bluuebunny/crossref_metadata_2025 huggingface dataset:
Imaging findings after a total reconstructed breast with autologous fat transfer: what the radiologist needs to know
Authors: Rijkx Maud E P , Heuts Esther M , Houwers Janneke B , Hommes Juliette E , Piatkowski Andrzej A , van Nijnatten Thiemo J A
Published: April 2024

Autologous fat transfer (AFT) is an upcoming technique for total breast reconstruction. Consequently, radiological imaging of women with an AFT reconstructed breast will increase in the coming years, yet radiological experience and evidence after AFT is limited.

 

The surgical procedure of AFT and follow-up with imaging modalities including mammography (MG), ultrasound (US), and MRI in patients with a total breast reconstruction with AFT are summarized to illustrate the radiological normal and suspicious findings for malignancy.

 

Imaging after a total breast reconstruction with AFT appears to be based mostly on benign imaging findings with an overall low biopsy rate. As higher volumes are injected in this technique, the risk for the onset of fat necrosis increases. Imaging findings most often are related to fat necrosis after AFT. On MG, fat necrosis can mostly be seen as oil cysts. The occurrence of a breast seroma after total breast reconstruction with AFT is an unfavourable outcome and may require special treatment. Fat deposition in the pectoral muscle is a previously unknown, but benign entity. Although fat necrosis is a benign entity, it can mimic breast cancer (recurrence).

 

In symptomatic women after total breast reconstruction with AFT, MG and US can be considered as first diagnostic modalities. Breast MRI can be used as a problem-solving tool during later stage. Future studies should investigate the most optimal follow-up strategy, including different imaging modalities, in patients treated with AFT for total breast reconstruction.
Parallel genetic screens identify nuclear envelope homeostasis as a key determinant of telomere entanglement resolution in fission yeast
Authors: Nageshan Rishi Kumar , Krogan Nevan , Cooper Julia Promisel
Published: April 2024

In fission yeast lacking the telomere binding protein, Taz1, replication forks stall at telomeres, triggering deleterious downstream events. Strand invasion from one taz1Δ telomeric stalled fork to another on a separate (nonsister) chromosome leads to telomere entanglements, which are resolved in mitosis at 32°C; however, entanglement resolution fails at ≤20°C, leading to cold-specific lethality. Previously, we found that loss of the mitotic function of Rif1, a conserved DNA replication and repair factor, suppresses cold sensitivity by promoting resolution of entanglements without affecting entanglement formation. To understand the underlying pathways of mitotic entanglement resolution, we performed a series of genome-wide synthetic genetic array screens to generate a comprehensive list of genetic interactors of taz1Δ and rif1Δ. We modified a previously described screening method to ensure that the queried cells were kept in log phase growth. In addition to recapitulating previously identified genetic interactions, we find that loss of genes encoding components of the nuclear pore complex (NPC) promotes telomere disentanglement and suppresses taz1Δ cold sensitivity. We attribute this to more rapid anaphase midregion nuclear envelope (NE) breakdown in the absence of these NPC components. Loss of genes involved in lipid metabolism reverses the ability of rif1+ deletion to suppress taz1Δ cold sensitivity, again pinpointing NE modulation. A rif1+ separation-of-function mutant that specifically loses Rif1's mitotic functions yields similar genetic interactions. Genes promoting membrane fluidity were enriched in a parallel taz1+ synthetic lethal screen at permissive temperature, cementing the idea that the cold specificity of taz1Δ lethality stems from altered NE homeostasis.
Utility of Cystatin C-based Equation for the Estimation of Glomerular Filtration Rate in a Pediatric Population
Authors: Ibrahim Ridwan B , Srivaths Poyyapakkam , Tam Estella , Devaraj Sridevi
Published: April 2024

Background

The accurate assessment of kidney function is vital for the early detection of kidney damage. The estimated glomerular filtration rate GFR (eGFR) from serum cystatin C (CysC) and creatinine-based equations are commonly used in clinical practice as an alternative to the invasive measured glomerular filtration rate (mGFR), which is the usually accepted overall best index of kidney function in health and disease. Recently the CKiD under 25 (CkiD U25) equations have been shown to perform well in children and young adults with chronic kidney disease (CKD). In this focused report, we evaluated the performance of the CkiD U25 equations alongside 3 non-race-corrected (NRC) eGFR equations commonly used in pediatrics in our cohort.

Methods

mGFR measured following the intravenous injection of tracer Tc-99mDTPA was retrospectively compared with eGFR from these equations in 57 patients (6 months to 22 years) from different races/ethnicities. Ordinary least squares regression analyses were used to assess correlation between the mGFRs and eGFRs.

Results

The average mGFR for this cohort was 84.1 mL/min/1.73 m2. The NRC creatinine equations overestimated eGFR across all groups, with the lowest bias for CKiD U25-creatinine (22.59 mL/min/1.73 m2). The best correlations to mGFR, P30, and lowest biases were the CKiD U25-CysC (0.6281, 80.7%, 3.72 mL/min/1.73 m2) and Schwartz CysC (0.6372, 77.2%, −4.68 mL/min/1.73 m2).

