bluuebunny/crossref_metadata_2025 huggingface dataset:
OA10 Survival analysis of 496 patients with systemic lupus erythematosus with up to 40 years follow-up shows improved survival in patients diagnosed in more recent time-periods
Authors: Luo Weike , Farinha Filipa , Isenberg David A , Rahman Anisur
Published: April 2022

Background/Aims

Patients with systemic lupus erythematosus (SLE) have increased mortality compared to age- and sex-matched controls. Lupus nephritis (LN) is a severe manifestation of SLE and an important cause of death. Our objective was to carry out a retrospective survival analysis to investigate factors that could influence risk of mortality and LN in a large multi-ethnic cohort of patients with SLE.

Methods

By careful review of medical records, we identified 496 patients with SLE for whom we had complete information regarding period of observation and occurrence of death and nephritis. Patients were stratified into groups according to sex, ethnicity (Caucasian, African/Caribbean, South Asian, East Asian, Other), age at start of follow-up (above and below median) and time-period of diagnosis (1978-89, 1990-99, 2000-5, 2006-11). Kaplan-Meier analysis was used to investigate differences between the groups in survival and LN.

Results

Overall, there were 454 women and 42 men. 91 patients died and 165 developed LN. Mean follow-up was 15.8 ± 8.75 years with a maximum of 40 years. Median age at start of follow-up was 28.0 ± 12.13 years.

Results are shown in Table 1

There were no differences between men and women in mortality or LN.

Caucasian patients were significantly less likely to develop LN (P < 0.0001) than other groups but there was no mortality difference between ethnic groups.

Patients diagnosed below age 28 were more likely to develop LN (P < 0.0001) but less likely to die (P = 0.0039) than those diagnosed above age 28.

Patients diagnosed between 2006 and 2011 were significantly less likely to die than those diagnosed between 1978 and1989 by Cox proportional hazards analysis of survival curves. (P = 0.019)

Conclusion

In this long-term survival analysis of 496 patients, non-Caucasian patients and those diagnosed below the age of 28 years were more likely to develop LN. The latter group were less likely to die than those diagnosed at older ages. Survival curves for groups of patients diagnosed in successive time periods suggested improved survival over time.

Disclosure

W. Luo: None. F. Farinha: None. D.A. Isenberg: None. A. Rahman: None.
OA28 Exploring the potential of polygenic risk scores for predicting coronary artery disease in patients with rheumatoid arthritis
Authors: Soomro Mehreen , Stadler Michael , Viatte Sebastien , MacGregor Alexander , Verstappen Suzanne , Barton Anne , Bowes John
Published: April 2022

Background/Aims

Patients with rheumatoid arthritis (RA) have a higher prevalence of coronary artery disease (CAD) than the general population which contributes to early mortality. Current screening tools for CAD, which are developed in the general population, are less effective for estimating CAD risk in patients with RA. This reduced performance is mainly due to the differing contribution from traditional risk factors and the contribution from disease-specific factors. Our understanding of the genetic basis of CAD has improved over recent years and shows promise for improving risk prediction in the form of polygenic risk scores (PRS). We hypothesise that PRS can help us improve CAD risk prediction in patients with RA by providing more accurate models of risk.

Methods

Patients were recruited from the Norfolk Arthritis Register (NOAR), a detailed community-based longitudinal observational study focused on the cause and outcome of inflammatory polyarthritis, between 1990 and 2017. Analysis was restricted to patients who satisfied the 2010 ACR criteria cumulatively over five years and had detailed clinical history at baseline and follow-up. We developed a prediction model based on traditional risk factors and explored the inclusion of a PRS (49K SNPs) in a subset of patients with available genetic data. Cox proportional hazards models were used to derive risk equations for evaluation of 10-year risk of CAD. We applied multiple imputations with chained equations using the Random Forest algorithm to replace missing values. Measures of calibration and discrimination were determined in the validation cohort of 423 individuals.

Results

A total of 2123 patients were included in the analysis with 136 incident cases of self-reported CAD. The model using only traditional risk factors achieved an AUC of 0.72 (95% CI 0.71, 0.73), with a calibration slope of 1.03, and explained approximately 50% (95% CI 47, 52%) of the variance of the outcome. We found that being male reduces the risk by a factor of 0.82 (95% CI 0.68, 1.00). The hazard ratio for age was found to be 1.00 (95% CI 0.99, 1.01) indicating risk remains the same across all age groups. Inclusion of a CAD PRS increased the performance with an AUC of 0.76 (95% CI 0.75, 0.77), explained variance of 53% (95% CI 49, 56%) but with a slightly worse calibration slope of 0.91.

Conclusion

An integrated risk score, that combines traditional risk factors with a PRS, improves CAD prediction in patients with RA. Further research is required to better understand the role of heritable components contributing to CAD risk in RA patients. By refining the underlying PRS, we hope to further improve CAD risk prediction in RA patients, through this integrated approach.

