In this study, samples of 420 stainless steel were obtained by hot pressing from powder at temperatures from 1,100 to 1,200 degrees C. The aim was to explore the influence of the processing temperature on their grain size, microstructure, densification and mechanical properties. The results showed that it is possible to produce dense samples at these sintering temperatures. The sintering temperature influenced the density, grain size, structural phases, and hardness of the samples. Martensite and austenite were present in the samples sintered at 1,100, 1,150, and 1,180 degrees C. Precipitation of Cr23C6 was observed after sintering at 1,200 degrees C. This sample was the one with the highest density (99.7% densification) and hardness (771.9 HV).

Background “Amigos de Fibro” (Fibro Friends), is a recent and innovative program created from the joint action of patients and health professionals, which can be an effective educational tool to be implemented in primary health care centers, promoting self-care, quality of life and health promotion in individuals with fibromyalgia in Brazil. Objectives Evaluate the effectiveness of an interdisciplinary health promotion educational program called “Amigos de Fibro” in improving pain intensity, symptom severity, quality of life, sleep quality and self-care agency in individuals with fibromyalgia in Brazil. Methods A randomized clinical trial was carried out with 24 participants divided into two groups: the experimental group (EG) and the control group (CG). The EG group held online meetings through the Google Meet platform with an interdisciplinary team (10 professionals) that worked in primary health care in Brazil, where they gave lectures and held debates and dynamics on the importance of health promotion and self-care in fibromyalgia. In addition, participants performed a physical exercise protocol. The “Amigos de Fibro” protocol has been previously published and showed good agreement. The control group (CG) received an education and self-care e-book for fibromyalgia that addressed information similar to the EG (http://www.amigosdefibro.com.br). Participants were assessed pre and post-intervention. A descriptive analysis of the data was performed, as well as the differences of the independent variables between the intervention and control groups were studied using Student's t test for independent samples. A significance level of 5% was adopted. Results The mean age of the participants was 38.7±9.4 years for the EG and 44.9±10.6 for the CG, all (100%) of whom were female in both groups. Compared to the baseline, all EG variables and only the FIQ symptoms domain of the CG showed significant improvements (p<0.005), however, the other CG variables showed improvements, but they were not significant (Table 1). Conclusion “Amigos de Fibro”, a light technology in health, was considered with good results and improvement of all studied variables that address the main aspects that promote the health of individuals with fibromyalgia and, therefore, being considered valid for use by health professionals with the target public in primary health care in Brazil, enabling them to act as health promoting agents. Our next steps are to expand knowledge of this program to other countries. References [1]Antunes MD, Schmitt ACB, Marques AP. Amigos de Fibro (Fibro Friends): development of an educational program for the health promotion of fibromyalgia patients. Primary Health Care Research & Development. 2022;23(e44):1–7. https://doi.org/10.1017/S1463423621000773[2]Antunes MD, Schmitt ACB, Marques AP. Amigos de Fibro (Fibro Friends): Validation of an Educational Program to Promote Health in Fibromyalgia. International Journal of Environmental Research and Public Health. 2022;19(9):e5297. https://doi.org/10.3390/ijerph19095297 Acknowledgements This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001 Disclosure of Interests None Declared.Table 1Results of the variables studied in both groups.EGCGPre-interventionPost-interventionp-valuePre-interventionPost-interventionp-valueMean±SDMean±SDMean±SDMean±SDGDI14±3,28,3±3,0<0,001*13,8±2,511,5±3,70,066SS10,3±1,86,9±2,70,001*10,8±1,010,1±1,40,244FIQ-RFunction21,0±4,610,6±4,8<0,001*21,4±4,719,3±5,40,128Global16,1±5,18,1±4,20,002*16,5±2,613,8±3,60,016Symptoms37,3±5,723,2±8,1<0,001*39,4±5,134,3±7,80,004*Total score74,6±12,842±15,1<0,001*77,3±9,667,5±14,60,006VAS7,8±1,04,7±2,2<0,001*7,7±1,56,9±2,40,193Sleep16,7±2,011,9±4,20,001*16,2±2,615,8±4,20,664Self-care51,3±6,863,6±5,60,001*53,1±7,349,1±11,10,251Caption: EG: Experimental Group; CG: Control Group; SD: Standard deviation; GDI: Generalized Pain Index; SS: Severity of Symptoms; FIQ-R: The Revised Fibromyalgia Impact Questionnaire; VAS: Visual Analog Pain Scale.