Conclusions

Overall, both CKiD U25-CysC and Schwartz CysC provide a good estimation of mGFR with the CKiD U25-CysC having the overall best performance compared to mGFR in our study.
Cosmetic penile enhancement procedures: an SMSNA position statement
Authors: Trost Landon , Watter Daniel N , Carrier Serge , Khera Mohit , Yafi Faysal A , Bernie Helen L , Ziegelmann Matthew , Köhler Tobias
Published: April 2024

Background

Penile cosmetic enhancement procedures have been performed for many years with varying success. However, they have historically been relegated to niche areas of sexual medicine, with limited data, and have not achieved mainstream adoption. More recently, the topic has been increasingly discussed within academic congresses due to availability of novel techniques, therapies, and procedures. Given their distinctive nature, the Sexual Medicine Society of North America (SMSNA) felt that it was pertinent to develop formal position statements to help guide both patients and sexual medicine providers on the current state of the scientific literature and to give recommendations for future research.

Aim

The study sought to provide an evidence-based set of recommendations for injection and surgical procedures designed to lengthen, augment, or otherwise cosmetically enhance the penis.

Methods

A review was performed of all scientific literature listed in PubMed from inception through December 2023 relating to penile cosmetic enhancement procedures. Only invasive (injection/surgery) therapies were included due to their distinct risk-benefit profile compared with more conservative treatments (eg, vacuum erection devices, penile traction devices). Similar therapies were categorized, with pertinent data summarized and used to help create relevant position statements. All statements were expert opinion only and were based on analyses of the potential risks and benefits of the specific therapies.

Outcomes

A total of 6 position statements were issued relating to 5 distinct sexual medicine cosmetic enhancement procedures.

Results

A consensus opinion was reached by SMSNA leadership on the state of injection/surgical penile cosmetic enhancement procedures as of 2024. Key topic areas addressed included injectable soft tissue fillers, suspensory ligament division, graft-and-flap procedures, silicone sleeve implants, and sliding/slicing techniques. Distinct recommendations were tailored to each therapy and were based solely on the current state of the literature. It is anticipated that future studies will further inform position statements and will lead to ongoing modifications.

Clinical Implications

The current position statements provide both patients and clinicians evidence-based, expert recommendations on best practices relating to penile cosmetic enhancement procedures.

Strengths and Limitations

Strengths include the use of an expert panel of sexual medicine clinicians, consensus design, and summary of existing literature. Limitations include expert opinion and limited research on the topic.

Conclusion

The current SMSNA position statements provide evidence-based, consensus opinions on the appropriate role for penile augmentation and cosmetic procedures in 2024.
Is medieval distant viewing possible? : Extending and enriching annotation of legacy image collections using visual analytics
Authors: Meinecke Christofer , Guéville Estelle , Wrisley David Joseph , Jänicke Stefan
Published: April 2024

Distant viewing approaches have typically used image datasets close to the contemporary image data used to train machine learning models. To work with images from other historical periods requires expert annotated data, and the quality of labels is crucial for the quality of results. Especially when working with cultural heritage collections that contain myriad uncertainties, annotating data, or re-annotating, legacy data is an arduous task. In this paper, we describe working with two pre-annotated sets of medieval manuscript images that exhibit conflicting and overlapping metadata. Since a manual reconciliation of the two legacy ontologies would be very expensive, we aim (1) to create a more uniform set of descriptive labels to serve as a “bridge” in the combined dataset, and (2) to establish a high-quality hierarchical classification that can be used as a valuable input for subsequent supervised machine learning. To achieve these goals, we developed visualization and interaction mechanisms, enabling medievalists to combine, regularize and extend the vocabulary used to describe these, and other cognate, image datasets. The visual interfaces provide experts an overview of relationships in the data going beyond the sum total of the metadata. Word and image embeddings as well as co-occurrences of labels across the datasets enable batch re-annotation of images, recommendation of label candidates, and support composing a hierarchical classification of labels.
Machine Learning-based Analysis of Publications Funded by the National Institutes of Health's Initial COVID-19 Pandemic Response
Authors: Chandrabhatla Anirudha S , Narahari Adishesh K , Horgan Taylor M , Patel Paranjay D , Sturek Jeffrey M , Davis Claire L , Jackson Patrick E H , Bell Taison D
Published: April 2024

Background

The National Institutes of Health (NIH) mobilized more than $4 billion in extramural funding for the COVID-19 pandemic. Assessing the research output from this effort is crucial to understanding how the scientific community leveraged federal funding and responded to this public health crisis.

Methods

NIH-funded COVID-19 grants awarded between January 2020 and December 2021 were identified from NIH Research Portfolio Online Reporting Tools Expenditures and Results using the “COVID-19 Response” filter. PubMed identifications of publications under these grants were collected and the NIH iCite tool was used to determine citation counts and focus (eg, clinical, animal). iCite and the NIH's LitCOVID database were used to identify publications directly related to COVID-19. Publication titles and Medical Subject Heading terms were used as inputs to a machine learning–based model built to identify common topics/themes within the publications.

Results and Conclusions

We evaluated 2401 grants that resulted in 14 654 publications. The majority of these papers were published in peer-reviewed journals, though 483 were published to preprint servers. In total, 2764 (19%) papers were directly related to COVID-19 and generated 252 029 citations. These papers were mostly clinically focused (62%), followed by cell/molecular (32%), and animal focused (6%). Roughly 60% of preprint publications were cell/molecular-focused, compared with 26% of nonpreprint publications. The machine learning–based model identified the top 3 research topics to be clinical trials and outcomes research (8.5% of papers), coronavirus-related heart and lung damage (7.3%), and COVID-19 transmission/epidemiology (7.2%). This study provides key insights regarding how researchers leveraged federal funding to study the COVID-19 pandemic during its initial phase.
OA08 GWAS meta-analysis of ankylosing spondylitis and Behçet's disease identifies novel MHC-I-opathy genes
Authors: Saeed Mohammad
Published: April 2024

Background/Aims

Spondyloarthropathies (SpA) and Behçet's disease (BD) have clinical and HLA locus overlap and have been grouped under MHC-I-opathy [1]. Genetic overlap can help elucidate MHC-I-opathy pathogenesis. Ankylosing spondylitis (AS) is a primary SpA. Here, a cluster-based approach helps to identify overlapping loci between AS and BD of even modest significance.

