J. Borges

Seismicity along the Azores-Gibraltar region and global plate kinematics

Seismicity along the western part of the Eurasia–Nubia plate boundary displays very complex patterns. The average motion is transtensional in the Azores, dextral along the Gloria transform zone and convergent between the SW Portuguese Atlantic margin and the Ibero-Maghrebian zone. To constrain the factors controlling the seismicity, we provide a new seismotectonic synthesis using several earthquakes. We show that the study area can be divided into six different regions, with each characterised by a coherent seismicity pattern. The total seismic moment tensor and the average slip velocities are provided for each region. To determine the spatial distribution of the seismicity, we computed the slip vector for each earthquake based on its focal mechanism and compared it to the relative velocity between the Eurasian and Nubian plates, deduced from global kinematic models. Despite local departures in the Alboran Sea and near the Mid-Atlantic Ridge, we found a good correlation between these two independent vector sets. Quantitatively, the slip velocities display a linear, non-affine correlation with the norms of the relative kinematic velocities. The norms of the slip velocities also seem to depend on the tectonic regime and on the morphology of the plate boundary.

Characterization of damage in Portuguese lupus patients: analysis of a national lupus registry.

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.

Effect of Comedication With Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Retention of Tumor Necrosis Factor Inhibitors in Patients With Spondyloarthritis: A Prospective Cohort Study.

To evaluate whether use of comedication with conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA).

Effect of comedication with conventional synthetic DMARDs on TNF inhibitors‐retention in patients with spondyloarthritis: A prospective cohort

To evaluate whether use of comedication with conventional synthetic disease‐modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA).

AB0297 Real-Life Effectiveness of Golimumab in Biologic-Naïve Rheumatoid Arthritis Patients – Data from reuma.pt, A Portuguese Registry

Background Registries are becoming an increasingly important source of data, providing additional information on the use of biologics in clinical practice. The real-world clinical data currently available regarding the use of SC anti-TNFs is still limited. Therefore, it is of utmost importance to increase the knowledge of Golimumab (GLM) effectiveness in the clinical practice. Objectives This study was designed to access the effectiveness of SC GLM 50 mg/monthly + MTX through 52 weeks of treatment in biologic-naïve RA patients. The primary objective was to investigate the proportion of patients achieving clinical remission (DAS28ESR<2.6). The secondary objectives were the evaluation of: the treatment persistence rates; the proportion of patients achieving functional response (ΔHAQ>0.22); and the effect of treatment on DAS28 individual components. Methods This was a retrospective non-interventional study based on the Rheumatic Diseases Portuguese Register (Reuma.pt). It was conducted in a cohort of patients aged >18 years with active RA despite previous treatment with conventional DMARDs, biologic-naïve, who started SC GLM+MTX, from March 2011 to August 2015. The cumulative incidence of achieving clinical remission, treatment persistence and functional response/remission were estimated using survival analysis. Cox regression was used to calculate the hazard ratios. Results A total of 109 patients (86.3% female, mean age 55.5±13.2 years; mean age of diagnosis 45.5±13.5 years, rheumatoid factor 78% positive) met the study criteria. Ninety-three had a follow up of at least 52 weeks (i.e. all patients who started treatment before August 2014). At week 52, 38.3% of patients were on clinical remission, 91.9% achieved functional response and 35.2% were on functional remission (HAQ<0.5). The treatment persistence rate was 75.3% for the individuals who were in the study for ≥52 weeks (Figure 1). For functional remission, high CRP levels at baseline seem to be a determining factor (HR=0.54, p=0.026). Conclusions This is the first Golimumab data analysis generated from the Portuguese registry Reuma.pt. Our results are in agreement with data from other national registries and demonstrate the long-term effectiveness and the high treatment persistence rates of GLM through 52 weeks. Disclosure of Interest A. F. Mourão Consultant for: Merck Sharp & Dohme, C. Ribeiro: None declared, J. Borges: None declared, M. J. Gonçalves: None declared, M. Bernardes: None declared, S. Fernandes: None declared, R. Dezerto Employee of: Merck Sharp & Dohme, P. A. Laires Employee of: Merck Sharp & Dohme, P. Machado Employee of: Merck Sharp & Dohme, M. Eusébio: None declared, M. J. Santos: None declared, H. Canhão: None declared

Los mayores sismos en Argelia en la época moderna: las fallas de El Asnam y Zemmouri-Boumerdès