BackgroundIn patients with fibromyalgia, the physiotherapist is essential in the treatment. He will act throughout the patient’s rehabilitation process, from the application of initial assessment instruments to full recovery.ObjectivesCheck the performance and benefits of physiotherapy resources in the current scientific literature for patients with fibromyalgia.MethodsA literature review was carried out in the databases Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Web of Knowledge ISI, Physiotherapy Evidence Database (PEDro), Excerpt Medical Database (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and SPORTDiscus for articles dated March 2012 to March 2022. The terms fibromyalgia AND (physiotherapy OR “physiotherapy” OR rehabilitation) were used as keywords in English, Portuguese and Spanish. The searches were not limited to titles and abstracts, we chose to leave them free, appearing in all fields of the articles. In addition, some specific physiotherapy interventions were manually searched. The articles were searched in all indicated databases and then the main information was read and collected and then analyzed descriptively.ResultsPhysical therapy interventions have shown positive therapeutic effects on fibromyalgia. Among the different interventions, aerobic and resisted physical exercises are the most indicated and widely used. With regard to manual therapy, myofascial release, connective tissue massage, manual lymphatic drainage and Shiatsu produce good results. Electrophysical agents are also used in the clinical practice of physiotherapists who assist individuals with this disease. The use of complementary therapies has increased and evidence shows that acupuncture, diet, herbal medicine, homeopathy, massage and supplements show promise for managing pain associated with various musculoskeletal conditions. Health education is essential and recommended for individuals with fibromyalgia. This type of intervention should promote the optimization of care through the physiotherapist’s guidance to the individual, guiding him on how to control pain and deal with problems associated with his lifestyle. As such, combining multiple therapies (including exercise) to devise an optimal treatment plan for different individuals would be an important developmental step for treating fibromyalgia in the future.ConclusionThere are several physiotherapeutic interventions that can be chosen to improve the health and quality of life of patients with fibromyalgia. Something very important is to always associate rehabilitative techniques with the patient’s health education. In Brazil there is a program that was created called “Amigos de Fibro”, an interdisciplinary educational program that seeks to promote the health of individuals with fibromyalgia and has shown promising results.References[1]Antunes MD, Couto LA, Bertolini SMMG, Rocha Loures FCN, Schmitt ACB, Marques AP. of interdisciplinary health education programs for individuals with fibromyalgia: A systematic review. Journal of Education and Health Promotion. 2021;10(64):1-8. Doi: https://dx.doi.org/10.4103%2Fjehp.jehp_592_20 [2]Antunes MD, Schmitt ACB, Marques AP. Amigos de Fibro (Fibro Friends): development of an educational program for the health promotion of fibromyalgia patients. Primary Health Care Research & Development. 2022;23(e44):1–7. https://doi.org/10.1017/S1463423621000773 [3]Antunes MD, Schmitt ACB, Marques AP. Amigos de Fibro (Fibro Friends): Validation of an Educational Program to Promote Health in Fibromyalgia. International Journal of Environmental Research and Public Health. 2022;19(9):e5297. https://doi.org/10.3390/ijerph19095297 [4]Antunes MD and Marques AP (2022) The role of physiotherapy in fibromyalgia: Current and future perspectives. Front. Physiol. 13:968292. doi: https://dx.doi.org/10.3389/fphys.2022.968292AcknowledgementsThis study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001Disclosure of InterestsNone Declared.

Background Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and many other rheumatic and musculoskeletal diseases (RMDs). It is widely recognized that patients prescribed with this, or other similar drugs, should be properly educated, namely by rheumatology nurses,[1] to better understand why and how to take it, the possible side effects and how to prevent and manage them. However, high disparities may exist across European countries regarding patient education (PE) and support about MTX. Objectives To assess patients’ and clinicians’ perspectives and experiences on education and support received about MTX treatment in Europe. Methods A survey was developed by a team of international researchers and clinicians, including rheumatology nurses (from adult and paediatric care), a pharmacist, a rheumatologist, and patient representatives. Common and sample-specific questions were conceived for adult patients or carers (≥18 years) of children/young with RMDs, nurses, and physicians working in rheumatology in Europe. The survey was available in English and, for patients, in 12 additional languages, disseminated between May and December 2022. Ethics committee approval was obtained (116_CEIPC/2022_IPC). Results Complete responses were obtained from 1536 patients (52% with RA), 154 careers, 335 nurses, and 299 physicians (96% rheumatologists), from 24 European Countries, mainly from Northern (nurses) and Southern Europe (patients and physicians) (Table 1). Only 28% of patients had a specific nurse consultation when they started oral MTX, slightly increasing when the subcutaneous form was prescribed (42%), with variations across Europe, being higher in the Western (43%) and Northern (39%) and lower in Eastern (29%) and Southern (11%). These patients’ perspectives are somewhat in line with physicians’ perspectives, although according to nurses the access to them is higher, independent of the form of prescription (Table 1). Clinicians perceive higher opportunities to discuss patients’ MTX concerns than the patients themselves (Table 1). Patients had more opportunities to voice their concerns (≥7 on a scale from 0 to 10) about MTX before starting it, in Western (57%) and Northern (42%) than in Southern (36%) and Eastern (31%) Europe. According to 47% of nurses, PE occurs on the same day of prescription, with the consultation lasting between 10-30 minutes in 50% of cases or even less than 10’ (15%). 37% of nurses do not perform MTX-related follow-up appointments. Only half of the nurses (49%) received specific training to advise patients about MTX (data not shown). The priority ranking of topics to be addressed was also assessed, with agreement on the top one (side effects and their management) (Figure 1). Around 77% of patients had/have concerns about potential unpleasant side effects, which were discussed with health professionals (mainly with rheumatologists) in 68% of the cases, despite not being clarified 46% of the times. Conclusion PE and support about MTX are unequal across Europe and can be improved by providing opportunities to clarify concerns, namely by providing patients with more access to nursing consultations. There is an overall agreement between patients and clinicians regarding key information areas of education, although a tailored approach is required. Reference [1]Bech B, et al. Annals Rheum Diseases 2020;79:61-68. Acknowledgements This study was funded by an unrestricted grant from medac, without any involvement in the scientific work. Disclosure of Interests Cristiano Matos: None declared, Andrea Marques: None declared, Khadija El Aoufy: None declared, Kristina Buerki: None declared, Ágnes Ágoston-Szabó: None declared, Darja Batšinskaja: None declared, Jana Melicharová: None declared, Marie-Louise Karlsson Speakers bureau: Novartis, Grant/research support from: Novartis, Karlien Claes: None declared, Ana Isabel Rodriguez Vargas: None declared, Ellen Moholt: None declared, Ane Ludvigsen: None declared, Una Martin: None declared, Ulrike Erstling: None declared, Angela Camon: None declared, Ana Pais: None declared, Mikaella Konstantinou: None declared, Myrto Nikoloudaki: None declared, Souzi Makri: None declared, Elena Nikiphorou Speakers bureau: Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius, Paid instructor for: Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius, Grant/research support from: Lilly, Pfizer, Claudia Paiva: None declared, Polly Livermore Consultant of: Nordic Pharma, Grant/research support from: GOSH NIHR BRC and NIHR Personal Fellowship, Ricardo J. O. Ferreira Speakers bureau: Sanofi, MSD, Paid instructor for: UCB, Consultant of: medac, abbvie, roche, Sanofi, Amgen, Grant/research support from: Abbvie.