Methods

Association clustering methods such as OASIS [2] reduce the multiple-testing burden and are therefore more powerful than single variant analysis for identifying modest genetic effects. Here, two large genome-wide association studies (GWAS) of AS (921 cases, 907 controls) and BD (1215 cases and 1278 healthy controls) from Turkiye, were subjected to OASIS meta-analyses to identify common non-HLA loci [3, 4]. Statistics used to identify significant loci included the novel OASIS locus index (OLI), defined as the product of maximum -logP at a locus with the ratio of actual to predicted number of significant SNPs.

Results

GWAS for both diseases had the highest significance at the HLA-locus. OASIS avoids the proportional signals problem, inherent in GWAS, by separately analysing highly significant loci (P < 10-8). Hence, of the 234 independent modestly significant non-HLA loci, there were 16 loci common to both AS and BD (Figure 1). These included known MHC-I-opathy loci, 1p31.3 for IL23R (P = 5.37 E-06, OLI = 52.7) and 13q14.11 for LACC1 (P = 7.41 E-06, OLI= 65.3) [1, 5]. Novel loci included 3p21.31 containing CCR9 (P = 2.46 E-05, OLI=25.8), 3q22.3 containing CLDN18 (P = 5.37 E-05, OLI=31.4) and 4q27-4q28.1 containing FGF2 (P = 1.1 E-04, OLI=29.5).

Conclusion

Five loci containing pathologically relevant genes for MHC-I-opathy were identified using a cluster-based approach in AS and BD GWAS datasets. These large meta-analyses will help identify pathogenic pathways for MHC-I-opathy, an entity that has so far largely remained elusive [6].

Disclosure

M. Saeed: None.
OA36 Systemic juvenile idiopathic arthritis: the Great Ormond Street Hospital experience (2005-2021)
Authors: Foley Charlene Majella , McKenna Dearbhla , Gallagher Kathy , McLellan Kirsty , Alkhdher Hanof , Lacassagne Sandrine , Moraitis Elena , Papadopoulou Charalampia , Pilkington Clarissa , Al Obaidi Muthana , Eleftheriou Despina , Brogan Paul
Published: April 2024

Background/Aims

sJIA is a complex, systemic-inflammatory disorder. The proposed biphasic model of disease suggests that unchecked early auto-inflammation driven by increased innate immune activation, including dysregulation of IL-1 and IL-6, may lead to a state of chronic T-lymphocyte activation. This leads to an unfavourable balance of T-effector and regulatory cells that can drive chronic arthritis over time. It is therefore unsurprising that there is growing evidence to support instigation of IL-1 or IL-6 blockade as first-line treatment in sJIA. Early cytokine antagonist therapy could abrogate development of a population of these arthritis-causing T-cells to avert chronic systemic inflammation and arthritis. Aims: 1) describe clinical presentations, therapeutic interventions, complications, and remission rates at different time-points over disease course in sJIA; 2) identify potential therapeutic signals in patients with sJIA who received biologic treatment early in disease course compared to those who did not.

Methods

Retrospective review of all patients with sJIA at GOSH (02/10/05-21/10/21, inclusive). Data collected: patient demographics; clinical and laboratory data; treatment history; adverse events. Time-points for data collection: at diagnosis; 3-months; 1-year; last follow-up. Descriptive statistics reported as median and range or IQR for continuous variables, and as absolute frequencies and percentages for categorical variables. Comparisons of quantitative variables were made by Mann-Whitney U-test. Categorical data were compared using Fisher’s exact test (p-values<0.05 were considered significant).

Results

A total of 76 children (female n = 40, 53%) were diagnosed with sJIA; median age was 4.5 years (range 0.6-14.1). A biologic disease modifying anti-rheumatic drug (bDMARD) alone was commenced as first-line treatment in 28% (n = 21/76) of the cohort; however, at last review, 84% (n = 64/76) had received treatment with a bDMARD. Clinically inactive disease (CID) was achieved by 88% (n = 67/76) of the cohort at last review; however, only 32% (24/76) achieved treatment-free CID. At 1-year follow-up, CID was achieved in a significantly greater proportion of children who received treatment with a bDMARD within 3-months of diagnosis compared to those who did not (90% versus 53%, p = 0.002).

Conclusion

We propose a UK treatment-algorithm for children diagnosed with sJIA (see figure). We recommend reappraisal of the current NHS England commissioning policy.

Disclosure

C. Foley: None. D. McKenna: None. K. Gallagher: None. K. McLellan: None. H. Alkhdher: None. S. Lacassagne: None. E. Moraitis: None. C. Papadopoulou: None. C. Pilkington: None. M. Al Obaidi: None. D. Eleftheriou: None. P. Brogan: None.
P016 Cardiovascular disease and rheumatoid arthritis among people with a history of cancer
Authors: Khubchandani Jagdish , Banerjee Sri , Onukogu Claret , Gonzales-Lagos Rafael
Published: April 2024

Background/Aims

Cardiovascular disease (CVD) is connected to many comorbidities and vascular diseases. Cancer also has certain inflammatory impact on the physiological mechanisms. However, the precise connection between these variables are unknown. In this research, we determined if there was an association between cardiovascular disease and overall mortality and how this connection may be modified by rheumatoid arthritis.

