D. Peixoto

AB0581 Two years existence of reuma.pt/vasculitis – the portuguese registry of vasculitis

Background The vasculitides are a group of relatively rare diseases with different manifestations and outcomes. New therapeutic options have led to the need for long-term registries. The Rheumatic Diseases Portuguese Register, Reuma.pt, is an electronic clinical record, created in 2008, which currently includes specific protocols for 11 diseases and >16000 patients registered from 79 national and international rheumatology centres. Since October 2014, a dedicated protocol to vasculitis has been created as part of the European Vasculitis Society initiative of having compatible European registries. Objectives To describe the structure of Reuma.pt/Vasculitis and characterize the patients registered over the last two years. Methods We developed a dedicated web-based software to enable prospective collection and central storage of anonymised data from patients with vasculitis. All Portuguese rheumatology centres were invited to participate. Data regarding demographics, diagnosis, classification criteria, imaging and laboratory tests, outcome measures of prognosis, damage, disease activity and quality of life, and treatment were collected. We performed a cross-sectional descriptive analysis of all patients registered up to January 2017. Results A total of 492 patients, with 1114 visits, from 11 centres were registered in Reuma.pt/Vasculitis. The mean age was 53±20 years at last visit; 68% were females. The diagnoses followed the 2012 Chapel Hill Consensus nomenclature (Table 1). The most common diagnoses were Behçets disease (BD) (39%) and giant cell arteritis (GCA) (20%). Patients with BD met the International Study Group 1990 criteria, the International Criteria for BD 2006 and 2013 in 84%, 95% and 95% of cases, respectively. Patients with GCA met the 1990 American College of Rheumatology criteria in 95% of cases. Data on vascular ultrasound was available in 74% of patients; 73% compatible with the diagnosis. Assessment of the Birmingham Vasculitis Activity Score (BVAS) and Vasculitis Damage Index (VDI) was available for all vasculitides and the Five Factor Score calculation of survival rate for ANCA associated vasculitis (AAV) and polyarteritis nodosa (PAN). The mean BVAS at first visit was 18±7 for AAV and 15±9 for PAN; the mean VDI at last visit was 3±2 for AAV and 2±2 for PAN. Health related quality of life assessments (SF-36, EQD5, FACIT and HADS) were also collected. Treatment registry with the disease assessment variables shown in graphics was available for all patients; only 6% were under biologic treatment. Conclusions Reuma.pt/Vasculitis is a registry adapted for routine care, allowing an efficient data repository at a national level with the potential to link with other international databases. It facilitates research, trials recruitment, service planning and benchmarking. Disclosure of Interest None declared