Background The recommendations reviewed by the European League Against Rheumatism (EULAR) for the management of fibromyalgia indicate the importance of combining pharmacological and non-pharmacological interventions. In addition, these guidelines highlight that the initial non-pharmacological strategy should be patient education centered on the process of adapting and coping with fibromyalgia in quality of life. Objectives Develop and validate an educational material to promote health in fibromyalgia and disseminate it to the community in the subway of São Paulo - SP, Brazil. Methods For the construction of educational material for dissemination, the following steps were followed: Step 1: Identification of the needs of individuals with fibromyalgia and health professionals in which a qualitative research was carried out, through a focus group (a group of patients with fibromyalgia and another of health professionals). Twelve individuals with fibromyalgia and 10 health professionals in Brazil were invited to participate. The group meeting sought to identify, through the participants' speech, what are the needs and problems reported by individuals with fibromyalgia and the possibilities of guidance by an interdisciplinary team of professionals to meet the needs and solve the problems. Qualitative data were analyzed using the content analysis method proposed by Bardin. The construction of the educational material used the Paulo Freire method, which began with an important survey to identify the primary needs of the participants so that they could be worked on so that, subsequently, the awareness process would take place. The researchers developed educational material containing information that was listed by individuals with fibromyalgia and health professionals. The educational material was made in online format. Results The educational material was developed based on the contents proposed in the previous phases and is shown in Figure 1. Conclusion The present study can contribute to the dissemination of educational strategies that promote health in fibromyalgia, for patients and for community, in order to disseminate scientific knowledge about the syndrome. References [1]Antunes MD, Couto LA, Bertolini SMMG, Rocha Loures FCN, Schmitt ACB, Marques AP. of interdisciplinary health education programs for individuals with fibromyalgia: A systematic review. Journal of Education and Health Promotion. 2021;10(64):1-8. Doi: https://dx.doi.org/10.4103%2Fjehp.jehp_592_20[2]Antunes MD, Schmitt ACB, Marques AP. Amigos de Fibro (Fibro Friends): development of an educational program for the health promotion of fibromyalgia patients. Primary Health Care Research & Development. 2022;23(e44):1–7. https://doi.org/10.1017/S1463423621000773[3]Antunes MD, Schmitt ACB, Marques AP. Amigos de Fibro (Fibro Friends): Validation of an Educational Program to Promote Health in Fibromyalgia. International Journal of Environmental Research and Public Health. 2022;19(9):e5297. https://doi.org/10.3390/ijerph19095297[4]García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, Toledano-Moreno S, Casas-Barragán A, Correa-Rodríguez M, et al. Effectiveness of health education in patients with fibromyalgia: a systematic review. European Journal of Physical and Rehabilitation Medicine. 2019;55(2):301–13, 2019. Doi: https://doi.org/10.23736/S1973-9087.19.05524-2[5]Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases. 2017;76(2):318-328. Doi: https://doi.org/10.1136/annrheumdis-2016-209724 Acknowledgements This study was financed in part by the Coordination for the Improvement of Higher Education Personnel – Brazil (CAPES) – Finance Code 001 Disclosure of Interests None Declared.Figure 1Educational material to promote health in fibromyalgia in Brazil.Source: the authors.

