Sónia Carvalho

Persistent object synchronization with active relational databases

One of the most common client/server architectures in enterprise systems today is the combination of object oriented applications with active relational database systems. With this combination, developers have to overcome a difficult problem: the impedance mismatch between object orientation and the relational model. To date, there are several incomplete approaches for describing the integration of static and dynamic object aspects and active relational databases. An important issue missing from these approaches is the state synchronization between server tuples and client cached objects. In a previous paper (A.M. Porto et al., 1998) we proposed a technique for mapping the dynamic behavior of objects into active relational databases, using database triggers and stored procedures. The paper extends our previous one with an architecture based on a replication strategy that maintains server tuples and client cached objects synchronized with respect to state. This architecture automatically updates client cached object versions when their corresponding server database tuples are updated.

Effectiveness and long-term retention of anti-tumour necrosis factor treatment in juvenile and adult patients with juvenile idiopathic arthritis: data from Reuma.pt

OBJECTIVESnAssess the effectiveness and safety of biologic therapy as well as predictors of response at 1 year of therapy, retention rate in biologic treatment and predictors of drug discontinuation in JIA patients in the Portuguese register of rheumatic diseases.nnnMETHODSnWe prospectively collected patient and disease characteristics from patients with JIA who started biological therapy. Adverse events were collected during the follow-up period. Predictors of response at 1 year and drug retention rates were assessed at 4 years of treatment for the first biologic agent.nnnRESULTSnA total of 812 JIA patients [65% females, mean age at JIA onset 6.9 years (s.d. 4.7)], 227 received biologic therapy; 205 patients (90.3%) were treated with an anti-TNF as the first biologic. All the parameters used to evaluate disease activity, namely number of active joints, ESR and Childhood HAQ/HAQ, decreased significantly at 6 months and 1 year of treatment. The mean reduction in Juvenile Disease Activity Score 10 (JADAS10) after 1 year of treatment was 10.4 (s.d. 7.4). According to the definition of improvement using the JADAS10 score, 83.3% respond to biologic therapy after 1 year. Fourteen patients discontinued biologic therapies due to adverse events. Retention rates were 92.9% at 1 year, 85.5% at 2 years, 78.4% at 3 years and 68.1% at 4 years of treatment. Among all JIA subtypes, only concomitant therapy with corticosteroids was found to be univariately associated with withdrawal of biologic treatment (P = 0.016).nnnCONCLUSIONnBiologic therapies seem effective and safe in patients with JIA. In addition, the retention rates for the first biologic agent are high throughout 4 years.

Object life-cycles in active relational databases

One of the biggest problems that object-oriented developers face today is having to integrate at the enterprise level, object-oriented applications with widely applied and quality active relational databases. This paper focuses on the issues of mapping object dynamic behavior into active relational databases. We present a technique for expanding active relational databases with object-oriented behavior semantics, extracted from state transition diagrams expressing object life cycles. We consider states as first class objects, and discuss state class and event inheritance.

AB0881 Biologic Disease Modifying Anti-Rheumatic Drug Use in the Treatment of Juvenile Idiopathic Arthritis: Data from the Rheumatic Diseases Portuguese Register, Reuma.Pt

Background The Portuguese Society of Rheumatology developed the Rheumatic Diseases Portuguese Register (Reuma.pt) encompassing also Juvenile Idiopathic Arthritis patients followed by rheumatologists and pediatricians. Objectives 1. To obtain an overview of biological agents use in Portuguese children with JIA. 2. To assess the effectiveness and safety of biological therapy at 6 months and 1 year of treatment. Methods We retrieved data from Reuma.pt, until December 2013. We collected baseline patient and disease characteristics of patients with JIA who started treatment with biological agents. Follow-up data were analyzed and are presented at 6 months and 1 year. Disease activity was assessed using the number of active joints, ESR and CHAQ. Results 812 patients with JIA,227 received biological therapy.The mean age at disease onset of patients treated with biologic DMARDs was 6.9±4.7years and the mean age for starting biological therapy was 16.1±9.4years. The most common JIA categories were polyarticular RF negative (23.3%), polyarticular RF+(17.5%) and extended oligoarticular (16.0%).The median duration of the first biological agent was 5.76years. Most patients were treated with antiTNF as first line (90.3%):etanercept 69.2%,adalimumab 12.8%,infliximab 8.4%. Mean baseline active joint count was 5.1±5.8, decreasing to 1.2±2.4 and 1.0±3.1 after 6 months and 1 year of therapy. Mean ESR was 33.9±25.3 mm/1sth and 26.9±23.9 and 19.1±180 after 6 months and 1 year. CHAQ decreased from 0.8±0.7 to 0.4±0.5 and 0.4±0.5 at 6 months and 1 year. 14.1% switched once to other biological therapy (3.08% in the first 6 months,4.4% in the first year), 5.73% switched twice (0.88% in the first 6 months,1.76% in the first year) and 2 patients (0.88%) switched 3 times after the first year of treatment. 14 serious adverse events were reported leading to discontinuation of the treatment, 6 in the first 6 months and 8 in the first year of treatment. There were no reported deaths. The one-year treatment retention with biological agents was 91%. Conclusions JIA patients treated with biologics and registered in Reuma.pt showed a good profile of effectiveness and safety at 1 year. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3142