FRI0330 Fatigue and depression in patients with behcet's disease

Background Behcets disease (BD) is a systemic vasculitis of unknown etiology defined by a classic triad consisting of aphtous ulcers of the mouth and genital and uveitis. In addition to these, BD may involve cardiovascular, pulmonar, neurological, articular and gastrointestinal manifestations. Fatigue, anxiety and depression are important problems in chronic inflammatory diseases. There are few studies on fatigue in BD patients. Ilhan et al. 1 reported more fatigue in BD patients than in healthy controls. Objectives The objective of this study was to investigate fatigue and depression in patients with BD and to examine the relationship between these symptoms and disease activity and gender. Methods Forty four patients with BD and thirty nine healthy controls (HC) were included in this study. Age, gender, disease duration and clinical involvements were recorded. All subjects completed the FACIT Fatigue Scale (FACIT-F), Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS) and Health Assessment Questionnaire (HAQ). Disease activity among BD patients was assessed using the Birmingham Vasculitis Activity Score (BVAS). Results The mean age was 40.0 years for BD patients and 38.7 for HC. 77% of BD patients were women. The mean disease duration for BD patients was 6.1 years. All patients had oral ulcers and genital ulceration; 20 had pseudofolliculitis; 9 had uveitis, 9 had erythema nodosum, 12 had articular involvement, 5 patients had vascular involvement, 4 had pathergia, 1 had orchitis and one had gastrointestinal involvement. Thirty two BD patients were taking medication, including colchicine or DMARDs or their combinations. Seventeen patients had inactive disease and twenty seven had BVAS ≥1. As shown in Table 1, both the HADS-depression (HADS-D) (4.7 vs 2.5) and HADS-anxiety (HADS-A) (8.3 vs 5.7) scores were elevated in BD patients compared to healthy controls. FACIT-F was higher in healthy controls in comparison with BD group (44.1 vs 36.6), revealing lower levels of fatigue. There were no differences between gender on these scores.Table 1. Comparison of BD patients and HC Scales BD (n=44) HC (n=39) P-value FACIT-F 36.6±7.3 44.1±6.4 <0.001 HADS-D 4.7±2.4 2.5±2.4 0.004 HADS-A 8.3±4.2 5.7±2.8 0.03 There were no significant differences in FACIT-F, HADS-A and HADS-D scores with the disease activity (P=0.952, P=0.391 and P=0.286, respectively). FACIT-F had a negative correlation with HAQ and HADS and a positive correlation with the different components of SF-36 and age. FACIT-F score was not correlated with disease duration (Table 2).Table 2. Correlations between FACIT-F and HAQ, HADS-A, HADS-D, SF-36, age, disease duration in BD HAQ HADS-A HADS-D SF-36 Age Disease duration r-value -0.670 -0.569 -0.562 0.857 -0.370 0.053 P-value <0.001 <0.001 <0.001 <0.001 0.013 0.103 Conclusions In our study, fatigue and increased levels of anxiety and depression were more common in BD patients. Contrary to the study of Ilhan et al 1, we found that fatigue was not higher in patients with active disease. Similarly, there were no correlation between the assessed scores and gender. In spite of these results, the authors believe that controlling the symptoms may improve the quality of life in BD patients. References Ilhan et al. Fatigue in patients with Behcets syndrome: relationship with quality of life, depression, anxiety, diability and disease activity. International Journal of Rheumatic Diseases. 2016. Disclosure of Interest None declared

AB0802 Beliefs and treatment satisfaction in patients receiving biological agents

Background Treatment satisfaction represents an important outcome as it is related to adherence and willingness to continue treatment. Patients beliefs related to the medication (eg, about side effects and safety) also influence their satisfaction and, consequently, the treatment success. Satisfied patients are more likely to maintain a good relationship with a healthcare provider and report better health status1. Objectives To evaluate the beliefs and satisfaction of our patients with inflammatory rheumatic diseases with their current biological therapies. Methods Forty-one consecutive patients observed at our day-care unit completed an 18-item questionnaire concerning biological treatment. It included questions addressing their perceptions and satisfaction with their current treatment, information provided by their physician and about the knowledge and satisfaction regarding the cost of these therapies. The questionnaire was applied by the nurses to patients and blinded to provide anonymity. The attending physician was previously asked to record the disease state (remission/not remission) of each patient. Results We included 26 females and 15 males, with a mean age of 47.1±11.9 years. Forty six percent of the patients had rheumatoid arthritis, 27% psoriatic arthritis, 22% ankylosing spondylitis and 5% had undifferentiated spondylarthritis. Forty six percent of the patients were treated with etanercept, 29% with adalimumab, 13% with infliximab, 7% with rituximab and 5% with tocilizumab and 85.4% of patients were in clinical remission. Regarding the information provided by their doctor about the treatment, 95% of patients were satisfied, 97.6% responded that this treatment was effective to control the disease and 100% that their quality of life improved with this medication. Concerning safety, although 82.9% considered this drug safe, 56% responded that they had to take special care about their health, 22% believed to have more health complications and 14.6% experienced some side effects. Regarding convenience, 87.8% responded that their treatment frequency was convenient but 46.6% were unsatisfied with the form of administration and 24.4% reported that their treatment form/frequency interfered with their professional life. In relation to costs of the biologic agents,83% of patients considered that they are expensive and 98% didn’t agreed with the price. However when we tried to understand if patients had a correct notion of the cost, 73% of patients responded <1000 euros (€)/month, 46% <500 €/month and 22% said <100 €/month. Conclusions The majority of our patients were satisfied with the information provided by their doctor, considered the treatment effective in controlling the disease, reported improved in quality of life and considered them as safe drugs. In the negative perspective, we emphasize that 46.6% of patients are unsatisfied with the form of administration and 24.4% reported that it interfered with their professional life. Although most patients considered biological agents as expensive drugs, the majority underestimated their real cost, which reinforces the need for continuous education to raise the awareness of patients to avoid oversights/waste with the drug. References DiMatteo MR, Prince LM, Taranta A. Patient’s perceptions of physician’s behavior: determinants of patient commitment to the therapeutic relationship. J Community Health 1979;4:280-90. Disclosure of Interest None Declared

