an important issue in everyday life of modern occidental societies. The quality of sexual life, self-esteem and relationship issues might be impaired in patients with chronic rheumatic diseases, due to their poor physical health, pain and functional disability.1 Objectives The aim of this study is to assess the self-esteem, confidence and relationship satisfaction in patients with rheumatic disease, maintaining sexual activity. Methods 97 patients were selected in an inpatient questionnaire was applied concerning sexual and socio-demographic information (age, education, marital status, occupation, frequency of sexual activity); the Self-Esteem and Relationship (SEAR) questionnaire: Sexual Relationship domain and Confidence domain; Quality of life was assessed by the Short Form-12 Health Survey (SF-12). Several visual analogue scales (VAS, higher value means higher involvement) were applied for pain, sleep quality, fatigue and two sexual questions: “how far your disease limited your sexual activity” (VAS-SexAct) and “how far your sexuality is important in your relationship” (VAS-Relation). Results A total of 42 patients were sexually active, 90.5% were female, mean age 56.3±9.8 years [34-77], were distributed by the following diseases: 31% with rheumatoid arthritis (RA), 19% with connective tissue disease (CTD), 16.7% with spondylarthritis, 16.7% with SMED, 11.9% with osteoarthritis (OA) and 4.8% for other diseases. In the frequency of sexual intercourse analysis, 64.3% reported “once or more than once a week”. Sex frequency was associated with higher limitation in VAS-Relation and with lower scores in SEAR domains. SEAR global score was 51±21 [11-89], (highest score means greater satisfaction) the sexual relationship domain was 42±25 and confidence domain had an average score of 59±21. The mean SF-12 physical component score (PCS) was 27±7 and the mental component score (MCS) 35±11. Higher limitation in VAS on “how far your disease limited your sexual activity” (VAS-SexAct) was related to lower values in the PCS. Patients with lower sexual satisfaction and confidence had higher MCS impairment. In RA patients, the global SEAR score and all SEAR domains correlated with VAS on “how far your sexuality is important in your relationship” (VAS-Relation); fatigue was associated with major limitations on VAS-SexAct. In patients with CTD, pain was associated to lower confidence; the PCS related to VAS-SexAct and the MCS with VAS-Relation. In SMED patients, SEAR score influenced the SF-12 mental health. In Spondylarthritis, sexual activity limitation by disease affected the quality of sleep; the mental health domain was associated with higher confidence. In patients with OA, the VAS-SexAct was related to pain and to the SF-12 physical health. Conclusions Our study demonstrates that the SF-12 scores were well below average, with significant impairment of physical and mental health. Mental health was related to confidence domain and to relationship limitation by disease. Sexual satisfaction was influenced by several factors, such as general health, pain, fatigue and sleep quality. It was demonstrated that the disease may be a constraint on relationship and sexual quality of life. References Sexual function in rheumatic diseases. Araujo DB, Borba EF, Abdo CH, Souza Lde A, Goldenstein-Schainberg C, Chahade WH, Silva CA: Acta Reumatol Port 2010 Jan-Mar;35(1):16-23. Disclosure of Interest None Declared

Background Physical disabilities can cause disturbances in a patient’s body image.Body dissatisfaction has severe impact on obesity related psychological distress and other mental health problems. The recommendation to achieve optimal weight and body fat tissue has been an essential principle in the non-pharmacologic treatment of most rheumatic diseases. Objectives This study aim is to evaluate body perception on rheumatic patients and its relation to body composition, pain and quality of life. Methods Demographic information was recorded, quality of life was assessed by the Short Form-12 Health Survey (SF-12) (physical component score - PCS and mental component score - MCS), the body image perception was assessed by an adapted body shape questionnaire (BSQ) with 13 figures, and two visual analogue scales (VAS, value increase with body surface area) for the current and ideal appearance. Body composition was determined by octapolar bioimpedance (Inbody720). Results A total of 96 patients from a rheumatology inpatient clinic, 95% female, mean age 61.5±11.9 years [34-91], 30% with rheumatoid arthritis (RA), 22% with connective tissue disease (CTD), 14.6% with Spondylarthritis, 14.6% with osteoarthritis (OA), 13.5% with SMED and 5% other diseases. The majority was overweight (36.5% pre-obese, 35.4% obese), with mean BMI of 28.3±5.7, no significant differences between diseases. Body fat (BF) average of 38.3% was higher in RA patients (42.1% GC; p=0.018). The visceral fat (VF) was increased in 80% of patients, especially in RA (89.7%; p=0.039). The current body image (CI-BSQ) was 7±3 figures, with higher value in RA (7.3) and the ideal appearance (IdI-BSQ) was 4±2, with a