Background:In rheumatoid arthritis (RA), global disease activity is commonly assessed, from the patient’s and the physician’s perspective, through a 100mm VAS. Previous studies have commonly shown a considerable discrepancy between the patient’s and physician’s assessment.Objectives:This study aimed evaluating patient-physician discordance in the assessment of disease activity and to explore its determinants.Methods:Cross sectional study including RA patients (ACR/EULAR 2010 classification criteria), aged ≥ 18 years, followed in a single tertiary centre. Data were collected from the most recent evaluation including sociodemographic features, disease duration (years), disease activity (DAS 28 3V-PCR), tender and swollen joint count 0-28 (TJC and SJC), VAS-pain-patient, patient and physician global assessment (PGA and PhGA respectively), erythrocyte sedimentation rate (ESR), C-reactive protein (CPR), Health assessment questionnaire (HAQ) and EuroQol five-dimension scale (EQ5D). The discrepancy between patients and physicians (ΔPPhGA) was defined as PGA minus PhGA, and a difference > |20mm| was considered as “discordant”. A descriptive analysis was performed and variables described as proportions or means (+/- SD), as adequate. Correlation between ΔPPhGA and other variables was assessed through Pearson’s correlation and comparison between groups through t-test. Variables with p<0.05 or otherwise considered clinically relevant were included in multiple linear regression analysis to identify predictors for ΔPPhGA. A p≤0.05 was considered statistically significant.Results:In total, 467 patients with RA were included (81.2% female; mean age 63.9% ± 12.2 years). PGA and PhGA were discordant in 61.7% of the cases, the patient scoring higher than the physician in 95% of these cases. The proportion of concordance increased (p< 0.01) when considering only patients in remission (DAS 28 3V <2.6), (Graph 1). ΔPPhGA was moderately correlated with VAS-pain-patient (r = 0.59) and weakly correlated with SJC (r = -0.12), HAQ (r= 0.27), EQ5D (r = -0.28) and age (r = 0.21); all p<0.01. In multivariate analysis, VAS-pain-patient (β 0.74, 95% CI 0.62-0.88, p=0.00) and TJC (β 0.16, 95% CI 0.45-0.48, p=0.02) remained associated with a higher ΔPPhGA.Conclusion:Our study confirmed that a significant discrepancy between patients and physicians in the assessment of global disease activity is frequent in clinical practice, probably due to valorization of different parameters. This was much less pronounced among patients in remission. Higher VAS-pain-patient and TJC were independent predictors of greater discrepancy between patients and physician’s assessment.Disclosure of Interests:Luisa Brites: None declared, Flavio Costa: None declared, João Dinis de Freitas: None declared, Mariana Luis: None declared, Ana Rita Prata: None declared, Helena Assunção: None declared, LILIANA SARAIVA: None declared, Marlene Sousa: None declared, Ana Rita Cunha: None declared, José Antonio P. da Silva Grant/research support from: Pfizer, Abbvie, Consultant of: Pfizer, AbbVie, Roche, Lilly, Novartis, Catia Duarte: None declared

Background: Health Literacy (HL) is a concept that can be analyzed in 3 domains: health promotion, disease prevention and health care. Objective: Describe HL level of a group of patients with hypertension and diabetes in a northern region of Portugal. Methodology: Cross-sectional descriptive-exploratory study. Sample of convenience, with 401 users of a cluster of health centers in the northern region of Portugal. Data were collected after informed consent of the users, through a survey with the LS assessment scale European Health Literacy Survey (HLS-EU-PT), translated and validated into Portuguese. Descriptive and inferential statistics techniques were used, using SPSS, version 24. Results: Users presented an inadequate or problematic level of HL. These considered the doctor and the nurse as the professionals who can improve their HL level. Conclusion: Low HL level is a problem for health management, it is important to focus on a strategy to increase HL in chronic disease patients.

Production Activity Control (PAC) is fundamental to Production Management, since it allows for meeting deadlines, ensuring product quality and reducing production costs. For these reasons, it is essential for the improvement of enterprise performance to understand the production system and its integrated parts. Another production concept linked to the efficiency of enterprise performance is Industry 4.0. This is the most recent revolution of industry and one of its main goals are related with the integration of production activity control by using information technologies. The objective of this project is to implement three different mechanisms of Production Activity Control in a Flexible Flow Shop (FFS), composed of three stages with three parallel machines each. The mechanisms implemented are Workload Control (WLC), Generic Kanban System (GKS) and Drum-Buffer-Rope (DBR), and all are associated with a make-to-order (MTO) production. Additionally, three independent machine selection criteria are evaluated: Random, Load Hours and Load Units. Simio software is used for the simulation of the production system and results are given by diverse Key Performance Indicators (KPIs). After completing simulations, it can be concluded that DBR is the mechanism of PAC with the best performance for the studied scenarios. However, the scenario with the smallest value of load norm is compromising the performance of WLC. Otherwise, this mechanism would be the one with the best performance. Regarding the machine selection criteria, Load Hours is the criterion with the best performance for almost all the KPIs.