THU0454 Thyroid Involvement in Patients with Spondyloarthritis

Background The association between chronic inflammatory diseases and thyroid dysfunction is well recognized. This fact can be attributed to hormonal factors and the presence of a facilitator genetic terrain. Increased prevalence of Hashimoto’s thyroiditis (HT) has been described in rheumatoid arthritis, sjögren’s syndrome and systemic lupus erythematosus1. However, there are few data on the association of this disease in other chronic rheumatic disorders such as spondyloarthritis (SpA). Objectives To assess the prevalence of HT in a group of patients with SpA. Methods We included in this study 62 consecutive patients with SpA and 61 age-matched controls with osteoarthritis, primary osteoporosis or fibromyalgia. From January 2012 until January 2013, blood samples were drawn in all subjects. Thyroid-stimulating hormone, free triiodothyronine, free thyroxine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), titers of antithyroglobulin (anti-TG) and antithyroid peroxidase (anti-TPO) antibodies were measured. The thyroid ultrasound was performed in all patients with changes in thyroid function tests. Age, gender, disease duration and medical treatments were collected. To assessdisease activity we evaluated the DAS 28 in peripheral SpA and the BASDAI in axial SpA. In the statistical analysis (chi-Square and student T-test for categorical and continuous variables, respectively), a significant association was considered if p<0.05. Results We found thyroid dysfunction in 12.9% of SpA and in 3.3% of controls (p<0.05). Hypothyroidism was more common than hyperthyroidism in both groups. We found anti-TG or anti-TPO positive in 16.1% of SpA and in 6.6% of controls (p=0.05) and the anti-TPO was the most frequent in both groups. The prevalence of HT (antibody positivity and ultrasonographic changes suggestive of thyroiditis) was higher in patients with SpA than in controls (9.7% vs 1.6% respectively, p<0.05). Among patients with SpA, HT was significantly more frequent in patients with peripheral involvement (83.3%) than in those with axial involvement (16.7%) and in patients with disease duration >5 years (p<0.05). Furthermore, patients treated with biologic therapy and those who were treated with ≥2 conventional DMARDs (in association) had significantly more HT (p<0.05). There was no association between subtype of SpA, actual ESR or CRP, the current DAS28 or BASDAI. Conclusions Our study demonstrates that HT occurs in patients with SpA with a higher prevalence than in controls, similarly as described in other chronic rheumatic diseases. Although we did not find association between HT with the current disease activity, the HT was significantly more frequent in patients with peripheral involvement, long disease duration and those treated with biological agents or with highest number of DMARDs. This suggests a possible relationship between HT and the maintenance of the inflammatory process in patients with SpA. These results suggest that thyroid function tests should be part of the clinical evaluation in patients with SpA. Currently, there is no clear explanation for the coexistence of these two diseases therefore further studies are needed to clarify the etiology of this association. References Chan T, Al-Saffar Z, Bucknall C. Thyroid disease in systemic lupus erythematosus and rheumatoid arthritis. Rheumatology 2001;40:353-4. Disclosure of Interest None Declared

