Silva C

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

Predictors of response and anti-TNF drugs comparative efficacy

Methods Analyses were performed upon Reuma.pt. Response to therapy was defined according to EULAR criteria. Probability of response was modeled. Multivariate logistic regression model predicting response over 1 year with all variables and automated stepwise selection models were built. In addition, we performed analyses using propensity score 1:1:1 nearest neighbor matching algorithms to obtain comparable groups regarding baseline features.