Disclosure

M. Soomro: None. M. Stadler: None. S. Viatte: None. A. MacGregor: None. S. Verstappen: None. A. Barton: None. J. Bowes: None.
OA33 The top 10 research priorities in psoriatic arthritis: a James Lind Alliance Priority Setting Partnership
Authors: Hailey Louise , Kinsella Suzannah , Bundy Chris , Burstow Helen , Chandler David , Cowper Russ , Helliwell Philip , Joannes Lucille , Kelly Andy , Kennedy Bronagh , McAteer Helen , Mukherjee Sandeep , Packham Jon , Wise Elspeth , Young Helen , Coates Laura
Published: April 2022

Background/Aims

This process aimed to identify and prioritise the top 10 research questions or evidence uncertainties for psoriatic arthritis (PsA) in adults. The British Psoriatic Arthritis Consortium (BritPACT) formed a Priority Setting Partnership (PSP) comprising people with PsA, carers and healthcare professionals, in association with the James Lind Alliance (JLA) to identify the key questions and priorities.

Methods

The JLA methodology involved a three-stage process: 1. A steering group composed of stakeholders conducted an initial online survey of people with PsA, families, carers and healthcare professionals to identify PsA questions. Participants were asked, “What do you think are the most important unanswered questions in psoriatic arthritis research?”. Duplicate questions and those which were out of scope were removed. Questions were checked against existing evidence to establish “true uncertainties”, which were then grouped as “indicative questions” reflecting the overarching themes of the original submissions (diagnosis, effects of disease and treatment, flares, psychological, financial and social factors, gender-associated issues, Covid-19 and treatment) to facilitate prioritisation in stage two. 2. In a second online survey, people with PsA, carers and healthcare professionals ranked the “true uncertainties” by importance. 3. During the final workshop, including people with PsA and clinicians, participants worked together to rank the questions to generate a top 10 list of research priorities.

Results

The initial survey recruited 317 respondents, submitting a total of 988 questions. The individual submissions generated 46 indicative questions. 69% of the respondents were people with PsA, and 15% were friends, relatives, or carers of someone affected by PsA. In the second survey, 422 respondents, of whom 82% were people with PsA, their carers, relatives or friends, prioritised these uncertainties; 18 of these questions were shortlisted and taken forward to the final online workshop. In the last stage, people with PsA, carers, and healthcare professionals met and reached a consensus on the final top 10 research priorities (Table 1).

Conclusion

The top 10 priorities identified will guide PsA research, ensuring that PsA researchers and those who fund research know the most urgent needs of people living with PsA, their families and carers, and those treating people with PsA.

Disclosure

L. Hailey: None. S. Kinsella: None. C. Bundy: None. H. Burstow: None. D. Chandler: None. R. Cowper: None. P. Helliwell: None. L. Joannes: None. A. Kelly: None. B. Kennedy: None. H. McAteer: None. S. Mukherjee: None. J. Packham: None. E. Wise: None. H. Young: None. L. Coates: None.
P032 Are telephone consultations as effective as face-to-face consultations in the follow-up of patients in the Rheumatology Clinic? A service evaluation
Authors: Paul Anupam , Walker Charles , McHugh Claire
Published: April 2022

Background/Aims

The COVID-19 pandemic forced rheumatology clinics to utilise telephone consultations as a means to limit footfall at hospitals and to protect our vulnerable patients. This was a new mode of service delivery for most rheumatology departments as previously all appointments used to be face-to-face. Although remote consultations were previously being considered as a mode of service delivery, the COVID-19 pandemic has expedited the uptake remote consultations within a very short span of time. There are no systematic studies to compare the effectiveness of remote consultations versus face-to-face consultations although remote consultations are now being widely adopted. Our aim was to assess the effectiveness of telephone consultations compared to face-to-face consultations in the routine review of rheumatology patients.

Methods

101 face-to-face consultations and 98 telephone consultations were randomly selected from the months of June and August in 2019 and 2020 respectively. The clinic letters were then accessed and the clinic outcomes were noted. The parameters chosen to aid comparison included start of new medication, medication dose changes, referral for investigations, referral to another specialty, referral to MDT, referral for a steroid injection, timescale of subsequent follow up and discharge from services.

Results

The main results broadly showed similarities in case-mix and several outcomes, including time scale of follow up and intra-articular and intramuscular steroid injections. Fewer patients were started on a new medication following a telephone consultation (14.9% vs 10.2%), more patients had their current medication dose changed (14.9% vs 17.3%) and slightly more patients were referred for investigations (25.7% vs 30.6%). Furthermore, telephone consultations resulted in a lower rate of referrals to MDT (13.9% vs 5.1%) and marginally fewer discharges.

Conclusion

The evaluation showed there were clear similarities between the two groups which showed telephone consultations were comparable to face-to-face consultations. Out of the 98 telephone consultations, only 10 were converted to a face-to-face appointment which was lower than many had predicted. However, the drop in referral rates to other specialties may represent that consultants do not feel confident to refer to another team without a comprehensive face-to-face assessment. Telephone consultations, with the back up of face-to-face slots made available for appropriate patients, appear to be an effective means of service delivery and is likely to continue in a scaled down form.