THU0342 Neuropathic pain in patients with systemic sclerosis

Background Systemic sclerosis (SSc) is a connective tissue disease characterized by fibrosis of the skin and internal organs, pronounced alterations in the microvasculature and frequent cellular and humoral immunity abnormalities (1). In clinical practice, patients with SSc occasionally complain of pain in the extremities, such as dysesthesia, burning pain, and autonomic nervous symptoms (1,2).Few studies in SSc include assessments of pain. To date, there are no studies assessing the prevalence of neuropathic pain in SSc (2). Objectives To study the prevalence of neuropathic pain (NP) in the SSc patients and associations between SSc clinical variables and pain in all patients with SSc and in limited cutaneous (lcSSc) and diffuse cutaneous (dcSSc) subsets Methods A total of 42 patients (36 females, 6 males) with a mean age 53.7±15.3 years, diagnosed according to American Rheumatism Association criteria for SSc were evaluated. Patients were classified into SSc subsets (lcSSc ordcSSc) according to the criteria for SSc by Leroy et al. Skin involvement was assessed with the modified Rodnan skin thickness score (MRSS) ranging from 0 to 51. The severity of Raynaud’s phenomenon was assessed with the number of patient-reported episodes in the past week. The severity disease was assessed by systemic sclerosis severity scale (SsSS) range from 0 to 36. The assessment of Hand Function was evaluated by Hand Mobility in SSc (HAMIS), range from 0 to 27 and the quality of life by Heath assessment questionnaire (HAQ). The neuropathic pain was evaluated by the DN4 neuropathic pain questionnaire. Using the DN4 neuropathic pain questionnaire, we divided patients into two groups: first group – patients with non- NP (0-3 points), second group - patients with NP (4-8 points). Results In SSc patients 67% (28 patients) had signs of NP by DN4. The prevalence of NP was higher in the patients who haddiffusecutaneous subsets. Patients with NP had longer disease duration (9.3±6.7years versus 3.8±2.3y, p<0.05) and a higher disease severity (15.3±9.2 versus 5.7±4.1 p<0,05). The modified Rodnan skin thickness score was higher in NP patients group (19.2±6.7 versus 8.6±4.6, p<0.01). The NP patients group had higher functional hand disability (12.6±9.6 versus 3.1±2.5 p<0.05). We found no significant differences between the two groups in quality of life andseverity of Raynaud’s phenomenon. NP presented with numbness 94%, tingling 92%, electric shocks 83%, painful cold 81%, burning 77% and itching 56% in the second group. In neurological examination 79% had hypoesthesia to pinprick and 72% had hypoesthesia to touch. Conclusions The pain syndrome in SSc is complex, because has multiples sources, with the neuropathic component prevailing in a 67% patients. SSc duration, skin thickness, diffuse cutaneous subsets and a disease severity had an impact in neuropathic severity, while severity of Raynaud’s phenomenon raynaud’s and HAQ is not linked to neuropathic pain. More attention to pain and how to best manage it is needed in SSc. References Valentini G. The assessment of the patient with systemic sclerosis. Autoimmun Rev 2003;2:370–6. Sokka T. Assessment of pain in patients with rheumatic diseases.Best Pract Res Clin Rheumatol 2003;17:427–49 Disclosure of Interest None Declared

