IntroductionLow-dose weekly methotrexate (MTX) is the mainstay in the therapy of rheumatoid arthritis (RA). It can be given via oral, intramuscular or subcutaneous (SC) route. This study sought to determine the real-world pattern of treatment with SC MTX in Portuguese adult patients with active RA.MethodsUtilization of Metoject® in Rheumatoid Arthritis (UMAR) was a non-interventional, cohort multicenter study with retrospective data collection. Eligible patients had active RA, at least 18 years of age, and started SC MTX treatment in 2009 or 2010 after failure or intolerance to oral MTX. Data were collected from patient’s clinical records. Both non-parametric and parametric survival methods were used to obtain a detailed understanding of SC MTX treatment duration.ResultFifty patients were included, of which only 9 discontinued SC MTX during the study follow-up period. The probability of discontinuation after 1, 2, and 3 years of treatment of SC MTX treatment is expected to be 6.10%, 8.50%, and 23.20%, respectively. The extrapolated median duration of SC MTX using an exponential model was 106.4 months/8.87 years. Mean dose of SC MTX was 18.36 mg. The reasons for treatment discontinuation were occurrence of adverse events in six patients and lack of efficacy in three.ConclusionThe long treatment duration of SC MTX highlights its excellent tolerability compared to oral MTX, especially concerning the frequent adverse gastrointestinal events of MTX. Furthermore, long MTX treatment duration provides the opportunity to postpone or even avoid expensive therapies with biologics. The results obtained from the UMAR study provide important information for the utilization and public financing of SC MTX in Portugal.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0276-3) contains supplementary material, which is available to authorized users.

Background Identifying predictors of response to biological therapies in patients with Ankylosing Spondylitis (AS) is of utmost importance, especially in view of the costs and potential side effects of these agents. Objectives To determine baseline predictive factors of response to biological therapies at 12 weeks in patients with AS in daily clinical practice. Methods Patients with AS under biological therapy and followed in the Rheumatic Diseases Portuguese Register (Reuma.pt) were included in this analysis. Reuma.pt is used as an electronic medical record and assessments are performed by rheumatologists. Patients with information at baseline and 12 weeks of follow-up were included in the analysis (n=197). Univariable logistic regression analysis of baseline predictors of ASDAS (improvement ≥1.1) and BASDAI response (improvement ≥2 units or ≥50%) were performed. Variables with a p-value<0.1 were re-tested in multivariable models. When both ASDAS and CRP (or ASDAS and BASDAI) were significant in the univariable analysis, they were included in separate multivariable models, in order to avoid collinearity-problems. Forward selection was performed until the best-fit model was obtained, taking confounding effects into account. Interactions were tested. Results ASDAS response at 12 weeks was predicted by male gender, higher educational level, lower back pain and higher ASDAS (table). When ASDAS was removed from the baseline predictors, both a younger age and higher CRP were significant predictors of ASDAS response. A BASDAI response was independently predicted by age (<40), gender (male), baseline BASDAI (per unit) or ASDAS (per unit) (depending on which was tested in the model). Table 1 ΔASDAS ≥1.1ΔBASDAI ≥2 or ≥50 OR (95%CI)OR (95% CI)OR (95% CI)OR (95% CI) (n=166)(n=135)(n=174)(n=193) Age at start of first biologic (<40 vs ≥40)**4.04 (1.86; 8.78)3.02 (1.56; 5.84)3.43 (1.82; 6.44) Gender (male vs female)3.01 (1.20; 7.57)**2.39 (1.21; 4.74)2.73 (1.36; 5.45) BMI (kg/m2)******** Educational level (years)1.11 (1.01; 1.21)**§§ Patient’s pain (≥4 vs <4; 0-10)0.27 (0.09; 0.84)**§§ ASDAS3.98 (2.19; 7.21)†1.47 (1.03; 2.10)† BASDAI (0-10)§§§1.20 (1.01; 1.43) CRP (≥5mg/l vs <5mg/l)†9.33 (3.89; 22.35)§§ §Not included in the multivariable model **Not selected during multivariable regression analysis (p≥0.05). †Excluded from the model due to collinearity; the same model is repeated with this variable included. Conclusions CRP is as an important predictor of ASDAS response, but not of BASDAI response. A better response can be expected in male- and younger patients. Baseline disease activity predicts a response at 12 weeks. The ASDAS predicts both ASDAS- and BASDAI response and the BASDAI only predicts the BASDAI response. Disclosure of Interest None Declared