higher value in the CTD (4.4). The mean current image VAS was 46.5±25.8 (higher score means larger body surface area), with higher value in the RA (EVA: 51); mean ideal VAS appearance of 18.6±15.1, was higher in Spondylarthritis (EVA: 21). Spondylarthritis (Δ3.43±3.1) and RA (Δ3.38±2.7) patients presented the highest body shape difference between current and ideal appearance, while current and ideal VAS’s variation was higher in RA (Δ31.5), SMED (Δ29.5) and CTD (Δ27.3). BMI was associated with higher CI-BSQ (r =0,770, p 0,455, p Conclusions The BSQ was correlated to the corresponding VAS (current and ideal), as well as body composition variables. We observed an increased prevalence of overweight and obesity (72%) and a significant excess of body fat (38%) and visceral fat (80%), especially in patients with RA. Body image dissatisfaction was higher in RA, even when no difference in BMI between the studied diseases. Patients with higher BMI, increased body fat and visceral fat generally reported greater dissatisfaction with body image. The larger body image gap to ideal appearance was observed in RA patients, showing the significant dissatisfaction with body image. Measuring body dissatisfaction might provide a good tool to identify high risk groups to develop optimal intervention programs, for which rheumatic patients would significantly benefit due to their physical impairments. Disclosure of Interest None Declared

Background Pharmacological treatment in osteoporosis (OP) has been demonstrated as effective in significantly reduction the risk of osteoporotic fracture. However, the effectiveness of this treatment may be compromised by poor treatment compliance and can result in increased rates of fracture 1 . Objectives To evaluate patients’ compliance for the treatment of OP, comparing patients in the general population and subjects in a high risk of fracture (HRF) population. Methods Cross sectional survey was performed including subjects representative of the Portuguese population ≥50 years (selected by random route method, door to door) and HRF population (convenience sample, selected from nursing homes and long term facilities from Portugal). Inclusion criteria for HRF population are age ≥50 years, history of femoral neck fracture on the 24 months prior and absence of cognitive limitations. The general and HRF population included demographics and clinical variables. Patients’ compliance was evaluated through the Morisky scale (range 0-7). It was performed a descriptive analysis of all variables collected, including relative frequencies for categorical variables and mean ± standard deviation for continuous variables. T-test and chi-square test were performed to validate the study hypothesis. All calculations were performed assuming a 5% significance level. Results This analysis included a total of 2007 subjects from the general population (mean age of 65.3±10.4 years, 55.2% female). 3.1% (n=62; CI: 2.4%>3.9%) had self-reported OP. HRF population included 419 subjects (mean age of 78.3±7.8, 70.4%female). From these, 37.5% (n=157; CI: 32.9%>42.2%) had self-reported OP. In general population with self reported OP 67.7% (n=42) referred being medicated and more than half referred to never forget to take their medication (56.5%; n=26). In HRF population 91.1% (n=143) were medicated for OP and the majority of patients reported never forgetting to take their medication (71.6%; n=106). Globally, the results suggest that HRF population is more compliant than the general population with self-reported OP (Morisky scale value 5.9±0.7 vs. 4.1±1.9; p vs. 2.0%; p vs. 5.4%; p vs. 8.1%; p vs. 4.1%; p Conclusions Our study proves that OP treatment is poor; especially the HRF population and that compliance is lower in the general population. This behavior may expose patients to higher risk of developing low bone mass and consequent osteoporotic fractures. Patient and physician awareness and education must be stimulated as a useful way of improving compliance with treatment. References Huas D, Debiais F, Blotman F, Cortet B, Mercier F, Rousseaux C, Berger V, Gaudin AF, Cotte FE. Compliance and treatment satisfaction of post menopausal women treated for osteoporosis. Compliance with osteoporosis treatment. BMC Womens Health. 2010 Aug 20;10:26. Disclosure of Interest None Declared

Background Osteoporosis (OP) is associated with pain, disability and increased mortality 1 . For being a silent disease and recognized by the general population as an aging disease 2 a population with OP and an older population can be more aware of its severity. Objectives To evaluate subjects’ perceptions on OP including its severity degree, in individuals in the general population and individuals in a high risk of fracture (HRF) population, comparing subjects with and without self-reported OP. Methods A cross sectional survey was performed including a representative sample of the Portuguese population aged ≥50 years (selected by a random route method, door to door) and a HRF population (convenience sample, selected randomly from nursing homes and long term facilities from Mainland Portugal). Inclusion criteria for the HRF population are age ≥50 years, history of femoral neck fracture on the 24 months prior and absence of cognitive limitations. Survey included demographics and clinical variables. A descriptive analysis was performed for all variables, including relative frequencies for categorical variables and mean ± standard deviation for continuous variables. T-test was performed for the study hypothesis. 