Background The EULAR task force “Implementation of a mobile health app for the self-management of juvenile-onset rheumatic and musculoskeletal diseases (jRMDs) during transitional care” aims at designing, developing and implementing a self-management program through a smartphone app (i.e., the EULAR Move-Up app). The first step of this task force was to adapt the current EULAR recommendations/points originally developed for adults, to young people (YP) with jRMDs. Objectives Adapting EULAR recommendations/points for patient education, pain management and physical activity for self-management of jRMDs during transitional care. Methods A multidisciplinary taskforce of 25 members from 11 European countries was convened. Using a Delphi technique, the level of agreement was established by anonymous online voting in three rounds. Results Four overarching principles and 8 points to consider were formulated (Table 1). The agreement was high, ranging from 8.7 to 9.9. Conclusion This work will feed into an evidence-based framework to inform the development of the EULAR Move-Up app aiming at improving the quality of transitional care of jRMDs. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests Rafael Prieto-Moreno: None declared, Javier Courel-Ibañez: None declared, Erica Briones-Vozmediano: None declared, Saskya Angevare: None declared, Jordi Anton: None declared, Patrocinio Ariza-Vega: None declared, Ilaria Bini: None declared, Daniel Clemente: None declared, Matilde Correia: None declared, Wendy Costello: None declared, De Cock Diederik: None declared, Andrea Domjan: None declared, Leticia Leon Mateos: None declared, Andrea Marques: None declared, Kirsten Minden Grant/research support from: Honoraria from Pfizer, Novartis and Medac., Ana Filipa Mourão: None declared, Aurelie Najm: None declared, Seza Özen: None declared, Georgina Pimentel: None declared, Zainab Saleem: None declared, Tomas Vetrovsky: None declared, Nico Wulffraat: None declared, Andrea Zacarias: None declared, Yeliz Prior: None declared, Loreto Carmona: None declared, Fernando Estevez-Lopez: None declared.Table 1Overarching principles and points to consider for the self-management of juvenile-onset rheumatic and musculoskeletal diseases during transitional careOverarching principlesAgreement (0 to 10)1YP with jRMDs should be offered education, physical activity advice and pain management recommendations and provided with access to relevant resources during transitional care, as soon as possible following the diagnosis9.62Health professionals in rheumatology should consider the use of digital health interventions in transitional care to support self-management9.53The content and delivery of transitional care should be individually tailored and needs-based according to the patients' priorities, preferences, capabilities and resources9.64Transitional care interventions should have clear personalised aims, which should be evaluated over time, preferably by a combination of objective and subjective (patient-reported outcome measures) assessments9.9Adapted points to consider in education1Education is a planned interactive learning process designed to support and enable YP with jRMDs to manage their health and chronic condition, and optimise their health and well-being during transitional care9.52Education should consist of a variety of learning formats and the programme should be designed through a shared decision-making process9.43Education should include the evaluation of outcomes reflecting both the knowledge acquired and, most importantly, translation to behaviour change8.7Adapted points to consider in pain management4All patients and their carers should be offered education on the importance of maintaining healthy body composition and explained that unhealthy body composition could contribute to pain and disability9.85Non-pharmacological approaches (e.g., physical activity, lifestyle change, psychological interventions) should be prioritised in newly-diagnosed patients and those in transitional care. If indicated, the patient should receive pharmacological treatment according to the most recent recommendations9.6Adapted points to consider on physical activity6Physical activity is part of a healthy lifestyle and should be optimised during the lifespan of individuals of all ages9.87Physical activity has health benefits for YP with jRMDs during transitional care and helps establishing healthy behaviours and lifestyles during adulthood9.88Healthcare providers should consider different formats of delivery of physical activity, in line with YP's preferences and disease requirements9.6YP = Young people; jRMDs = juvenile-onset rheumatic and musculoskeletal diseases;

Background Fibromyalgia is present in women with FMR1 gene premutation. (Fragile X Messenger Ribonucleoprotein 1). Few studies have evaluated the impact of fibromyalgia on the sleep and on the quality of life in premutation women. Objectives The aim of the present study was to compare the impact of fibromyalgia on sleep and quality of life in women with FMR1 gene premutation as compared to a group of paired control without fibromyalgia. Methods The study included 140 women who were divided into two groups: Women with FMR1 Gene premutation (n=70) and Women without FMR1 Gene premutation (n=70). The impact of fibromyalgia on quality of life was verified using the Fibromyalgia Impact Questionnaire - QIF, validated for the Brazilian version, in which the maximum score is 100 and the higher the score, the greater the impact of fibromyalgia on the quality of life. Sleep quality was assessed by the Pittsburg Sleep Quality Index, in which the sum of the scores of its components generates a global score, which varies from 0 to 21, classifying sleep quality as good, bad or presence of sleep disturbance. Data were analyzed using descriptive statistics. Results Among premutated women group, the mean age was 41.96 ± 8.02 years, most of them white (81.43%) and with a (post-) graduate degree (48.57%). Among women without premutation, the mean age was 38.51 ± 10.24 years and the majority was white (58.57%) and had a (post-) graduate degree (64.28%). In the women premutation group the impact of fibromyalgia on quality of life was 39.68±19.27 points, indicating a medium impact on quality of life. As to sleep quality, 17.14% presented good quality, 51.43% poor and 31.43% disturbed. In the contol group, the impact of fibromyalgia on quality of life was 30.97 ± 18.76 points, indicating medium impact and on sleep, 14.00% presented good quality, 51.43% poor and 20.00% sleep disturbance. Conclusion The present study confirms that the impact on quality of life and sleep disturbance seems to be greater in women with FMR1 gene premutation when compared to control women without the premutation. References [1]Hagerman RJ, Protic D, Rajaratnam A, Salcedo-Arellano MJ, Aydin E Y, Schneider A. Fragile X-associated neuropsychiatric disorders (FXAND). Frontiers in Psychiatry. 2018; 9: 564. [2]Johnson K, Herring J, Richstein J. Fragile X premutation associated conditions (FXPAC). Frontiers in Pediatrics, 2020; 8: 266. Acknowledgements: NIL. Disclosure of Interests None Declared.