Disclosure

A. Paul: Other; Sponsorship for educational meetings from UCB, AbbVie, Pfizer, Novartis and Celgene. C. Walker: None. C. McHugh: None.
P033 The intriguing association between fibromyalgia, hypermobility and neurodivergence: a pilot study
Authors: Yearoo Tasnime B , Kelly Clive
Published: April 2022

Background/Aims

Fibromyalgia (FM) is a common disorder with an estimated UK prevalence of 4%. An association with hypermobility spectrum disorder (HSD) has been recognised for several years and is increasingly recognised as a common precedent to chronic pain and FM. It has been recently suggested that these patients may have a higher rate of autistic spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) or other neurodivergent conditions than the general population. This is supported by the observation that neurodivergence is strongly associated with chronic pain and disability.

Methods

We sought to assess the prevalence of ASD/ADHD among all first- and second-degree relatives of index patients who had presented to secondary care with the combination of FM, HSD and either ASD or ADHD. Eight consecutive index cases with this combination agreed to research their relatives and prepare a detailed family tree listing all family members, identified only by age and gender. They were asked to record the presence of all confirmed diagnoses of FM, HSD and ASD/ADHD among their first- and second-degree relatives. We then calculated the prevalence of each of these conditions among the close blood relatives of our index cases and compared this to the prevalence derived from a control group of index cases with osteoarthritis.

Results

Our eight index cases (seven female) had a mean age of 38 years. They identified 80 relatives, among whom 31 (39%) had a diagnosis of ASD/ADHD, compared to a prevalence of 2.8% in the relatives of our control group (p < 0.01). The prevalence of HSD among the relatives was 30% (vs 8% in controls) and the prevalence of FM was 18% (vs 3% in controls). There was significant overlap, with the prevalence of HSD and FM among relatives with ASD/ADHD being recorded as 50% and 30% respectively. 62% of the relatives were female.

Conclusion

Neurodivergent conditions are present from birth and therefore predate the onset of both HSD and FM. This pilot study confirmed that patients with the combination of FM and HSD have a much higher prevalence of neurodivergence than the general population, and that their close relatives also exhibit this association. Females are disproportionately over-represented in contrast to the distribution of neurodivergent conditions in the community, where males predominate. We noted that females with FM and HSD were more likely to have ASD, while males tended to carry a diagnosis of ADHD. One recent study suggested gene clustering among people with neurodivergence and those with FM / HSD. However, the reasons for, and mechanism of, this association remain to be defined. Much more work is needed to assess the evolution of pain among people with neurodivergent conditions if we are to learn how to intervene effectively.

Disclosure

T.B. Yearoo: None. C. Kelly: None.
P048 A young girl with myocardial infarction
Authors: Janagan Shalini , Gunathilaka M. P. M. L , Rajagopala Lavanya , Jagoda J. D
Published: April 2022

Background/Aims

Takayasu arteritis is a chronic granulomatous inflammatory disease of the aorta and its major branches. It is commonly seen in young women but has been reported in children as young as 6 months. Acute myocardial infarction due to coronary artery involvement is a rare presentation in Takayasu’s arteritis.

Methods

A previously healthy 13-year-old girl presented with a history of five episodes of short lasting exertional tightening type chest pain with adrenergic symptoms over a week which was relieved by rest. She didn't have any history of shortness of breath, limb claudication or constitutional symptoms. However, on two of the occasions she felt faint. She denied any recreational drug use. There was no family history of cardiovascular disease, connective tissue diseases or sudden cardiac death. On examination she was of average build with no peripheral stigmata of connective tissue diseases or hypercholesterolemia. Apart from a tachycardia of 110 bpm, her cardiovascular examination was normal. There was no BP difference between the arms and no audible bruits. All her peripheral pulses were felt.

Results

Her ECG showed ST segment depressions in V1-V5. High sensitivity Troponin I was strongly positive. An urgent CT coronary angiogram revealed aortitis involving the ascending and arch of the aorta extending to the left subclavian artery with both coronary arteries showing smooth short segment narrowing at the origin. Doppler USS abdomen showed wall thickening of proximal and mid abdominal aorta. Blood investigations showed a leucocytosis of 14,100/µl and thrombocytosis of 532000/µl. Her ESR was raised at 31 mm/hr and CRP was 5 mg/l. While further awaiting investigations she was started on treatment as for non-ST elevation myocardial infarction according to standard guidelines. Screening for tuberculosis and VDRL were negative . A CT aortic angiogram showed wall thickening involving the aortic root, coronary arteries, ascending aorta and the abdominal aorta with involvement of the origins of coeliac axis and the superior mesenteric artery. Appearance were suggestive of Takayasu arteritis Type v. She was pulsed with intravenous methylprednisolone 30 mg/kg for 3 days followed by oral prednisolone 2 mg/kg. As a steroid sparing agent methotrexate was added. Despite treatment, while in hospital she developed chest pain with ECG showing new onset ST elevation in aVR. An urgent coronary angiogram done showed severe LMCA disease for which stenting was done.

At this stage Tocilizumab was initiated. A year later she remains well controlled in terms of her disease activity.