THU0446 Evaluation of Fatigue in Patients with Spondyloarthritis

Background Fatigue is common to all the rheumatic conditions, in varying degrees, and is a frequent, often severe problem that has major consequences on patients life. Objectives To evaluate the fatigue in a group of patients with spondyloarthritis and possible associations with anemia, disease activity index and degree of pain with fatigue experienced by patients. Methods Patient’s demographic data were collected. The Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT F), version 4- Portuguese translation available, was applied for fatigue measurement. Scores range from 0 to 160, with lower scores reflecting greater fatigue. Patients were grouped by predominant axial or peripheral involvement. Clinical measures were collected according to the predominant involvement (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) for the axial and Disease Activity Score in 28 joints- erythrocyte sedimentation rate (DAS28- ESR) for the peripheral). In all, global assessment (PGA) of disease activity, pain on a 0-100-mm visual analog scale (VAS) and laboratory findings were recorded. Correlation studies were performed with Spearman test. Results A total of 51 patients were consecutively included, 32 (62.7%) were male and 19(37.3%) were female, with a mean age of 44.1±13.9 years (17 to 69) and a median disease duration of 137.6±110.1 months (7 to 445). The predominant involvement was axial in 28 (54.9%) patients and peripheral in 23 (45.1%). Nineteen (37.3%) patients were treated with biological therapies and 24 (47.1%) with classical disease-modifying anti-rheumatic drugs (DMARDs). Mean DAS28 was 2.41±1.26 (0.53 to 4.76) and BASDAI 2.78±2.43 (0 to 8.24), mean fatigue question in BASDAI of 3.03±2.98 (0 to 10) and mean BASFI was 3.31±2.89 (0 to 9.3). Mean of PGA and pain scores on a VAS was 31.51±25.44 and 32.57±29.1 respectively. FACIT-F scored from 61 to 158 (mean of 112.37±23.44). Mean FACIT-F was statistically significant lower in women than men (p<0.05) and the functional component of FACIT-F lower in patients with predominant peripheral involvement (p<0.05). Correlation with FACIT-F total score was strongest for BASFI (r= -0.710; p<0.01); BASDAI (r= -0.501; p<0.01); BASDAI-fatigue (r=-0.466; p<0.01), pain (r= -0.505; p<0.01), PGA (r=-0.455; p<0.01) and age (r=-0.404; p<0.01). DAS28, hemoglobin and ESR correlated with the physical component of the FACIT-F (r=-0.538; r=0.356; r=-0.382 with a p<0.05) but not with the total FACIT-F score. Fatigue levels were not significantly different between patients on biologic or other treatments. Conclusions Fatigue is an important symptom in patients with inflammatory arthritis. FACIT-F is a psychometrically sound measure of the fatigue in different domains. The FACIT-F showed a good (negative) correlation with measures of pain, disease assessment and disease function, showing a trend to be lower in patients with higher activity. No association was found with therapy, disease duration, acute-phase reactants or anemia. References Webster k, Cella D, Yost K. The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation. Health and Quality of Life Outcomes 2003, 1:79 Disclosure of Interest None Declared

Heterocontrole da fluoretação da água de abastecimento público do município de Jaguaribara, Ceará, Brasil - doi: 10.5020/18061230.2012.p271

Objective: To monitor the levels of fluoride (F) in public water supplies in the city of Jaguaribara, Ceara, Brazil. Methods: Water samples were collected from the urban area, at three different points. Samples were collected twice a month, from August 2010 to July 2011. The samples were analyzed in triplicate, using the combined electrode connected to a meter, previously calibrated with standards containing 0.2 to 6.4 ppm F, with Tisab II. Data was analyzed by three criteria: I (Brazil, 1975), II (Ramires et al., 2006) and III (Technical Consensus, 2011). results: Among a total of 72 water samples, we observed an average of 0.55 (± 0.19) ppm F, median of 0.61. According to Criterion I, acceptable levels of fluoride were found in 47.2% of samples, while 44,4% were underfluoridated ( 0.84 ppm F). Based on criterion III, 25% of samples showed negligible risk and benefits concerning dental fluorosis and prevention of dental caries, while 11.1% of the samples presented low risk and benefit and 63.9% pointed to low risk and maximum benefit. Conclusions: Altered levels of fluoride were observed in public water supplies in the studied period. It is suggested the need to improve operational control and also the external control of water fluoridation in Jaguaribara, Ceara, Brazil

CONTROLE DA DOR PÓS-OPERATÓRIA EM CIRURGIA ORAL: REVISÃO DE LITERATURA

Objectives: To discuss effective analgesic strategies for controlling postoperative pain in oral surgery in order to support drug choice more appropriately. Material and Methods: The literature review was conducted in the databases Medline, PubMed, Science Direct, EBSCO, and Cochrane. 29 studies were selected, including 13 conventional literature reviews, 05 systematic reviews and 11 randomized controlled trials. Results: The surgical procedures in the oral cavity were found to be more invasive and with increased potential to cause postoperative pain, what requires from the professional the use of pharmacological strategies to minimize discomfort generated by such interventions. Several drugs might help in controlling pain, like opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and steroidal anti-inflammatory drugs (corticosteroids). Each drug has a specific mechanism of action, associated with varying degrees of efficiency at each stage of the painful process. Conclusions: The control of postoperative pain should be made individually, choosing the drugs correctly and always taking into account the etiology of pain, type and severity of the procedure performed and patients systemic conditions, among other factors. Strategies with the combined use of painkillers that act on different nociceptive pathways have shown a better effect in controlling postoperative pain in patients undergoing oral surgery. DESCRIPTORS: Analgesia. Pain, Postoperative. Oral Surgery.