95% Confidence intervals (CI) are determined and all calculations assume a 5% significance level. Results The analyses included 2007 subjects from the general population (mean age 65.3±10.4 years; 55.2% female). 62 subjects self-reported OP (3.1%; 95% CI:2.4%>3.9%). The HRF population included 419 subjects (mean age 78.3±7.8), being 70.4% female. 37.5% self-reported OP (n=157; 95% CI: 32.9%>42.2%). In a scale from 1 (no severity) to 10 (maximum severity), the general population graded OP as 5.7±2.0. Self-reporting OP subjects significantly graded this disease as more severe than the remaining population (7.6±1.9 vs. 5.7±2.0; p vs. 6.4±2.2; p vs. 6.8±2.2; p vs. 5.6±2.4; p vs. 6.1±2.5; p Conclusions The high risk population understands OP as a more severe disease than the general population. Moreover, subjects with self-reported OP tend to grade OP as a more serious disease when comparing with subjects without OP, in both studied populations. Awareness of this disease must be improved in order to trigger prevention measures especially for the general population. References American College of Rheumatology. The Role of Rheumatologists in the Management of Osteoporosis – Position statement. Werner P. Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int 2005;16(2):115-27. Disclosure of Interest None Declared

Background Osteoporosis (OP) is a major public health problem with great impact on patient’s quality of life and daily living activities. Knowledge on OP may influence the engagement in preventive measures for the development of the disease and fracture 1,2 . Objectives To evaluate information sources and knowledge about OP, comparing three populations: general practitioners (GPs), general population and high risk fracture (HRF) population. Methods Cross sectional survey was performed including GPs (convenience sample, contacted via email or telephone), subjects representative of Portuguese population aged ≥50 years (selected by random route method, door to door) and HRF population (convenience sample, selected from nursing homes and long term facilities from Portugal). Inclusion criteria for HRF population were age ≥50 years, history of femoral neck fracture on the 24 months prior, absence of cognitive limitations. Descriptive analysis was performed, including relative frequencies for categorical variables and mean ± standard deviation for continuous variables. Results 194 GPs were included (mean age 51.6±9.9 years, 53.1% female). In general population, 2007 subjects were included (mean age of 65.3±10.4 years, 55.2% female). 419 HRF subjects were included (mean age of 78.3±7.8, 70.4% female). GPs mentioned congresses and clinical meetings (88.7%), followed by medical sales representatives (74.7%) as the most common sources of information on OP. General population referred having heard about OP (80.9%), mostly through television (64.8%) and GPs (41.5%). In HRF population, 80.7% referred having heard about OP, being the most referred information sources GPs (57.8%) and television (29.8%). In a TRUE and FALSE questionnaire, all GPs referred as being TRUE OP is more frequent in women after menopause (100%). In general population, 75.4% acknowledged OP is a bone disease, OP is an unavoidable consequence of aging (43.0%) and for the majority of subjects with OP the mean life expectancy is significantly affected (40.1%). For HRF population, the three most frequently indicated as being TRUE were OP is a bone disease (75.2%), OP is an unavoidable consequence of aging (63.7%) and OP is a joint disease (47.7%). GPs considered fracture (94.8%), height decrease (83.0%) and curvature of the spine (79.9%) as the main OP symptoms. 70.3% of general population mentioned at least one disease symptom, being most commonly pointed pain (82.1%). In HRF population, 76.4% indicated at least one OP symptom, with pain (86.3%) and fracture (81.3%) the most common ones. Conclusions Despite the awareness about the existence of the disease, there is still a great gap in the knowledge of OP symptoms, severity and consequences. Both general population and HRF population referred GP has one of their sources of information. Strategies for information dissemination could be developed to help increasing GP awareness for this disease that will also help spreading it to the rest of the population. References von Hurst PR, Wham CA. Attitudes and knowledge about osteoporosis risk prevention: a survey of New Zealand women. Public Health Nutr. 2007;10(7):747-53. Riaz M, Abid N, Patel J, Tariq M, Khan MS, Zuberi L. Knowledge about osteoporosis among healthy women attending a tertiary care hospital. J Pak Med Assoc 2008;58(4):190-4. Disclosure of Interest None Declared