Background Systemic Lupus Erythematosus (SLE) is a chronic inflammatory disease, multisystemic, of unknown cause, autoimmune, with periods of exacerbations and remissions, which may generate limitations in functional and occupational capacity. Brazil has high prevalence rates of SLE (20 to 150 cases per 100,000 inhabitants). The survival rate of these patients has increased in the last century (from 50% to 95%). This context raises questions about the social, health, and quality of life profile of the patient. Objectives To profile and evaluate the quality of life of patients with SLE residing in Brazil. Methods This is a cross-sectional study, in subjects aged ≥18 years, diagnosed with SLE and residing in Brazil. We applied online form through Google Forms and collected sociodemographic (age, sex, marital status, years of study, occupational activity, and self-reported race), clinical (Body Mass Index (BMI), duration of disease, presence of comorbidities and use of corticosteroids) and quality of life data through the Systemic Lupus Erythematosus Quality of Life (SLEQOL). Data analysis was descriptive (mean, sample standard deviation, and percentage). Results 642 volunteers were female (98.29%), aged between 18 and 73 years, and BMI of 27.3 ± 45.8. Greater representation from the Southeast region (60.12%); self-reported white race (54.98%); married marital status (39.88%), education with ≥12 years of schooling (64.64%), have already withdrawn from occupational activity (74.92%) and changed profession after SLE diagnosis (37.85%). The duration of SLE was ≥ 5 years (45.64%) and they have other diagnosed comorbidities (63.24%), and they use corticoid (62.62%). Quality of life had a score of 137.72 ± 51.89, closer to the minimum score (minimum score = 40 and maximum = 280; whereby, higher values correspond to worse quality of life). Conclusion Most of the sample are female as already pointed out in other studies; the most recurrent self-reported race was white, unlike studies that the Afro-descendant race was more frequent. Throughout their illness, patients encounter physical, psychological, and social challenges, reflecting on their functional capacity, interfering with occupational activity (leaves of absence and sometimes changing professions) even with education ≥12 years of study. These changes can interfere with health-related quality of life. Care strategies aimed at decreasing the impact of the disease for the patient and his family are needed; as well as, future studies to explore non-drug therapeutic resources for an integral care of the patient. References [1]Baker K, Pope J. Employment and work disability in systemic lupus erythematosus: A systematic review. Rheumatology (Oxford). 2009; 48: 281–84. [2]Freire EA, Guimarães E, Maia I, Ciconelli RM. Systemic lupus erythematosus symptom checklist cross-cultural adaptation to Brazilian Portuguese language and reliability evaluation. Acta Reumatol Port. 2007; 32(4):341-4. [3]Pons-Estel GJ, Alarcón GS, Scofield L, Reinlib L, Cooper GS. Understanding the epidemiology and progression of systemic lupus erythematosus. Semin Arthritis Rheum. 2010; 39: 257–68. Acknowledgements This work has been supported by the following Brazilian research agencie: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Disclosure of Interests None Declared.

Background The term invalidation refers to the patients’ perception that their medical condition is not recognised, either in denying, lecturing, not supporting or not acknowledging the condition. This may be the felt from health professionals themselves but also from family, friends, at work and in other social areas, imposing great suffering.[1] The European Alliance of Associations for Rheumatology (EULAR) has made efforts to raise awareness for the burden imposed by rheumatic and musculoskeletal conditions (RMDs) and promote the best quality of care, including recognition and psychosocial support. However, it is unclear how frequent and severe the problem remains nowadays. Objectives The aims of this national survey were: (i) to identify the levels of invalidation and lack of understanding felt by adults with RMDs from health professionals and other people, (ii) to investigate the relationship between invalidation, sociodemographic characteristics and disease; and (iii) to understand its impact on people’s life and health outcomes. Methods An online survey was developed by the national health professionals in rheumatology and patients’ organisations and opened between May and December of 2021. The questionnaire included demographic and disease information, the Illness Invalidation Inventory (3*I),[1] with additional questions in a Likert format and open questions for a detailed understanding of the phenomenon. The 3*I is composed of 8 items, measured from 1 (=never) to 5 (=very often), forming two factors: Discounting (mean of 5 items; lower scores indicating more discounting) and Lack of understanding (mean of 3 items; Higher scores representing higher lack of understanding). Quantitative data were analysed using descriptive statistics. Associations were tested with a t-student and ANOVA one-way test (Bonferroni correction). Open responses were categorised using the content analysis technique, and themes were defined a posteriori . Results From the > 1500 responses obtained, 1410 responses were filled out completely (mean age of 46 years [SD=11], 95% females, 60% with FM, among which 59% were diagnosed in the last 5 years). Invalidation was reported by 86% of the participants and 70% rated ≤5 on a scale from 0 (nothing) to 10 (totally) on feeling understood by other people. Invalidation was mostly felt from family (56%), health professionals (48%), friends (39%) and social environment (38%). The impact of this invalidation is mainly on the psychological well-being (58%), also reducing seeking health care (41%) and therapeutic adherence (17%), affecting work (41%), and to a less extent, (family) relations (31%). Figure 1 shows the frequency of responses and means scores on the 3*I items and factors for participants with and without FM. The burden is greater for people with FM, which was statistically significant. People with higher education felt more discounting and more lack of understanding. No differences (p>0.05) were observed for gender or civil status. Figure 1. Percentages of responses per type of disease for the eight items of the Illness Invalidation Inventory. Elucidative expressions of invalidation were shared, mostly by people with FM, encompassing their ability to work and need for social support, faking pain and treatment efficacy, and even intimacy aspects. These emotionally uncomfortable situations can be linked to lesser engagement with healthcare and disease management, and therefore, with worse health outcomes. Conclusion Invalidation remains a source of suffering, affecting well-being and health outcomes. Specific awareness and educational campaigns are needed to target this problem on different play-actors. References [1]Kool MB, et al. Ann Rheum Dis 2014;73:551–556. doi:10.1136/annrheumdis-2012-201807 Disclosure of Interests None declared.