Conclusion

Though rare, Takayasu’s arteritis should be considered in any adolescent female presenting with ischemic type symptoms and positive inflammatory response. High index of suspicion can lead to early imaging and aggressive immunosuppression that will reduce the morbidity and mortality of this disease.

Disclosure

S. Janagan: None. M.P.M.L. Gunathilaka: None. L. Rajagopala: None. J.D. Jagoda: None.
P107 Improving care for people with chronic low back pain - ESCAPE-pain for back
Authors: Hurley Michael , Thompson Francesca , Sibley Fay , Carter Andrea ,   ESCAPE-pain Team Health Innovation Network
Published: April 2022

Background/Aims

Chronic low back pain (cLBP) is extremely prevalent, difficult to manage and impinges and all aspects of an individual’s life and its socioeconomic impact is enormous. ESCAPE-pain is an effective rehabilitation programme for knee and hip pain that is now being rolled out across the UK and beyond. We adapted ESCAPE-pain making it relevant to people with cLBP to improve their management. This study evaluated the efficacy of the programme in improving pain, function and mental well-being for people with cLBP.

Methods

Participants attended 12 sessions (2/week over 6 weeks) in groups of ∼10. Each session lasted 60-90 minutes, comprised of education and supervised, progressive exercise regimen. It was delivered by physiotherapists and therapy assistants. Data collected before and after the programme on MSK-HQ, self-reported physical activity (days active for 30 minutes each week) and function (30 second sit-to-stand). Feasibility was established from the number of Trusts willing to deliver the programme, participant recruitment and attendance. Participant and clinician satisfaction with, acceptability and experiences of the programme was gleaned from qualitative feedback from the “friends and family test” and semi-structured interviews.

Results

Four NHS Trusts took up the offer to deliver the programme, 165 people (106 women), mean age 55yrs were recruited. On average 78% of participants attended 74% of the programme. All Trusts were planning the continue to deliver and expand the programme after the evaluation ended. This uptake by organisations and participants is a proxy measure of the acceptability of the programme to providers and participants. The average number of days each week participant’s undertook for more than 30 mins physical activity increased from 2.3 to 3.6, number of sit-to-stand participants could perform in 30 seconds increased from 8 to 12, and mean MSK-HQ score increased from 25.5 to 35.2 (9.97).

Participant feedback was very positive describing how they “⋯gained lots of information to help me manage my pain...”,“⋯when I started I could only walk for 10 minutes before the pain started. I can now walk a lot further and I do not need to stop...”,“⋯I received the knowledge to understand that it is not just rest that I need for my pains but also activity and exercise...”,“⋯helped me feel more motivated and confident to exercise⋯”,“⋯it has improved the quality of my life and I feel a whole lot better⋯”

Conclusion: ESCAPE-pain for backs was accepted, well liked and improved clinical outcomes. The programme delivered care in line with NICE guidelines. The organisations were planning to expand delivery across other sites within their Trusts. Following wide expressions of interest we are rolling out of ESCAPE-pain for backs in NHS, leisure and community centres across the UK.

Disclosure

M. Hurley: None. F. Thompson: None. F. Sibley: None. A. Carter: None.
P121 Using patient experiences to redesign health provision - is this the future of rheumatology services?
Authors: Shaikh Alizeh R , Crix Douglas , Earl Susannah
Published: April 2022

Background/Aims

Chronic conditions in Rheumatology place an increasing burden on healthcare services, with the prevalence of such conditions on the rise. It is important, therefore, for us to understand what determines a patient’s experience of care and what they might need from their health service to support them to manage their condition. This study used a survey to explore patient’s perception of both their health and service experiences, with the aim of reviewing and refining the care we provide.

Methods

A questionnaire was sent to 250 patients under the Rheumatology Department of the Royal Devon and Exeter Foundation Trust. Inclusion criteria included patients above 18 years of age who had a diagnosis of either of the following conditions: Rheumatoid Arthritis, Ankylosing Spondylitis, Systemic Lupus Erythematous, Juvenile Idiopathic Arthritis, or Psoriatic Arthritis. The survey consisted of 13 questions: eight of which required responses on a Likert scale, and a further five required responses with free writing. 93 responses were acquired, and analysis used multivariate models in addition to thematic analysis.

Results

Multivariate models revealed a statistically significant relationship between the Rheumatology team’s understanding of the overall impact of a patient’s condition on their life [Q6] and the team’s support in helping to reduce this impact on what matters to the patient [Q8], (p < 0.01, SE = 0.10). Q6 also shared a significant association with positive patient relationships with the Rheumatology team [Q5], (p < 0.01, SE = 0.11). In relation to improving health service for patients, most common recurring themes during analysis were: understanding of impact on life and emotional wellbeing, lifestyle and social support, and responsiveness. Secondary multivariate analyses showed significant relationships between patient’s emotional wellbeing [Q4] and their confidence in being able to manage their symptoms [Q3], (p < 0.01, SE = 0.15), in addition to their overall quality of life [Q1], (p < 0.01, SE = 0.16).

Conclusion

The data acquired has reiterated a need to incorporate stronger psychosocial frameworks into patient care. Re-designing resources in such a way could prove to be a cost-effective manner in which to increase patient activation, reduce disease burden, and manage ever-increasing service demands.