Methods

The National Health and Nutrition Examination Survey (NHANES) survey was conducted by the National Center for Health Statistics (NCHS) for the six cycles or years of 1999 to 2010 with mortality follow-up through December 31, 2019. This data is published biennially. Our study was conducted on participants with a history of cancer that were aged 40 years or older living in the United States with cardiovascular disease. CVD was determined by a history of stroke, congestive heart failure, coronary heart disease, and myocardial infarction. History of cancer was considered positive if the respondent answered “yes” to the question “Ever told you had cancer or malignancy”. We assessed RA status by using the arthritis question. We determined diabetes by healthcare worker diagnosed recall of the diagnosis of the disease. In this prospective analysis that we performed Complex Samples Cox regression with adjustment for known confounders to determine the relationship of chronic kidney disease and mortality, and if rheumatoid arthritis has an overall relationship in those living with diabetes.

Results

Among individuals living with cancer and rheumatoid arthritis, percent mortality for males was 58.2% and for females was 61.9%. For overall mortality, crude hazard ratio (HR) for diabetes was 2.13 (95% confidence interval [CI], 1.39-3.25 p < 0.001). The adjusted HR was elevated, 1.86 (CI 1.17-2.96, p = 0.01), among people with cardiovascular disease who also had rheumatoid arthritis but close to 1.0 (1.36 CI 1.09-1.70, p = 0.01) among individuals with cardiovascular disease who had no rheumatoid arthritis, after adjusting for medical (cardiovascular disease, asthma, chronic kidney disease, chronic obstructive pulmonary disease, and obesity) and demographic risk factors (gender and age). Similar patterns do not exist in the general population.

Conclusion

Among individuals has had a history of cancer, not only does cardiovascular disease lead to two times higher overall mortality but also rheumatoid arthritis occurrence impacts the relationship between cardiovascular disease and overall mortality even after controlling for potential medical and demographic confounders. Cardiovascular is the primary cause of death in many high- and middle-income countries in the world. More prevention efforts need to be made in order to prevent CVD and treat rheumatoid arthritis.

Disclosure

J. Khubchandani: None. S. Banerjee: None. C. Onukogu: None. R. Gonzales-Lagos: None.
P055 Prevalence, incidence, and mortality of Raynaud’s phenomenon, scleroderma, Sjogren’s syndrome and systemic lupus erythematosus: an overview of systematic reviews and meta-analyses
Authors: Chen Anthony , Lax Stephanie , Grainge Matthew , Lanyon Peter , Pearce Fiona
Published: April 2024

Background/Aims

To comprehensively review any existing systematic reviews and/or meta-analysis on the prevalence, incidence, and mortality rates of Raynaud’s Phenomenon (RP), Sjögren’s Syndrome (SS), Scleroderma and Systematic Lupus Erythematosus (SLE).

Methods

An umbrella review of systematic reviews and/or meta-analysis was undertaken using two electronic databases - PubMed and Embase (OVID). The searches were limited to English language and a publication period of 2000-2023. Any systematic reviews and/or meta-analysis reporting the prevalence, incidence, or all-cause/cause-specific mortality of the studied diseases were collected. The number of included and excluded studies were reported through the PRISMA checklist. The pooled estimate and its corresponding 95% confidence intervals and P-values were reported from each included study. If there were no pooled estimates reported in the study, a narrative synthesis of their results was reported.

Results

In this umbrella review, a total of 43 systematic reviews and/or meta-analysis were reported, of which 1 was RP, 5 SS, 11 scleroderma and 26 SLE. The pooled prevalence and incidence rates for RP was 4.85% (95% CI: 2.08-8.71%) and 0.25% (95% CI: 0.19-0.32%), respectively. There was a lack of mortality findings for RP. The global prevalence rate for SS was reported to be 60.82 per 100,000 (95% CI: 43.79-77.94). The pooled incidence rate and cardiovascular mortality risk ratio were reported to be 6.92 (95% CI: 4.98-8.86) per 100,000 person-years and 1.48 (0.77-2.85), respectively. The pooled prevalence and incidence rates for scleroderma were found to be 17.6 (95% CI 15.1, 20.5) and 1.4 (1.1-1.9) per 100,000 person-years-at-risk. The pooled standardised mortality ratio (SMR) for Scleroderma ranged from 2.82 to 3.4. The global prevalence rate for SLE was found to be 43.7 (15.87-108.92) per 100,000. Incidence rates for SLE were found to be 5.14 (95% CI: 1.4-15.13) per 100,000. SMR of SLE ranged from 1.35-4.60.

Conclusion

Included studies reported varying values for the prevalence, incidence, all-cause/cause-specific findings of SS, scleroderma, and SLE. This could be due to differences in study populations, diagnostic criteria, case definitions, and included studies’ design. Although there were number of systematic reviews and/or meta-analysis investigating the epidemiology of scleroderma and SLE, there were few in RP and SS.