Background Low back pain is the second most common health condition in Brazilian elderly, after arterial hypertension, and can be defined as any pain between the last ribs and the lower gluteal folds, with or without pain in the lower limbs, manifesting itself acutely, subacutely or chronically. Objectives To analyze the effect of segmental stabilization in comparison with the Pilates method in elderly patients with chronic non-specific low back pain. Methods 9 elderly people with chronic low back pain participated in the study, randomized into two groups: Segmental Stabilization Group (SG n=9; age 66.11±4.78; Body Mass Index - BMI 28.21±4.05) and Pilates Group (PG n=13; age 67.46 ±4.89; BMI 28.18±3.48). Both groups performed 16 individual 60-minute sessions twice a week and evaluated before and at the end of treatment. Pain was assessed using the Visual Numerical Pain Scale; functional disability, by the Oswestry disability index; excessive fear of movement and physical activity, by the Tampa Kinesiophobia Scale; level of confidence in balance for specific activities, by the Activities-specific Balance Confidence (ABC) scale and; activation of the transversus abdominis muscle, by the pressure biofeedback unit Stabilizer of the brand Chatanooga. The allocation and assessments of participants were performed by a blinded examiner. Data were analyzed using Student’s t test with the level of significance (p≤0.05). Results Pain intensity had a greater reduction in the SG when compared to the PG (p=0.0015), as well as a reduction in functional disability (p=0.0043). The activation of the transversus abdominis was greater in the PG (p=0.0213). There was no difference in kinesiophobia and the level of confidence in balance for specific activities. Conclusion Segmental stabilization and Pilates were effective in improving pain and functional disability, with SG showing a better effect for these variables. The PG obtained better results when compared to the SG regarding the activation of the transversus abdominis muscle. It is suggested to carry out studies with a greater number of participants, a longer treatment and follow-up time to complement these findings. References [1]Boonstra AM, Preuper HRS, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. IJSR 2008; 3(2):165-9. [2]Marques AP, Mendes YC, Taddei U, Pereira CAB, Assumpção A. Brazilian-Portuguese translation and cross cultural adaptation of the activities-specific balance confidence ABC) scale. Braz J Phys Ther 2013; 17(2): 170-8. [3]Siqueira FB, Teixeira-Salmela LF, Magalhães LC. Análise das propriedades psicométricas da versão brasileira da escala tampa de cinesiofobia. Acta Orto Bras 2007; 15(1): 19-24. [4]Viggato R, Alexandre NMC, Correa Filho HR. Development of a Braziliam Portuguese version of the Oswestry Disability Index: cross-cultural adaptation, reliability, and validity. Spine 2007; 32(4):481-6. Acknowledgements Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Disclosure of Interests None declared

OBJECTIVE:To perform a systematic literature review (SLR) on different outcomes of remote care compared with face-to-face (F2F) care, its implementation into clinical practice and to identify drivers and barriers in order to inform a task force formulating the EULAR Points to Consider for remote care in rheumatic and musculoskeletal diseases (RMDs). METHODS:A search strategy was developed and run in Medline (PubMed), Embase and Cochrane Library. Two reviewers independently performed standardised data extraction, synthesis and risk of bias (RoB) assessment. RESULTS:A total of 2240 references were identified. Forty-seven of them fulfilled the inclusion criteria. Remote monitoring (n=35) was most frequently studied, with telephone/video calls being the most common mode of delivery (n=30). Of the 34 studies investigating outcomes of remote care, the majority addressed efficacy and user perception; 34% and 21% of them, respectively, reported a superiority of remote care as compared with F2F care. Time and cost savings were reported as major benefits, technical aspects as major drawback in the 13 studies that investigated drivers and barriers of remote care. No study addressed remote care implementation. The main limitation of the studies identified was the heterogeneity of outcomes and methods, as well as a substantial RoB (50% of studies with high RoB). CONCLUSIONS:Remote care leads to similar or better results compared with F2F treatment concerning efficacy, safety, adherence and user perception outcomes, with the limitation of heterogeneity and considerable RoB of the available studies.

BackgroundIn the optimal treatment of fibromyalgia, international recommendations highlight non-pharmacological treatment as the key to success. Health education is one of the main tools to promote the health of patients with fibromyalgia. Educational strategies are essential for the care of patients with fibromyalgia.ObjectivesDevelop and validate an e-book to promote the health of people with fibromyalgia who live in Brazil.MethodsThis is a methodological study, initially, through a bibliographic survey, the available publications on the subject were analyzed. Then, this knowledge was used to build the theoretical content addressed and the art and layout of the e-book was elaborated. Finally, the validation of the constructed material was carried out with three groups of specialists: content specialists (n=23), technicians (n=23) and design specialists (n=23). In addition, it was also decided to validate the e-book with individuals who have fibromyalgia (n=45. The e-book was evaluated by specific instruments through the Delphi technique. The data were analyzed, and the reliability was evaluated by the Alpha of Cronbach (αC) and agreement, using the Content Validity Index (CVI).ResultsIn the global evaluation, all the judges agreed with the items evaluated in the e-book, presented a considerable minimum of the CVI, being: content (0.79), technical (0.89), design (0.92), and target audience (0.97). Regarding reliability, all groups also had an αC within the acceptable range: content (0.960), technical (0.963), design (0.977), and target audience (1.08).ConclusionE-book was prepared and validated in terms of content and relevance, and can be used in Brazil to promote the health of individuals with fibromyalgia, mainly as a complement to treatments already carried out for fibromyalgia. In the future, this e-book may be translated and adapted into new languages.References[1]Antunes M, Schmitt A, Marques AP. Ab0912-hpr Amigos de Fibro (Fibro Friends): educational program to promote the health of people with fibromyalgia in Brazil. 2021; Annals of the Rheumatic Diseases 2021;80:1478.[2]Antunes MD, Couto LA, Bertolini SMMG, Rocha Loures FCN, Schmitt ACB, Marques AP. of interdisciplinary health education programs for individuals with fibromyalgia: A systematic review. Journal of Education and Health Promotion. 2021;10(64):1-8. Doi: https://dx.doi.org/10.4103%2Fjehp.jehp_592_20.[3]García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, Toledano-Moreno S, Casas-Barragán A, Correa-Rodríguez M, et al. Effectiveness of health education in patients with fibromyalgia: a systematic review. European Journal of Physical and Rehabilitation Medicine. 2019;55(2):301–13, 2019. Doi: https://doi.org/10.23736/S1973-9087.19.05524-2AcknowledgementsThis study was financed in part by the Coordenação deAperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001Disclosure of InterestsNone declared