Background:Historically, axial spondyloarthritis (particularly ankylosing spondylitis) was considered a men’s disease and has been under-recognized in women.Emerging evidence reveals gender differences in patophysiology, disease presentation and therapeutic efficacy.Objectives:To determine if there are differences between genders in a Portuguese cohort of patients with axSpA as regards clinical manifestations, disease activity, functional capacity, patient related outcomes and radiographic findings.Methods:Patients with ≥18 years fulfilling the ASAS- Assessment of Spondyloarthritis International Society classification criteria for axSpA and registered in the electronic national database- Reuma.pt were included in a multicentric cross-sectional study. Sociodemographic data, clinical features and radiographic findings were collected from the first record in Reuma.pt. These variables were compared between genders using Mann-Whitney test and Chi-Square test. Variables with a significant association with group variable (gender) were considered in the multiple variable analysis to adjust the gender effect on the outcome variables.Results:A total of 1995 patients were included, 1114 (55.9%) men and 881 (44.1%) women. Men had a lower median age at onset of disease (25.1 vs 28.4, p=0.000) and median age at diagnosis (26.9 vs 30.4, p=0.000) and were more frequently smokers (32.1% vs 15.7%, p=0.000). Comparing to women, men had worse BASMI scores (4.0 vs 3.4, p=0.000), higher levels of CPR (10.5 vs 6.9, p=0.000) and were more often HLA-B27 positive (67.8% vs 54%, p=0.000). In univariable analysis, sacroiliitis on radiograph or/and MRI (95.5% vs 91.7%, p=0.04) was more common in men, however that wasn’t confirmed in multivariable analysis.In contrast, women more frequently had more inflammatory bowel disease (8.8% vs 4.9%, p=0,004), higher levels of ESR (25.0 vs 21.0, p=0.003) and worse PROs- BASDAI (5.7 vs 4.5, p=0.000), PGA (60.0 vs 55.0, p=0.000) and fatigue (6.2 vs 5.4, p=0,000).Conclusion:Physicians must be aware of differences between genders in axial spondyloarthritis because this can result in less underdiagnosis and misdiagnosis, allow optimization of treatment strategies, and decrease overall disease burden in women with axSpA patients.References:[1]Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE. Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky. Curr Rheumatol Rep. 2018;20(6):35.[2]Tournadre A, Pereira B, Lhoste A, Dubost JJ, Ristori JM, Claudepierre P, et al. Differences between women and men with recent-onset axial spondyloarthritis: results from a prospective multicenter French cohort. Arthritis Care Res (Hoboken). 2013;65(9):1482-9.Disclosure of Interests:None declared

Background:Physician’s global assessment of disease activity (PhGA) is highly influential upon treatment decisions taken by rheumatologists, surpassing the impact of DAS28. [1, 2]. However, data regarding its psychometric properties are scarce.Objectives:To evaluate the reliability and responsiveness of PhGA.Methods:We included two consecutive visits of RA patients followed in a Tertiary Rheumatology Department. Socio-demographic (age and gender) and clinical data were collected including tender (TJ28) and swollen (SJC28) joints in 28 count, C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Disease activity Score (DAS28-3v-CRP, DAS28-3v-ESR, DAS28-4v-CRP, DAS28-4v-ESR), PhGA and Patient Global Assessment of disease Activity (PGA) through a Visual Analogic Scale (VAS) 0-100mm. Changes (Δ) between the two visits were calculated. Only patients without missing data were included. Correlations between ΔPhGA and change of other variables were assessed using Pearson’s correlations. Reliability was evaluated through Intraclass Correlation Coefficient (ICC) between two consecutive appointments in a subgroup of patients with stable disease activity (Δ DAS28-4vESR [-0.6 to 0.6]. An ICC above 0.8 was considered indicative of excellent reliability. Sensitivity to change was assessed in the subgroup of patients who improved their disease activity at least 0.6 on DAS28-4V-ESR, through Standardized Response Mean (SRM). The respective intervals of confidence were obtained through bootstrapping procedures. SRM above 0.8 were considered large. Independent factors associated with ΔPhGA were identified through multivariate linear regression analysis. p<0.05 was considered statistically significantResults:121 RA patients (84.3% female and 64.0±12.6 years) were included. Δ PhGA was weakly correlated with ΔCRP (r=0.23), Δ PGA (r=0.31) and Δ pain (r=0.37). Moderate to strong correlations were observed with Δ DAS28-3V-ESR (r=0.55), Δ SJC28 (r=0.56), Δ DAS28-3V-CRP (r=0.58), Δ DAS28-3V-CRP (r=0.60), Δ TJ28 (r=0.62) and Δ DAS28-4V-CRP (r=0.63). ICC between two consecutive visits was 0.7, [95%CI:0.47-0.83] and SRM was -1.01 [95%CI:-1.26-(-0.73)]. In the multivariate regression analysis, ΔSJC28 (β=4.01; 95% CI:3.07 to 4.96) and Δ Pain (β=0.18; 95%CI: 0.07 to 0.28) remained as independent factors associated with ΔPhGA (R2:0.49, p<0.01)Conclusion:In this study, PhGA showed a high reliability and sensitivity to change regarding disease activity, in clinical practice. Changes in SJC had the strongest association with change in PhGA scoring, but Δ Pain was also significantly correlated (graph 1).Figure 1.Graph 1 – Explicative model to variations on PhGAReferences:[1]Choy T et al. Rheum (Oxford, England). 2014;53(3):482-90.[2]Rohekar G et al. Jour Rheum. 2009;36(10):2178.Disclosure of Interests:LILIANA SARAIVA: None declared, Luisa Brites: None declared, Ana Rita Cunha: None declared, Helena Assunção: None declared, Ana Rita Prata: None declared, Mariana Luis: None declared, Flavio Costa: None declared, Pedro Freitas: None declared, Marlene Sousa: None declared, José Antonio P. da Silva Grant/research support from: Pfizer, Abbvie, Consultant of: Pfizer, AbbVie, Roche, Lilly, Novartis, Catia Duarte: None declared