Background Previous studies demonstrated functional and morphological microcirculatory abnormalities that may be relevant to the pathophysiology and clinical manifestations of fibromyalgia (FM). Objectives To ascertain and compare capillary morphology of FM patients with and without Raynaud's phenomenon (RP) using nailfold videocapillaroscopy (NVC). Methods Patients fulfilling the 2010 American College of Rheumatology Diagnostic Criteria for FM were allocated in 2 groups according to the presence or absence of RP (RP+ or RP-, respectively). All patients with secondary causes of RP other than FM were excluded. One blinded operator performed all the NVC using a 200x amplification digital microscope and analytical software. Capillary parameters evaluated in fingers II-V of both hands included: tortuosity, apex enlargement, branch enlargement, microhemorrhages, giant capillaries, capillary density, capillary branching and architectural derangements. Each parameter was rated 0-3 (0= no changes; 1= <33% abnormalities; 2=33-66% abnormalities; 3= >66% abnormalities) and the mean scores were calculated. The association of RP with the capillary parameters was assessed using multivariate linear regression adjusted for age, FM duration and occupation. Results Twenty FM patients were enrolled, 10 in each group, however 2 patients RP+ were excluded due to thyroid disease. Included patients were all female, had a mean age of 50.4 years and a mean duration of disease of 12.8 years. In both RP+ and RP- groups, the most frequently found abnormalities were minor dysmorphies, namely tortuosities, apex enlargement and branch enlargement. However, scoring of these parameters showed no significant difference between the 2 groups. More than half of RP+ and RP- patients presented slight focal decreases in capillary density, once again with no difference between groups. The only giant capillaries were found in a RP+ patient with an “early scleroderma pattern” as proposed by Cutolo et al. Hemorrhages were scarce and had a traumatic appearance, except in the previously mentioned patient. Interestingly, RP associated negatively with the capillary branching score. Table 1 summarizes the results. Table 1. Microcirculatory parameters assessed in fibromyalgia patients with and without Raynaud's phenomenon Parameters RP+, n=8 RP−, n=10 Adjusted p-value n (%) Score, median (IQR) n (%) Score, median (IQR) Tortuosity 8 (100) 1.17 (0.66) 10 (100) 1.25 (0.53) 0.99 Apex enlargement 7 (87.5) 0.31 (0.50) 10 (100) 0.14 (0.06) 0.26 Branch enlargement 7 (87.5) 0.13 (0.33) 10 (100) 0.03 (0.06) 0.06 Microhemorrhages 2 (25) 0 (0.06) 2 (20) 0 (0) 0.20 Giant capillaries 1 (12.5) 0 (0) 0 (0) 0 (0) 0.24 Capillary density 5 (62.5) 0.03 (0.09) 6 (60) 0.08 (0.19) 0.98 Capillary branching 3 (37.5) 0 (0.03) 5 (50) 0.03 (0.13) 0.04 Architectural derangements 2 (25) 0 (0.08) 3 (30) 0 (0.03) 0.27 IQR, interquartile range; RP, Raynaud's phenomenon. Conclusions No association was established between RP and microcirculatory abnormali...

Geometallurgical models are commonly built by combining explanatory variables to obtain the response that requires prediction. This study presented a phosphate plant with three concentration steps: magnetic separation, desliming and flotation, where the yields and recoveries corresponding to each process unit were predicted. These output variables depended on the ore composition and the collector concentration utilized. This paper proposed a solution based on feature engineering to select the best set of explanatory variables and a subset of them able to keep the model as simple as possible but with enough precision and accuracy. After choosing the input variables, two neural network models were developed to simultaneously forecast the seven geometallurgical variables under study: the first, using the best set of variables; and the second, using the reduced set of inputs. The forecasts obtained in both scenarios were compared, and the results showed that the mean squared error and the root mean squared error increase in all output variables evaluated in the test set was smaller than 2.6% when the reduced set was used. The trade-off between simplicity and the quality of the model needs to be addressed when choosing the final neural network to be used in a 3D-block model.

Background Tumor necrosis factor-alpha inhibitors (TNFi) are currently the only therapeutic option when conventional treatment fails in ankylosing spondylitis (AS) patients. Objectives To assess the retention rate and investigate predictive factors and reasons for drug discontinuation in patients with AS starting their first TNFi. Methods We included all new biological starters AS patients fulfilling the 1984 modified New York classification criteria, registered at the Rheumatic Diseases Portuguese Register, Reuma.pt from June 2008 until October 2011. Retention rate at 2 years was evaluated using survival-data analysis methods with discontinuation of the drug, regardless the reason, as the primary outcome. Potential predictive factors of drug discontinuation (demographic, clinical and laboratorial) were assessed using log-rank tests and a Cox proportional-hazards regression model. Results Of the 334 AS patients starting a TNFi, 265 (79.34%) maintain treatment after 2 years of follow-up. Median drug survival among patients who discontinued treatment was 10.9 months (95% CI: 7.7 – 13.0 months) with a discontinuation rate of 11.6% per year. The main reason for treatment cessation was adverse events (34.4%) followed by lack of response at 12 weeks (23.2%). Drug survivals were similar regardless of the reason for discontinuation or TNFi used. Compared with patients who retain their first TNFi those who discontinue treatment, were more frequently women (p=0.04), were older at disease beginning (p=0.01) and at TNFi beginning (p=0.03), had higher BMI (p=0.01) and higher Bath Ankylosing Spondylitis Functional Index (BASFI, p=0.02) at baseline. In multivariable Cox regression, older age at TNFi beginning was the only baseline predictor of drug discontinuation (HR 1.06, 95% CI 1.02 – 1.10, p=0.006). Conclusions Retention rate was high among AS patients starting their first TNFi. Adverse events were the main reason for drug discontinuation and older age at treatment onset was a predictor of shorter drug survival. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3916