Disclosure

A.R. Shaikh: None. D. Crix: None. S. Earl: None.
P125 The advancement of digital health technology in the outpatient setting, is speech recognition software useful?
Authors: Crawshaw Helena , Jamal Safwan , Andev Rajinder
Published: April 2022

Background/Aims

Over the last 20 years, innovation in digital health technology have been propelling health systems forwards. With the advent of the electronic health record, digital prescribing and artificial intelligence and machine learning comes new opportunities. The use of voice recognition systems in the transcription of rheumatology clinics has the potential for cost and time effectiveness which is ever important within the NHS. Here we review the use, user-interface acceptability and potential cost savings.

Methods

In speech recognition software the speech is converted to a sequence of words in written text. This is not a new technology and in particular has been widely used within radiology departments across the UK. Rheumatology is largely a clinic-based specialty, with high output of clinic letters. Speech recognition software removes the need for transcription-based services. As a new technology we have reviewed its use within the rheumatology, dermatology, endocrinology, renal and paediatric departments at a large district general hospital.

Results

143 staff members have been provided with a license and on average 64% are regularly using the available software. Over 3 months an average of 14,843 minutes per month of dictation has been completed. It has been estimated that over 12 months’ use there has been £100,000 savings through administerial time saved. The average turnaround time for clinic letters from dictation to delivery (electronically) to GPs has improved from approximately 1-2 weeks (but delays up to 4 weeks seen) to an approximately 24-36 hours. Preliminary data from users of this software suggest that compared to traditional dictation devices: 33% found it ‘much better’, 33% ‘better’ and 33% ‘the same’. 67% of participants found it ‘easy, or very easy’ to use whilst 16% found it ‘difficult’. 50% of participants found it ‘usually’ saved time, 33% ‘sometimes’ and 16% ‘rarely’ saved time.

Conclusion

This preliminary data suggest potential time and cost savings with largely positive feedback from users. Further work is needed to assess potential patient safety issues including errors and inaccuracies compared to traditional dictation means. We aim to complete this work prior to presentation of this abstract should it be accepted.

Disclosure

H. Crawshaw: None. S. Jamal: None. R. Andev: None.
P131 Adult coeliac disease and bone mineral density at the femoral neck, total hip and lumbar spine: an age- and sex-matched case-control study
Authors: Shtarbanov Petko , Bukhari Marwan
Published: April 2022

Background/Aims

Coeliac disease (CD) is characterised by intestinal villous atrophy causing malabsorption. Decreased bone mineral density (BMD) has been reported in CD. To the best of our knowledge, no published paper has documented BMD comparisons in detail at different sites. We aim to determine the prevalence of osteoporosis and BMD values at multiple locations in a group of adult CD patients, and compare them to those of age and sex matched controls.

Methods

We analysed data of adult patients referred for BMD estimation at a district scanner from 2004 to 2018. Dual-energy x-ray absorptiometry was used for all subjects. Patients diagnosed with CD (cases) were age- and sex-matched with subjects referred with no reason for scanning (controls). Additional FRAX(TM) risk factors for osteoporosis were recorded. Comparison was made using chi-squared for categorical values, student's T test for continuous variables, then a univariate followed by a multivariate stepwise logistic model, adjusting for height, weight and body mass index (BMI), were fitted.

Results

645 (474 female) patients in the coeliac group were matched with 645 (474 female) controls. There was no significant difference in the mean age (years) at scan: cases 56.24 (SD 14.79) vs controls 56.24 (SD 14.80), p-value 1.00. The coeliac group had a significantly higher proportion of osteoporotic (T-score ≤-2.5 SD) patients at all locations compared to the control group. Cases had significantly lower mean BMD (gcm-2) and mean Z-scores at all locations than the controls. In the multivariate stepwise model, adjusted for height, weight and BMI, only the total hip, lumbar spine and their sub-sites revealed significant associations between having CD and a BMD (gcm-2) in the lowest tertile for the whole cohort. Key results are summarised in Table 1.

Conclusion

We confirmed that adult CD patients have higher prevalence of osteoporosis and lower BMD values compared to controls. Bone impairment was pronounced at the L1 and L2 vertebrae; least pronounced at the femoral neck. This might be due to CD preferentially damaging trabecular bone, which is predominant in the lumbar spine than femoral neck.

Disclosure

P. Shtarbanov: None. M. Bukhari: None.
P139 The impact of identifying poor adherence to bone protective treatment via postal questionnaire - Bath Fracture Liaison Service (FLS) audit
Authors: Warren Susie M , Webb Jackie L , Ahmed Tehseen
Published: April 2022

Background/Aims

As part of the Royal United Hospitals Bath FLS, postal questionnaires assessing adherence to treatment are sent to patients (aged 50 or above) in whom we had recommended initiation of bone protective treatment (BPT) following identification of a low-trauma fracture. Upon receipt by the FLS of a completed adherence questionnaire, correspondence is sent to the GP to report the outcome, with recommendations as appropriate. The aim of this audit was to assess how many patients started (or re-started) treatment after reporting poor adherence.

