AB0172 ELDERLY ONSET RHEUMATOID ARTHRITIS (EORA): WHAT TO EXPECT IN REAL LIFE

Background:The term elderly onset of rheumatoid arthritis (EORA) refers to patients with rheumatoid arthritis (RA) onset after the age of 60. Data published in the literature suggest a special clinical pattern and different prognostic factors in this class of patients.Objectives:To analyze prospectively a cohort of patients diagnosed with EORA, their disease particularities, comorbidities and treatment.Methods:This cohort included consecutive EORA patients, diagnosed and treated in “Sfanta Maria” Clinical Hospital, Bucharest, Romania. The study was conducted for 2 years. Demographic, clinical and laboratory data was obtained. Disease activity was assessed using Disease Activity Score of 28 joints with erythrocyte sedimentation rate (DAS28-ESR). The patients were monitored using disease activity, treatment schedule modifications and possible adverse reactions.Results:The cohort included 110 patients (88 females, 22 males). Their mean age at the beginning of disease manifestations was 70.14 years and the mean age at the diagnosis was 70.85 years. There was no statistical difference regarding the patient’s residential area (urban/rural) and the period between the appearance of clinical signs and the moment of diagnosis confirmation. A great proportion of patients (77 patients, 70%) had seropositive RA, ACPA being found in 84% of the patients with seropositive RA. The mean DAS28-ESR at the diagnosis was 4.44(±1.54). A proportion of 40% of the patients had moderate disease activity, 35 patients (32.73%) - high disease activity, 11 patients (10%) - low disease activity and unexpectedly there were 19 patients (17.27%) in remission at the moment of RA diagnosis. Joint distribution was analyzed: 61.82% patients had large joint involvement, 91.82% - small joint involvement and 53.64 % had mixed joint pattern involvement. A negative significant correlation was found between the small joint involvement pattern and the body mass index (BMI) (p=0.028, R=-0.21). The mean BMI at the diagnosis was 25.81±5.358. Ninety five patients (86,36%) had at least one cardiovascular comorbidity. Hypertension was found in 70% of the patients. Only 4.55% of the patients had rheumatoid nodules and a similar proportion (4.55) had Sjogren syndrome associated. Pulmonary fibrosis was found in only 2 patients. At the moment of diagnosis 50% of patients had anemia, 36.36% had osteoporosis, 25.46% of the patients - hepatic disease, 11.82% - chronic kidney failure and 6.36% were found with a neoplasia. The main conventional synthetic disease modifying drug (csDMARD) that was recommended was methotrexate (81.8%). The second most used csDMARD was hydroxichroloquine (42 patients, 38,18%). The proportion of patients with monotherapy (50%) was similar to that with csDMARD combination (49.09%). During the follow up period only 8 patients (7.27%) had biologic therapy (4 patients - an anti TNF drug). Non steroid anti-inflammatory drugs were used in 46.63%. Cortisone therapy was used for more than 3 months in 80% of the patients. In patients with biologic therapy chronic glucocorticoids were stopped. At least one infection was documented in 20.91% of patients: 2 patients out of 6 patients (33.33%) with biologic DMARD, 14.81% of the patients with csDMARD combination and 21.81% of the patients with csDMARD monotherapy. csDMARD therapy was well tolerated with only 23.63% adverse reactions.Conclusion:Compared to the data published in the literature, in our cohort the rate female:male was higher (4:1). A distinct feature was the high proportion of patients with seropositive RA. The joint pattern seems to be influenced by BMI: small joint pattern is less found in patients with higher BMI. As expected, the patients with EORA had multiple cardiovascular comorbidities. Arterial hypertension was the most frequent. Caution is needed in choosing treatment regarding comorbidities and the risk of infection in these patients.References:[1]Villa-Blanco JI, Calvo-Alén J. Elderly onset rheumatoid arthritis: differential diagnosis and choice of first-line and subsequent therapy. Drugs Aging. 2009;26(9):739-50.Disclosure of Interests:None declared

Top managers' communication efforts as response to tensions in product innovation: an attention-based view

PurposeThe purpose of this study is to map different kinds of tensions in product innovation and investigate how top managers use communication to shape subordinates' attention and thereby respond to these tensions.Design/methodology/approachThis study adopted an embedded case study of four innovation centers within a Nordic multinational firm.FindingsThis study identifies three kinds of tensions that reside in product innovation, namely dilemma, paradox and trade-off. Further, this study reveals how joint attention (among top managers and subordinates) as a response to tensions can be achieved through different aggregates of top managers' communication efforts.Originality/valueIn opening the black box of tensions in product innovation and identifying multiple tensions, this study contributes to advancing the understanding of the attention-based view. Different from previous studies that simply consider communication as channels for information processing, the findings indicate that the contents and practices of communication can help top managers to shape subordinates' attention and thereby respond to tensions. This study also extends the research focus of attention from top managers to the whole organization, by revealing the importance of building a joint pattern of attention among top managers and subordinates.

Kinematic Analysis of the Dam and Powerhouse Sites of the Baglihar Hydropower Project

The present study assesses the slope stability at the most significant Baglihar Dam for slope failure and landslides occurrences. The study comprises of twelve sites which were selected for detailed geotechnical investigation for assessment of potential slope failures using basic Rock Mass Rating (RMRb), Slope Mass Rating (SMR) and kinematic analysis techniques. The results show that even though the rocks are of fair quality but other factors including joint pattern and density caused by tectonic and anthropogenic activities have rendered three sites completely unstable, 8 sites are unstable and one site is stable. Moreover Nine sites are susceptible to wedge failure, six to topple and two to plane failure. The RMRb value varies from 45 to 55 and SMR value varies from 11 to 44. The thorough results and interpretation of work done is presented in this paper.

Fast 3D Pattern Synthesis with Polarization and Dynamic Range Ratio Control for Conformal Antenna Arrays

This paper proposes an iterative algorithm for the 3D synthesis of the electric far-field pattern of a conformal antenna array in the presence of requirements on both the polarization and the dynamic range ratio (DRR) of the excitations. Thanks to the use of selectable weights, the algorithm allows a versatile control of the DRR and of the polarization in a given angular region and requires a low CPU time to provide the array excitations. Furthermore, a modified version of the algorithm is developed to enable the optimization of the polarization state by phase-only control. Numerical results are presented to verify the usefulness of the proposed approach for the joint pattern and polarization synthesis of conformal arrays with reduced or even unitary DRR.