Mixed plastics waste (MPW) constitute a material of extreme recycling difficulty due to their heterogeneity and contamination level. As a consequence, a large fraction of MPW is landfilled. It is imperative to find new applications for MPW that bring new value as a raw material, with application in high added-value products. The restrictions on the marketing and application of biocidal products such as the creosote treatment performed on wood railway sleepers, introduced by Directive 98/8/EC, triggered the replacement of several products traditionally produced in wood. Currently, there is a global need to find solutions for replacement of wood railway sleepers for specific railway applications. The present study investigates the application requirements and proposes a new solution based on MPW composites for the production of eco-friendly railway sleepers. The composites are mostly based on MPW and glass fibers. The prototype composite sleepers were produced by intrusion processing and tested in simulated mechanical and environmental operating conditions. Overall this new circularity approach will largely contribute to reduce the deposition of MPW in landfills, responding to a current need of the railway sector, and will contribute to implement circular economy and resource efficiency.

Background Fibromyalgia is a rheumatologic syndrome characterized by chronic pain and symptoms such as fatigue, morning stiffness, sleep disturbances and depression. Health perception is a global assessment of health based on an analysis of the objective and also subjective aspects of each person. Health self-assessment is increasingly researched and shows the health status of the population, considering the individual’s personal perspective and that this information can be useful to propose health promotion strategies. Objectives To identify the health perception of patients with fibromyalgia who live in Brazil. Methods This is a cross-sectional study that was carried out in Brazil in 2021. They were invited to participate in the research. Individuals with fibromyalgia were invited to participate in the study through the Brazilian Association of Fibromyalgia Patients (ABRAFIBRO) in August 2021. The invitation was sent via email to all people registered with this association in the country. Self-perception of health was questioned through the following response options: bad, fair, good or very good. Data were analyzed using descriptive statistics. Results The study consisted of 243 people with fibromyalgia living in different states of Brazil. Most were female (97.5%), married or living with a partner (63.7%), of white race/color (58%), receiving 1 to 2 minimum wages (60.4%), with complete higher education (46.5%) and who administer more than 2 medications per day (65.8%). Regarding the perception of health, the majority reported that their health was regular (42.4%), followed by bad (38.3%), good (16%) and very good (3.3%). Conclusion The most prevalent health perception in people with fibromyalgia in Brazil was: “regular”, followed by “bad”, “good” and “very good”. In view of the findings of this study, measures to control and prevent health risks in people with fibromyalgia become necessary. In order to implement policies to promote a healthy life for this population, it is necessary to know the determinants of these indicators of self-reported health morbidity in Brazil. It is also suggested that the results of this investigation be monitored by periodic population-based surveys, in order to verify the determination of the observed associations, being able, in the future, to detect an association with other variables. In addition, these data can guide and evaluate education and health promotion strategies in fibromyalgia. References [1]Antunes M, Schmitt A, Marques AP. Ab0912-hpr Amigos de Fibro (Fibro Friends): educational program to promote the health of people with fibromyalgia in Brazil. 2021; Annals of the Rheumatic Diseases 2021;80:1478. [2]Antunes MD, Couto LA, Bertolini SMMG, Rocha Loures FCN, Schmitt ACB, Marques AP. of interdisciplinary health education programs for individuals with fibromyalgia: A systematic review. Journal of Education and Health Promotion. 2021;10(64):1-8. Doi: https://dx.doi.org/10.4103%2Fjehp.jehp_592_20 . [3]García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, Toledano-Moreno S, Casas-Barragán A, Correa-Rodríguez M, et al. Effectiveness of health education in patients with fibromyalgia: a systematic review. European Journal of Physical and Rehabilitation Medicine. 2019;55(2):301–13, 2019. Doi: https://doi.org/10.23736/S1973-9087.19.05524-2 Acknowledgements This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001 Disclosure of Interests None declared

Background:Fibromyalgia is defined as a chronic non-articular rheumatic disease, characterized by generalized, diffuse bilateral pain and the presence of tender points in specific anatomical regions. Its symptoms are characterized by a very varied picture and the etiology is considered multifactorial. Today, with difficult treatment, fibromyalgia has been a major challenge for healthcare professionals. Aquatic physiotherapy is currently one of the most commonly used forms of intervention in the management of fibromyalgia, and for this reason it has been used in interdisciplinary rehabilitation programs to promote health.Objectives:To evaluate the effects of aquatic physiotherapy on pain and quality of life in patients with fibromyalgia.Methods:This is an interventional, quasi-experimental study carried out at the Physiotherapy School Clinic of Universidade Cesumar in the city of Maringá, PR, Brazil. The study was approved by the Human Research Ethics Committee of Unicesumar under opinion No. 1,025,567. Participated in the study, elderly women aged 60 years, with clinical diagnosis of fibromyalgia. To assess the quality of life, the Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) instrument was used and to verify the intensity of the pain, the Visual Analogue Scale was used. The aquatic physiotherapy intervention protocol was to perform 10 Watsu sessions, performed twice a week, lasting 40 minutes each. To perform the Watsu method, the following steps of the technique were followed: before starting, opening, delivering the water, dancing the breath in the water, breathing balance and to finish releasing the spine. For data analysis, the Shapiro-Wilk test was initially applied to verify the normality of the variables under study. As the data presented a normal distribution, mean, standard deviation, minimum and maximum were used to characterize the results. To compare the initial and final variables, the dependent student t test was used. The significance adopted was p <0.05.Results:The study included 17 elderly women with a mean age of 67.5 ± 4.7 years. When comparing the evaluation and the reassessment, a statistically significant improvement was evidenced in the domains of quality of life: functional capacity (p=0.00445), limitation due to physical aspects (p=0.01347), pain (p=0.00861), vitality (p=0.00044), limitation due to emotional aspects (p=0.02019), mental health (p=0.00748). The domains that did not show statistical increase were the general health status (p=0.30663) and the social aspects (p=0.05037). The pain, on the other hand, was statistically less after the intervention (p=0.00059).Conclusion:Aquatic physical therapy provided benefits in reducing pain and improving the quality of life of elderly women with fibromyalgia. It is important to encourage individuals with fibromyalgia to perform non-pharmacological interventions, such as aquatic physiotherapy, to promote their health and quality of life.References:[1]Oliveira DV, Ferreira AAM, Oliveira DCD, Leme DEDC, Antunes MD, Nascimento Júnior JRAD. Association of the practice of physical activity and of health status on the quality of life of women with fibromyalgia. Journal of Physical Education. 2019;30(1): e3027. https://doi.org/10.4025/jphyseduc.v30i1.3027.[2]Antunes MD, Vertuan MP. Miquilin A, Leme DEC, Morales RC, Oliveira DV. Efeitos do Watsu na qualidade de vida e quadro doloroso de idosas com fibromialgia. ConScientiae Saúde. 2016;15(4), 636-641. https://doi.org/10.5585/conssaude.v15n4.6756.[3]Antunes M, Ferreira A, Oliveira D, Júnior JN, Bertolini S, Marques AP. There is association between the level of physical activity and quality of life of women with fibromyalgia?. Annals of rheumatic diseases. 2019;78(2)650-1. http://dx.doi.org/10.1136/annrheumdis-2019-eular.2835.Acknowledgements:This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.Disclosure of Interests:None declared