Disclosure

A. Chen: None. S. Lax: None. M. Grainge: None. P. Lanyon: None. F. Pearce: None.
P177 The prevalence and incidence of psoriasis and psoriatic arthritis in England from 2009-2019: an observational study using primary care data
Authors: Vivekanantham Arani , Burn Edward , Moncusi Marta Pineda , Khalid Sara , Alhambra Daniel Prieto , Coates Laura C
Published: April 2024

Background/Aims

Psoriasis (PsO) and psoriatic arthritis (PsA) greatly impact quality of life and result in substantial personal and societal costs. Complete and up-to-date data on the prevalence and incidence of these conditions and whether these change over time and vary by age is important for healthcare service planning so that specialist care and funding can be appropriately allocated.

Objective

to determine the prevalence and incidence of PsO and PsA in males and females from 2009-2019 across all age groups in England.

Methods

We used Clinical Practice Research Datalink AURUM, a primary care electronic health record database, including 20% of the English population. The codes used to identify patients with PsO and PsA were selected by rheumatologists and dermatologists and cross-checked with published code lists from other studies. All included patients must have data for at least 1 year before their diagnosis. The annual incidence and point prevalence were calculated from 2009-2019 and stratified by age/sex. The study period ended in 2019 to avoid COVID-19 pandemic affecting results.

Results

The prevalence of PsO and PsA in males and females has increased annually, peaking in 2019 (PsO males 2.41% [95% confidence interval (CI) 2.40, 2.42];

PsO females 2.60% [95% CI 2.59-2.61]; PsA males 0.20% [95% CI 0.20-0.20]; PsA females 0.21% [95% CI 0.21- 0.22]), as illustrated in Table 1. In 2019, the prevalence of PsO and PsA was highest in the over 65 years age group; PsO 4.25% [95% CI 4.22-4.28] and PsA 0.38% [95% CI 0.37-0.38]. The annual incidence (per 100,000 person years) of PsO has gradually decreased in males (from 168 [164-171] in 2009 to 148 [145-151] in 2019) but in females it has been stable with a slight annual decrease (from 180 [177-184] in 2009 to 173 [170-176]) in 2019. The annual incidence for PsA has increased in both males and females; 13 (12-14) in 2009 and 15 (14-16) in 2019 for males and 12 (11-13) in 2009 and 18 (17-19) in 2019 for females.

Conclusion

The increasing prevalence of PsO and PsA highlights the importance of organising healthcare services to meet this need, particularly in the elderly population.

Disclosure

A. Vivekanantham: None. E. Burn: None. M. Pineda Moncusi: None. S. Khalid: None. D. Prieto Alhambra: Consultancies; DP-A’s research group has received consultancy or speaker fees from Astellas, Amgen, AstraZeneca, and UCB Biopharma. Grants/research support; DP-A’s research group has received research grants from the European Medicines Agency; the Innovative Medicines Initiative; and Amgen, Chiesi, and UCB Biopharma. L.C. Coates: Grants/research support; LCC has received grants/research support from AbbVie, Amgen, Celgene, Eli Lilly, Novartis and Pfizer; worked as a paid consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene.
E001 Pre-screen chest X-ray before starting methotrexate in autoimmune disease
Authors: Khan Muhammad A , Khan Abdul , Vijayan Aswathy , Hajilou Ashcaan , Win Myat
Published: April 2024

Background/Aims

This audit seeks to assess adherence to BSR guidelines and NICE recommendations concerning chest X-ray screening before initiating methotrexate. We also aim to evaluate the time elapsed from X-ray to radiologist reporting and the frequency of methotrexate initiations for various diagnoses.

Methods

We identified 127 cases from the rheumatology department (2017-2021) involving patients aged 18 or older with diagnoses of rheumatoid arthritis, psoriatic arthritis, lupus, or autoimmune connective tissue disease. We checked patient records for evidence of pre-treatment chest X-rays

Results

Rheumatoid arthritis was the most common diagnosis for methotrexate initiation. Out of the 127 patients, 102 underwent chest X-rays (80%), while 23 did not. For 2 patients, the status of chest X-ray performance remained unknown. The breakdown of percentages by hospital was as follows: QEQM (87%), WHH (70%), KCH (77%). The distribution of report times across the three hospitals was as follows: 1-7 days (52%), 8-14 days (4%), 15-31 days (12%), 32-62 days (11%), 63-100 days (15%), 101+ days (6%).

Conclusion

Urgent reporting of chest X-rays is imperative. Proposed solutions include flagging X-rays as urgent by incorporating a 'Patient starting Methotrexate?’ query. If selected 'yes’ this would flag the report as urgent on the Soliton system. This allows for prompt reporting of these X-rays with timely starting of the DMARDs treatment in various autoimmune conditions. This was done as beforehand, X-rays were not reported in a prompt manner even if they were stated as urgent in the requests. A smaller post-audit analysis involving 15 patients achieved 100% compliance of reporting within one week by implementing these changes.

Disclosure

M.A. Khan: None. A. Khan: None. A. Vijayan: None. A. Hajilou: None. M. Win: None.
E006 Providing information on arthritis medication: a service evaluation
Authors: Ryan Sarah , Hider Samantha , Paskins Zoe
Published: April 2024

Background/Aims

Traditionally patients commencing disease modifying anti-rheumatic medications (DMARDs) attended a face to face consultation with a rheumatology nurse or pharmacist, to discuss benefits, concerns and safety monitoring. The pandemic has led to an increase in the use of remote methods of information sharing including telephone consultations. The aim of this service evaluation was to elicit patients preferences on receiving information on arthritis medications to help inform service development.