Methods

Patients sent an adherence questionnaire in 2019 were screened for inclusion in the audit. These patients had sustained a low-trauma fracture approximately 1 year prior. For those reporting poor adherence (defined as either BPT not prescribed, or non-adherence to treatment), our hospital electronic record system (Millennium) and primary care electronic records (SystmOne) were scrutinised to assess whether BPT was subsequently initiated.

Results

A total of 1164 questionnaires were sent and 684 (59%) were completed and returned to the FLS. Of the questionnaires returned, 366 (54%) reported good adherence and 257 (38%) reported poor adherence. 61 (9%) of patients reported a decision not to take treatment. 88 of the 257 patients who reported poor adherence were excluded from the audit for the following reasons: 5 patients excluded because an outcome letter was inadvertently not sent to the GP and therefore these patients were not directly comparable with the other patients. 25 subsequently deceased patients were excluded because we were unable to ascertain if they had started/re-started treatment following the poor adherence letter. 51 patients were excluded because the primary care electronic record was unavailable and therefore although there was no evidence on our hospital electronic record system that treatment had been prescribed, we could not be certain that this was the case. 7 patients reported that they had not been prescribed treatment but there was evidence that treatment had been prescribed at the time of the adherence check. This provided us with a final eligible cohort of 169 patients for further analysis. We found evidence that 65 (38%) of 169 patients were prescribed or re-prescribed bone protection treatment following our poor adherence letter to the GP. Treatment was ongoing in 40 (24%) patients at the time of this analysis.

Conclusion

Our FLS policy of sending outcome letters to GPs following patient-reported poor adherence to BPT is partially effective in prompting prescription/re-prescription of treatment where appropriate. Our FLS will need to employ additional/alternative methods to improve our performance.

Disclosure

S.M. Warren: None. J.L. Webb: None. T. Ahmed: None.
P142 Fracture risk in diabetes: to FRAX or not to FRAX?
Authors: Mathew Mekha , Dwivedi Shivangi , Buch Harit , Venkatachalam Srinivasan
Published: April 2022

Background/Aims

Diabetes mellitus is associated with decreased bone strength as well as increased fracture risk. The risk of fragility fracture increases with an increase in the duration of diabetes and worsening of glycemic control. However, this increased fracture risk often goes unidentified. Identifying patients at risk of fracture is fundamental in helping to prevent fractures. WHO FRAX (fracture risk assessment) tool computing the 10-year probability of hip fracture or a major osteoporotic fracture helps ascertain fracture risk. In Type 2 Diabetes Mellitus (T2DM), the diagnosis of osteoporosis by dual-energy X-ray absorptiometry (DXA) and the FRAX are only partially useful in assessing fracture risk. Our aims were: 1. To identify the fracture risk in patients with diabetes and 2. To assess the impact of adding diabetes as a risk factor in the calculation of FRAX score.

Methods

One hundred patients above the age of 50 years with duration of diabetes above a year who attended the diabetes clinic from December 2020 to June 2021 were included. Data was collected on demographics (age, sex, ethnicity), diabetes-related factors (the type, duration, complications and medications) and clinical risk factors for osteoporotic fracture (parental fracture, previous fracture, smoking, alcohol intake) from patient interviews and the FRAX score was calculated. FRAX tool was modified for diabetes by adding either 10 years of age or Rheumatoid arthritis as risk factor.

Results

Mean age of our cohort of patients was 67 years and their mean BMI was 33 kg/sq m. Duration of diabetes was over 5 years in 95% of the patients. T2DM was seen in 82% and Type 1 Diabetes mellitus (T1DM) in 18%. The mean HbA1c was 8.4%. Unadjusted mean FRAX score for a major osteoporotic fracture was 8.9% and hip fracture 2.3%. High risk of future fracture was seen in 4% of the patients and intermediate risk in 23% and low risk in 73%. Four patients had Rheumatoid arthritis and 21 had previous fragility fractures. Modifying the FRAX tool by adding 10 years to age moved 15% more patients to the intermediate-risk category needing DXA and 5% more to the high-risk category needing osteoporosis treatment. However, adding Rheumatoid arthritis changed 20% more patients to the intermediate-risk category needing DXA and 7% more to the high-risk category needing osteoporosis treatment.

Conclusion

Modifying FRAX tool in patients with diabetes mellitus will enable more patients to have a DXA scan and to receive osteoporosis treatment and the strategy using rheumatoid arthritis as a risk factor identified more patients than adding 10 years of age.

Disclosure

M. Mathew: None. S. Dwivedi: None. H. Buch: None. S. Venkatachalam: None.
P149 Prescription for consultations with gout flare in primary care: an observational study
Authors: Padmanabhan Nishita , Muller Sara , Mallen Christian , Roddy Edward
Published: April 2022

Background/Aims

Gout flares are severely painful and managed with non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids. NSAIDs are used most commonly, yet many patients with gout have contraindications such as chronic kidney disease (CKD). We investigated the medications prescribed for gout flares in primary care, how these differed according to CKD, colchicine dosing, and prescription trends over time between 2005 and 2015.