Background: The COVID-19 pandemic has resulted in unforeseen challenges for humanity, taking a significant toll, especially the immune-suppressed individuals. In this regard, the health and general well-being of people with rheumatic diseases, the great majority users of immunosuppressives, have been at stake. Objectives: To explore the impact of the COVID-19 pandemic on people with rheumatic diseases on immunosuppression during the first wave, concerning a) (self-)management of their disease; b) interaction with the health care team; c) emotional well-being and d) overall health. Methods: A qualitative study was conducted following a phenomenological approach. Adults (>18 years) with a rheumatic disease from four European countries (Cyprus, England, Greece, Portugal). Patients were recruited through patient’s associations and social media and were invited to participate in semi-structured, audio-recorded interview or focus groups, between July - August 2020. Following a pilot study the information provided was transcribed verbatim, anonymized and translated into English where necessary. An inductive approach was adopted to carry out a thematic framework analysis with the assistance of ATLAS.ti to identify key themes and subthemes. Data validation strategies were employed, and Ethical approval and informed consent were obtained. Results: Participants were 24 patients (21 women, age range 33 to 74 years) divided by 7 focus-groups and 1 individual interview. Most frequent diagnoses were rheumatoid arthritis (n=7), lupus (n=4), juvenile idiopathic arthritis (n=3). Three key themes with 3-7 subthemes were identified within the analytical framework, centred around the impact of the Covid-19 on patients’ lives (Figure 1): i) individual person (e.g. fear for myself and family, social isolation and lack of personal freedom, more time with family) ii) health settings (e.g. (un)clear information about risks of contamination, fear or risk of shortages of medication, remote consultations), and iii) work and community (e.g. persistent stress due to mass media exposure, lack of awareness by others about patients’ rheumatic disease and its disclosure, hope and suspicion about new vaccine development: “I hear that they will ask vulnerable groups to have the vaccine first (...) Why is that? we will be again the innocent victims”). Findings were similar across countries, except for spirituality (i.e. the pandemic as “the hand of God”), a coping subtheme particular to Portugal. These main themes resonated well with the social ecological model and Walsh’s Family Resilience Process [1,2]. Conclusion: When experiencing a significant life-event people require some time to process the different lived experiences. This study provides insights on how patients from four countries coped with the new challenges. Such insights are invaluable for health care providers and policy makers, in guiding more meaningful support tailored to individual needs, especially at times of crisis. The study highlights the impact of COVID-19 on the lives of people with rheumatic disease. A follow-up study is currently underway to examine the effect of subsequent waves of the pandemic. References: [1]Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39(3):364-72. doi: 10.1177/1090198111418634. [2]Walsh F. Family resilience: a framework for clinical practice. Fam Process. 2003;42(1):1-18. doi: 10.1111/j.1545-5300.2003.00001. Acknowledgements: We thank the participants of this study. Disclosure of Interests: None declared

Objective To assess the educational needs of people with ankylosing spondylitis (AS) and psoriatic arthritis (PsA), test differences across patient subgroups and identify factors independently associated with their educational needs. Methods This was a cross-sectional analytic study. Patients with AS and PsA completed the Portuguese version of the Educational Needs Assessment Tool (PortENAT). Data were Rasch-transformed before descriptive and inferential analyses were undertaken. Univariable and multivariable analyses were used to determine differences between patient subgroups and factors independently associated with their educational needs. Results The study included 121 patients with AS and 132 with PsA. The level of educational needs varied by diagnostic group, but higher needs for both subgroups were reported regarding the "Disease process", "Feelings" and "Managing pain" domains. Overall, patients with AS had a higher level of educational needs than those with PsA. In both diagnostic groups, female gender was independently associated with higher educational needs. In the PsA group, a shorter disease duration was independently associated with higher educational needs in the following domains: "Managing pain", "Movement" and "Feelings". Conclusion Educational needs vary by diagnostic group, gender and disease duration. These differences merit consideration in the design of patient education interventions.