Methods

A service evaluation with contributions from patients and stakeholders was designed and registered with the trust. Patients who were commencing or taking DMARDs attending, one of two hospital sites, in North Staffordshire were asked to complete a short questionnaire from November 2022-April 2023. Some patients completed the questionnaire at the end of their telephone drug counselling appointment with the assistance of the nurse whilst others completed the questionnaire whilst attending in person for their appointment. The questionnaire focused on the preferred format for receiving information on arthritis medications including a face to face appointment with a health professional (even if this meant a wait), telephone consultation, attending a group counselling session, having a drug information leaflet with the option to contact a health professional to answer any questions or watching a video on a device with internet access (computer, smart phone or tablet). The importance of receiving information on the same day as commencing treatment was also explored.

Results

64 patients took part in the survey. No demographic data was collected. The most popular method for receiving information on arthritis medications was a face to face appointment, even if it meant a delay in starting medication (n = 32,50%). The second most popular method was an information leaflet with the option to discuss any concerns via the telephone (n = 12,19 %). The third preference to receive information were via a video, again with the option to discuss concerns remotely (n = 10, 16%) or a telephone appointment, even if it meant a delay in starting medication (n 10,16%) Surprisingly although no patients expressed a preference to attend a group counselling session, 36 (56%) would attend if offered. When presented with the option of having information on the same day as the decision was made to commence medication, or, having to wait to discuss the mediation with a health professional, there was a strong preference to see a health professional (n = 46, 72%)

Conclusion

Patients clearly value discussing commencing DMARDs with a health professional even if this means a delay in treatment. Having just one approach to information giving does not equate with individual needs and a range of options regarding information delivery that the patient can select from is required.

Disclosure

S. Ryan: None. S. Hider: None. Z. Paskins: None.
E015 Importance of smoking cessation in rheumatological outcomes
Authors: Osikoya-Yekini Modupe , Walshe William , Bharadwaj Anurag , Nandagudi Anupama
Published: April 2024

Background/Aims

Smoking is a major preventable risk factor for many rheumatological diseases and can influence the severity of symptoms in conditions such as psoriatic arthritis (PsA), ankylosing spondylitis, giant cell arteritis (GCA) and systemic lupus erythematosus (SLE). The increased risk due to smoking is dose dependent. The objective was to identify the proportion of patients with rheumatological conditions who smoke and to ensure that smoking cessation advice is given in line with NICE guidelines.

Methods

A retrospective qualitative study with data collected from electronic patient records (EPR) between September and November 2022 across multiple rheumatology clinics. Data included age, gender, smoking status, diagnosis, disease duration, comorbidities, treatment, and smoking advice status.

Results

459 patients were analysed (68% female), of which 11% were smokers, 6% were ex-smokers, 83% were non-smokers, and 1 vapes regularly. Among the smokers, 72% were female. The median age was 61 years, with a range of 18-91 years. The commonest age range for all patients is 71-80 years, while the commonest age range among smokers was 41-50 years at 28%. The commonest disease duration among smokers is 1-5 years.

The most common disease diagnosis among smokers were RA (30%), PsA (19%) and SLE (6%). Regarding disease activity among smokers, 36% had mild, 56% had moderate, and 8% had severe disease activity.

Among the 12 patients with respiratory comorbidities; 6 had asthma, and 4 had COPD. Among the 21 patients with cardiovascular comorbidities; 13 had hypertension, and 6 had hypercholesterolaemia.

For patients on cDMARDS, 26% were on methotrexate, 11% were on sulfasalazine, 9.4% were on hydroxychloroquine and 2% were on leflunomide. 13% were on prednisolone, while 7.5% had required methylprednisolone injections. 11% were on bDMARDs, most commonly adalimumab.

Smoking cessation advice was documented in 4%, whereas 96% had no evidence of any smoking cessation advice.

Conclusion

This study illustrates the most common age range of smokers in this cohort was 41-50 years (28%), which was almost twice the equivalent national level (14.3% in 45-54 years). Nationally, the most common age range is 25-34 years (15.8%). Patients with rheumatological disease who smoked were of younger age compared to non-smokers, and smoking rates were higher in females compared to males. Smoking cessation advice was only documented in 4% of this cohort. This indicates much scope for improvement, and enhanced disease control in a population with multiple challenges, primarily socioeconomically. VBA (Very Brief Advice) has been shown to be the single most effective and clinically proven preventive action a clinical can give to patients in relation to smoking cessation. The NCSCT (National Centre for Smoking Cessation Training) encourages the 3A’s (ASK, ADVICE, ACT).

Disclosure

M. Osikoya-Yekini: None. W. Walshe: None. A. Bharadwaj: None. A. Nandagudi: None.
E019 Management of idiopathic inflammatory myositis - a Northamptonshire audit of British Society for Rheumatology guidelines
Authors: Chauhan Neal , Abushama Sara , Jeffery Rachel
Published: April 2024

Background/Aims

The idiopathic inflammatory myopathies (IIM) are a rare group of multi-system autoimmune conditions characterised by muscle inflammation. They have an incidence of up to 19 per 1,000,000 person years in adults and a UK prevalence of 10,000 people. Last census data estimated the Northamptonshire population at approximately 785,200.

The small cohort of patients reflects the limited evidence base for best practice. In March 2022, the first UK evidence guideline on IIM was published from the British Society for Rheumatology (BSR). In view of absence of prior guidance, there is expected variability in patient management within and between centres.

To evaluate local practice against these standards an audit was conducted in Northampton General Hospital (NGH).

Methods

Using local MYOACT registry data and consultant caseload knowledge, a cohort of adult patients with IIM diagnoses consulted within the last 5 years were identified.