Methods

Using the Consultations in Primary Care Archive, an electronic health record database from thirteen general practices in North Staffordshire, we identified all consultations for a gout flare. Prescriptions for NSAIDs, colchicine and prednisolone were identified. We calculated the proportion of consultations resulting in a prescription for NSAIDs, colchicine and corticosteroids, overall and stratified by eGFR (≥60, <60 ml/min/1.73m2). We examined which NSAIDs and which colchicine doses were prescribed. The trends in prescriptions of NSAID, colchicine or oral prednisolone prescriptions from 2005 to 2015 were described.

Results

We identified 2641 people with a diagnosis of gout and 1308 consultations for gout flares. The mean (SD) age at flare consultation was 62.6 (14.9) years, and 1025 (78.4%) were male. Flare consultations resulted in 408 (31.2%) NSAID, 294 (22.5%) colchicine, 9 (0.7%) prednisolone prescriptions. We found that 619 (47.3%) did not have a prescription. 21 (1.6%) received a prescription for more than one drug class (colchicine and either NSAID or prednisolone). eGFR was recorded as < 60ml/min/1.73m2 in 224 (17.1%) of the sample. Colchicine doses prescribed were 500mcg 1-2 times/day in 84 (28.6%), 500mcg 3-4 times/day in 112 (38.1%), 500mcg 6-8 times/day in 49 (16.7%) and as directed in 49 (16.7%) consultations. Diclofenac was the most commonly prescribed NSAID (n = 143, 35.1%), followed by naproxen (n = 106, 26.0%) and indomethacin (n = 93, 22.8%). Colchicine (n = 65, 29.0%) was the most common treatment choice in individuals with eGFR<60 and NSAIDs (n = 372, 34.3%) in those with ≥60ml/min/1.73m2. Over time, the proportion of patients prescribed colchicine rose from 15.5% in 2005 to 31.2% in 2015, whereas NSAID prescriptions declined from 38.1% in 2005 to 15.0% in 2015.

Conclusion

Gout flares were most commonly treated with NSAIDs, except in individuals with CKD, where colchicine was most common. Over time, colchicine prescriptions have become more common, whereas NSAID prescriptions have declined.

Disclosure

N. Padmanabhan: Grants/research support; N.P. is an NIHR Academic Clinical Fellow. S. Muller: Grants/research support; S.M. is part-funded by the NIHR Applied Research Collaboration West Midlands (ARC WM). C. Mallen: Grants/research support; C.D.M. is part-funded by the NIHR Applied Research Collaboration West Midlands (ARC WM), C.D.M. is funded by the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice. E. Roddy: None.
P166 Working in partnership with the third sector to provide support for paediatric, adolescent patients and families throughout COVID-19 and beyond
Authors: Connor Klaire
Published: April 2022

Background/Aims

A youth work approach to the delivery of additional support for young people and families has been used for the past 2 years within the paediatric rheumatology service in Glasgow. The approach takes into consideration that young people choose to participate, it's person-centred and built from where the young people are, young people and staff are all part of the journey and learning process. During the COVID-19 pandemic the support for young people went virtual, linking young people with peer support and online support. Dedicated service and delivery model in partnership with pediatric clinical services, ensure specific support needs are met. The approach to working with young people is bespoke and delivered by teams that understand the needs of young people.

Methods

The youth work approach recognises that young people choose to participate, it's person-centred and bespoke to the specific needs of young people. Young people and specialist staff are equal parts of the journey. Listening to unmet needs of young people as well as sector best practice - from intense 121 support for families to digital tools to meet growing expectations post-COVID-19. Support in clinic is youth and family led: with unique peer model, youth empowerment, communities of support and co-production. With staff delivering 121 support, and peer volunteers delivering and leading group work out with clinical settings. Third sector staff are integrated with the paediatric rheumatology team, working together to support young people and families holistically.

Results

The youth work approach best fits with the unmet needs of the young people within clinical settings. Young people are supported to feel more confident, less isolated and more hopeful about the future. They are encouraged to build positive peer-to-peer relationships and feel they are taken seriously and supported through their journey alongside partners. The approach to delivery is based on well-grounded practical and experiential knowledge. This is proven to enhance the lives of young people and offers them effective tools to use throughout their development. Our approach is based on best practice youth work.

Conclusion

Early youth work intervention and integration is highly valued by young people and families, offers holistic, person-centred, and developmentally appropriate care with lifelong benefits. Integrated and localised delivery creates unique insight, offering bespoke support to young people within clinical settings and beyond. Quality relationships with youth workers and clinicians can lead to improvements in holistic care and support for young people. An effective way to reach young people at key points - diagnosis, treatment and transition to adult services. Integration ensures that there is an ‘in house' expertise in youth work and joined-up services and support for young people and families.

Disclosure

K. Connor: None.
P191 To investigate the mechanisms of action of novel compounds ex vivo in cells obtained from the inflammatory synovium of patients with rheumatoid arthritis
Authors: Turner Madeleine P
Published: April 2022

Background/Aims

To investigate the ex vivo effect of JAK1/2 inhibitor baricitinib on the expression of pro-inflammatory mediators in normal and RA diseased fibroblasts stimulated with oncostatin M (OSM) as well as in cells derived from RA inflamed synovial membrane cells (RA SMC).