Algeria has experienced many destructive earthquakes during the last few centuries (e.g., Ayadi and Bezzeghoud, 2015). The city of El Asnam (formerly Orleanville, today Chlef) was severely damaged in 1954 and 1980 by magnitude 6.7 and 7.3 earthquakes, respectively. On October 10, 1989, a magnitude 5.9 earthquake struck the Mont Chenoua-Tipasa coastal area approximately 150 km west of Zemmouri, which is where the May 21, 2003 earthquake occurred (Mw6.8). Many other large historical and instrumental earthquakes have severely damaged the coastal cities of Algeria over the last few centuries (i.e., around Algiers, Oran, Mascara, Djidjelli, Constantine and Bejaia). These earthquakes suggest active deformation of the margin in conjunction with the clear offshore extent of active coastal faults. According to several studies, the main active geological structures around El Asnam, Algiers, Zemmouri and Boumerdes have experienced several disastrous earthquakes. Many other earthquakes have occurred in and around the Chlef and Mitidja Basins, underlining the seismic activity in the area. In this chapter, we highlight the main characteristics of the two largest earthquakes that have occurred in Algeria in the modern period: the El Asnam earthquakes of September 9 (Mw6.7) and October 10 1980 (Mw7.3), and the Zemmouri-Boumerdes earthquake of May 21, 2003, (Mw6.8).

AB1168 Touch study: technology and outcomes used in clinic in a day hospital

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 Português 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)Table 1. Results comparing questionnaires by diagnosis and intervals Paper interval 0 Interval 1 Interval 2 (Sept –Nov 15) (Nov 15- Jan 16) (Jan – Mar 16) AS N N Quest. Pct. N N Quest. Pct. N N Quest. Pct. BASDAI 95 95 100,00% 92 87 94,57% 93 92 98,92% BASFI 95 94 98,95% 92 89 96,74% 93 92 98,92% EQ5D 95 91 95,79% 92 85 92,39% 93 88 94,62% AsQol 95 88 92,63% 92 83 90,22% 93 85 91,40% SF-36 95 80 84,21% 92 72 78,26% 93 77 82,80% HADS 95 27 28,42% 92 87 94,57% 93 91 97,85% FACIT 95 93 97,89% 92 91 98,91% 93 92 98,92% RA HAQ 112 111 99,11% 124 124 100,00% 115 114 99,13% SF-36 112 96 85,71% 124 101 81,45% 115 98 85,22% HADS 112 9 8,04% 124 111 89,52% 115 114 99,13% FACIT 112 108 96,43% 124 122 98,39% 115 114 99,13% EQ5D 112 105 93,75% 124 119 95,97% 115 113 98,26% Only HADS had a significative (p<0.000) improvement for every disease, with the use of the touchscreen computers from interval 1 to 2. 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

THU0536 Remission and Re-Treatment of Patients with Paget's Disease of Bone Treated with Zolendronic Acid – A Single Center 10 Year Experience

Background Treatment of Pagets 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 Pagets Disease. N Eng J Med. 2005 Set:353(9):898–908 Reid IR, Brown JP, Levitt N et al. Re-treatment of relapse Pagets 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

AB1072 Work Disability, Productivity, Presenteeism and Absenteeism in Rheumatic Patients

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 <.05. 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<.0001), FACIT (r=.720, p<.0001), both SF12 scores (r>.517, p<.0001), all 4 WPAIs scores (r>.296, p<.01) and inversely with SPS 6 (r= -.341, p=.002). WPAIs scores were all significantly associated to HAQ, FACIT, SF12 PCS and sick leave in the last 12 months (p<.05). SPS 6 was inversely related to HAQ and FACIT scores, WPAI presenteeism, work and activity impairment (p<.05), but not with absenteeism. Pain and fatigue were significantly higher in patients with higher WALS and WPAI scores, in exception to absenteeism, and pain was associated with SPS 6 (p<.05). Sleep quality was decreased when related to higher WALS and WPAI scores (p<.05). When comparing the employed/unemployed patients, WPAI activity impairment, PCS, MCS, HAQ, FACIT, pain and disease activity (p<.01), we verified significantly higher limitations and impairment in the unemployed group, in exception to SPS 6, fatigue and sleep quality. 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

AB1071 The Use of Visual Analogue Scale in Rheumatic Disease: Validation of an Electronic Version

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 patients 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 Cronbachs 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. Table 1. Results Touch-screen Paper ICC (Touch-screen vs Paper) VAS (last week) How the disease disturbs (n=88) Mean (standard deviation) 36.08 (25.56) 40.28 (27.19) 0.906 Pain intensity (n=87) Mean (standard deviation) 36.15 (25.87) 38.06 (25.63) 0.921 Spondylitis: VAS (last week) (n=56) Back pain during the night Mean (standard deviation) 25.61 (26.23) 25.55 (28.73) 0.943 Back pain at any time (day and night) Mean (standard deviation) 27.96 (25.09) 28.30 (26.37) 0.924 How the disease disturbs Mean (standard deviation) 30.57 (26.34) 29.66 (27.30) 0.867 ICC: Intraclass Correlation Coefficients. 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