Retrospective clinical letters were analysed for details of patient care and compared to the 26 recommendations as set out by the myositis guideline.

Results

A total of 12 patients were sampled as having attended the rheumatology department within the last five years at NGH. All 26 standards will be presented, but for the purposes of this abstract, key results for discussion include:

• 100% of corticosteroids were tapered as the patient responded to treatment. • In presence of muscle inflammation 91% were treated with DMARDs. • In presence of active skin disease, 100% received treatment with csDMARD, IVIG or rituximab. • 100% of patients were screened for interstitial lung disease. • In presence of active muscle disease, 56% of patients received an exercise program led and monitored by therapists. • In 45% of patients’ psychological well-being and health was formally considered.

Conclusion

Initial service evaluation against BSR IIM recommendations reflects typical strengths and weaknesses encountered in delivering rheumatology services. There was strong concordance in diagnostic and pharmacological domains. However greater variability was encountered when considering multidisciplinary psychosocial domains involving access to therapy services and psychological support.

Tools such as the 36 Item Short Form Survey, highlighted in BSR recommendations, may offer a validated method for physicians to formally consider and target psychosocial domains in management of idiopathic inflammatory myopathies.

Disclosure

N. Chauhan: None. S. Abushama: None. R. Jeffery: None.
E022 Audit on the baricitinib dose in elderly and patients with chronic kidney disease among a cohort of rheumatoid arthritis patients
Authors: Rosa Chamith , Joseph Joyal , Kasavkar Ganesh
Published: April 2024

Background/Aims

Baricitinib use among elderly patients and in patients with chronic kidney disease needs modification of the dose. Baricitinib dose should be reduced to 2mg daily in patients who are 75 years or older given the associated increased risks in this age group. Additionally, baricitinib should be avoided in patients with creatinine clearance of less than 30 ml/min and dose needs to be reduced in patients with a creatinine clearance between 30-60 ml/min because it is primarily renally excreted drug.

Methods

All the blueteq requests for baricitinib at University Hospitals Coventry and Warwickshire, from 05/07/2021 to 05/07/2023 were evaluated. There were 128 patients who have been on baricitinib during this period. Twenty patients out of this, were 75 years or above. The baricitinib dose in patients above the age of 75 and in patients with chronic kidney disease was assessed by using NICE guidance on the use of baricitinib in patients with rheumatoid arthritis and the BNF as the audit standards respectively.

Results

Of the 20 patients who were 75 years and above, 13 patients were still on baricitinib. Ten patients were on a dose of 2mg daily which is in keeping with NICE guidance while 3 patients were still receiving a dose of 4mg daily. Seven patients were started on baricitinib after 75 years and 4 of them were started on 4mg daily which is not keeping with NICE guidance.

Of the 128 patients, none of them had a creatinine clearance less than <30 ml/min while there were 16 patients who had received baricitinib (at some point) with a creatinine clearance of 30-60 ml/min. Of them, 14 patients were at some point on 4mg daily dose of Baricitinib which is not in keeping with guidance. Of those 14 patients, 6 patients were still receiving a dose of 4mg daily.

Conclusion

In conclusion, it appears that we have not completely adhered to standard criteria laid down by NICE guidelines and in the BNF. This presentation aims to raise awareness among rheumatologists regarding these guidelines. Also, changing the format of the prescription to include the age and renal functions would prompt the prescriber to amend the dose accordingly.

The use of baricitinib may reduce in the future due to concerns of increased cardiovascular disease. However, there is a group of patients who are already on baricitinib and will want to continue, despite these concerns, given the significant improvements in disease control.

Disclosure

C. Rosa: None. J. Joseph: None. G. Kasavkar: None.
E045 Adherence to physiotherapy among patients with knee osteoarthritis in a rheumatology specialized care unit in Sri Lanka
Authors: Ubhayasiri Sasheela K , Abeysinghe Duminda
Published: April 2024

Background/Aims

Knee osteoarthritis is a degenerative joint disorder that has a significant impact on global health and healthcare resources. Non-pharmacological interventions play a vital role in the management of osteoarthritis, and their effectiveness relies on the patient’s active participation and adherence. But non-adherence to these interventions including physiotherapy has become a recognized problem across the globe. The extent of adherence to physiotherapy specifically in the Sri Lankan population with osteoarthritis has not been assessed to date.

Methods

This cross-sectional study was conducted at Rheumatology and Rehabilitation Hospital, Ragama, Sri Lanka recruiting 100 patients diagnosed with knee joint osteoarthritis according to the EULAR 2011 Recommendations. General Rehabilitation Adherence Scale (GRAS) was used to score the adherence level to center-based physiotherapy. Home-based physiotherapy adherence was measured using a 5-point scale. Demographic data also were assessed to determine the associations with adherence levels. Data were analysed by using the Statistical Package of Social Sciences (SPSS).

Results

The study population consisted of 93% females and 7% males. Center-based physiotherapy adherence according to the GRAS score revealed 53% had a high adherence rate while 8% found poorly adhered to. Of the highly compliant patients, the majority, 35.8% patients were within the 60-69 years age group and 35.8% were housewives. 37.7% were not having co-morbidities. 41.7% have reported a disease duration of 1-5 years. The majority complained that they had poor adherence due to other commitments (36%) followed by and lack of time (34%). The third common cause for the default was transport expenses (26%). 91% of patients had knowledge of home-based physiotherapy activities. Of them, 32% followed the exercise regime as advised and 13% continued it as far as possible. 17% were unable to engage in those at all. As reasons for noncompliance to home therapy, 35% of patients reported having a lack of time and 31% had poor motivation. None of the sociodemographic factors significantly correlated with center-based or home-based physiotherapy adherence.