Methods

RA SMC and fibroblast like synoviocytes (RA FLS) were isolated from synovial membranes of patients undergoing surgery using enzymatic digestion and cell propagation. Normal fibroblast-like synoviocytes (FLS) and normal human skin fibroblasts (HSF) were purchased from commercial sources. All fibroblasts were cultured in media supplemented foetal bovine serum and antibiotics in incubators using established laboratory procedures, and serum-starved prior to stimulation with OSM with or without baricitinib. RA SMC were cultured in the presence of baricitinib without OSM as they spontaneously release pro-inflammatory cytokines. Levels of mRNA and proteins of the various inflammatory cytokines (IL-6, IL-8, MCP-1, CCL5 and IP-10) were determined by qPCR, ELISA and MSD. Western blot was used to measure levels of phospho-JAK specific components.

Results

qPCR analysis found that baricitinib inhibited OSM induced IP-10 and MCP-1 mRNA expression but not RANTES mRNA expression in normal human skin fibroblasts and RA FLS. In normal FLS however, baricitinib was found to inhibit RANTES and MCP-1 mRNA expression, but not IP-10 mRNA expression. Expression levels of IL-8 were too low for accurate conclusions to be drawn in all cell types apart from the RA SMCs, and in this case baricitinib did not inhibit IL-8 expression. ELISA results showed that baricitinib inhibited OSM induced MCP-1 expression in all cell types investigated. OSM induced IL-6 expression was inhibited in RA FLS but no other cell type.

Conclusion

Baricitinib inhibits OSM stimulated pro-inflammatory cytokine production through JAK1, 2. It has a varying inhibitory effect on the production of different cytokines: it is shown to particularly inhibit MCP-1. Baricitinib was found to have no effect on the production of spontaneously released pro-inflammatory cytokines in RA mixed cell populations.

Disclosure

M.P. Turner: None.
P208 A retrospective survey of arthritis among inpatients at a consultant hospital in Northern Tanzania from 2017 to 2019
Authors: Yongolo Nateiya M , Krauth Stefanie J , Biswaro Sanjura M , Moshi Baraka , Mwanswila Manasseh , Hemed Asia , Njau Rosalia , Ng’unda Neema Allen , Walker Richard , Kilonzo Kajiru , Siebert Stefan , Halliday Jo , McIntosh Emma , Kelly Clive , Mmbaga Blandina , Temu Gloria
Published: April 2022

Background/Aims

Musculoskeletal (MSK) disorders affect many people worldwide, but there is minimal access to medical care in low and middle-income countries (LMICs). Few hospital-based studies on MSK disorders have been conducted and there are limited prevalence data on MSK diseases in sub-Saharan Africa (SSA). Arthritis is the most common MSK condition, both reducing physical activity and increasing the risk of disability and other non-communicable diseases (NCDs). Given the high prevalence of MSK disorders and the associated significant clinical and economic burden in developed countries, an estimate of the frequency of these conditions in SSA is overdue. We aimed to determine the recorded prevalence of arthritis and related clinical features among patients admitted to a tertiary care hospital in Northern Tanzania from 2017-19.

Methods

Ethical approval was obtained to review the medical records retrospectively for all patients aged over 13 admitted to medical wards at Kilimanjaro Christian Medical Centre, a zonal tertiary care hospital, over this 3-year period. We collected demographic characteristics including age, gender, diagnoses and outcome. Diagnoses specifying arthritis were specifically sought. The prevalence of arthritis among inpatients over this period estimated. Analysis was conducted using STATA version 15 with categorical variables summarized using frequency and percentage.

Results

A total of 8023 patient files were examined with a slight majority of males 4181 (52.1%). An arthritis was recorded in 129 (1.6%) with 71 (55%) aged ≥60 years and 74 (57.4%) being female. The commonest presenting symptoms were joint pain in 69 (53.5%), swelling in 38 (29.5%) and stiffness in 18 (14%). A precise diagnosis for the arthritis was rarely recorded, although rheumatoid arthritis and gout were specified in a minority. Overall mortality was 12.4% among patients with arthritis. In addition, a diagnosis of systemic lupus erythematosus was recorded in a further 16 (0.2%) patients.

Conclusion

The recorded prevalence of arthritis among hospital inpatients in this LMIC study was low but the associated mortality appeared high. The retrospective nature of the data is highly likely to have underestimated the true prevalence of MSK disease and emphasizes the need for improved awareness of MSK diagnostic and management strategies. A teaching and training program has been developed to assist with this.

Disclosure

N.M. Yongolo: None. S.J. Krauth: None. S.M. Biswaro: None. B. Moshi: None. M. Mwanswila: None. A. Hemed: None. R. Njau: None. N. Allen Ng’unda: None. R. Walker: None. K. Kilonzo: None. S. Siebert: None. J. Halliday: None. E. McIntosh: None. C. Kelly: None. B. Mmbaga: None. G. Temu: None.