Conclusion

The findings indicate that a significant proportion of patients demonstrated high adherence to center-based physiotherapy. Although a majority of patients had knowledge of home-based physiotherapy activities, only a portion followed the prescribed exercise regime. Addressing barriers such as time constraints, commitments, and transportation expenses is crucial. Future research should explore personalized approaches and innovative strategies to enhance engagement and overcome challenges to optimize physiotherapy adherence.

Disclosure

S.K. Ubhayasiri: None. D. Abeysinghe: None.
E060 A multinational survey investigating the unmet needs and patient perspectives concerning proton pump inhibitors in systemic sclerosis
Authors: Bandini Giulia , Alunno Alessia , Oliveira Pinheiro Filipe , Campochiaro Corrado , Galetti Ilaria , Cerinic Pietro Matucci , Ruaro Barbara , Aoufy Khadija El , Melis Maria Ramona , Pignone Alberto Moggi , Dagna Lorenzo , Cerinic Marco Matucci , McMahan Zsuzsanna H , Hughes Michael
Published: April 2024

Background/Aims

The gastrointestinal (GI) tract is largely (>95%) affected in systemic sclerosis (SSc) and its involvement is associated with significant morbidity, mortality and huge impact on the quality of life. Upper GI tract dysfunction, often presenting with gastroesophageal reflux disease (GERD) is one of the principal complaints. Proton pump inhibitors (PPIs) are widely used to treat GERD in SSc. However, not all patients respond to this therapy, and many remain on long-term treatment. Significant concerns about PPI long-term safety have been raised. Our aim was to identify perspectives and unmet needs of SSc patients on PPIs.

Methods

An online English survey, targeting SSc patients on PPIs was developed and distributed through social media and international patient associations. The survey was launched on 4th November 2022 and kept open for 4 weeks.

Results

301 respondents from 14 countries completed the survey (UK 19.3% and US 70.4%). Most respondents were between 30-70 years and the majority were female (95%).

The most frequently reported symptoms were acid reflux (97%), dysphagia (60%), and trouble swallowing or food got stuck in the chest (32%).

Multiple PPIs use (two: 30% and three: 21%; in series) was common and the majority (89%) reported improvement in GI symptoms with PPIs.

Even though only 19% experienced side effects on PPIs, most respondents (79%) were concerned (Table 1). Half (47%) experienced a flare of symptoms after initial improvement with PPIs and 58% received lifestyle information, while most (85%) searched online for information about PPIs.

A minority (12%) reported that a surgical approach was discussed, and 46% indicated that they would be willing to undergo surgery, despite having significant concerns.

Conclusion

Our survey highlights the importance of upper GI symptoms in SSc patients and the frequent use of PPIs. There is significant heterogeneity in use, and treatment is often not fully effective. Patients have concerns about side effects related to long-term PPI use. There is a clear unmet need regarding patients’ education about PPIs. A surgical approach is rarely discussed, although patients would potentially consider this approach. Further research is needed to optimize the therapeutic strategy concerning PPIs in SSc.

Disclosure

G. Bandini: None. A. Alunno: None. F. Oliveira Pinheiro: None. C. Campochiaro: None. I. Galetti: None. P. Matucci Cerinic: None. B. Ruaro: None. K. El Aoufy: None. M. Melis: None. A. Moggi Pignone: None. L. Dagna: None. M. Matucci Cerinic: None. Z. McMahan: None. M. Hughes: None.
Natural Infection of Murraya paniculata and Murraya sumatrana with ‘Candidatus Liberibacter asiaticus’ in Java
Authors: Lestiyani Ayu , Joko Tri , Holford Paul , Charles Beattie George Andrew , Donovan Nerida , Mo Jianhua , Subandiyah Siti , Iwanami Toru
Published: April 2024

The phloem-limited bacterium ‘Candidatus Liberibacter asiaticus’ (CLas) is the putative causal pathogen of the severe Asiatic form of huanglongbing (citrus greening) and is most commonly transmitted by the Asiatic citrus psyllid Diaphorina citri. CLas severely affects many Citrus species and hybrids and has been recorded in the Citrus relative, orange jasmine, Murraya paniculata (L.) Jack (syn. M. exotica L.). In this study, 13 accessions of three Murraya species (M. paniculata, M. sumatrana Roxb., and M. lucida [G.Forst.] Mabb.) and the Papuan form of a putative hybrid (M. omphalocarpa Hayata) were identified morphologically and molecularly based on sequence identity of the matK-5′trnK region of the chloroplast genome, and infection on these plants under field conditions was determined by PCR and quantitative real-time PCR (qPCR) on two to four occasions over 14 months. CLas was repeatedly detected in leaflet midribs by PCR and qPCR on four and three accessions of M. paniculata and M. sumatrana, respectively. It was not detected in leaflet midribs of single accessions of M. lucida and M. omphalocarpa. The species identification of the CLas-positive accessions was further confirmed using all the molecular taxonomic markers consisting of the six fragments of the maternally inherited chloroplast genome and part of the nuclear-encoded internal transcribed spacer (ITS) region. The results indicated that natural infection of M. paniculata and M. sumatrana with CLas can occur in Java. To our knowledge, this is the first demonstration of the natural infection of M. sumatrana with CLas. Further studies are required to determine whether infections persist in the absence of D. citri.