bluuebunny/crossref_metadata_2025 huggingface dataset:
P009 Biologics prescribing trends over 10 years: a retrospective analysis of 799 patients in routine clinical practice
Authors: Zubairi Rumaisa , Suhaimi Ak Muhd Adiib Pg , Olsson Lewis , Smyth Rachel , Baxter Derek , Laws Arrianne , Perry Martin E
Published: April 2022

Background/Aims

To investigate the biologic prescribing trends for a secondary care patient cohort over a 10-year period for rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthropathy (SpA), and compare against current local guidelines.

Methods

Departmental database holding patient data was interrogated. Labelled data were consolidated into distinct diagnostic categories of rheumatoid arthritis, psoriatic arthritis and spondyloarthropathy. For ease of analysis, biologic drugs were classified based on their mechanism of action into TNF-alpha blockers (TNFi) and non-TNF-alpha blockers (non-TNFi). Data was collated identifying prescribing trends of first, second and third-line therapies for RA, PsA and SpA. This was compared against local NHS guidelines. Overall cost of biologic prescription for first line therapies was calculated

Results

There were 799 patients with a diagnosis of RA, PsA or SpA. Both RA and PsA had the same general prescribing pattern of TNFi as first-line, another TNFi as second-line and non-TNFi as third-line. In SpA, TNFi were mostly used as first, second and third-line. An adalimumab biosimilar was used first-line in 90 (30.6%) RA patients, 42 (35.1%) PsA patients and 32 (32.3%) SpA patients. Methotrexate was co-prescribed with a TNF-alpha blocker in 128 (58.7%) RA patients, 51 (36.4%) PsA patients and 7 (7.7%) SpA patients. TNFi biosimilar drug prescribing has increased from 33% in 2016 to being the most prescribed drug in 2020 (62%). In the entire database cohort of 926 patients, the vast majority are prescribed biosimilars (Table 1). The overall cost of biologic prescriptions has reduced by 49% from 2019 to 2020 as the proportion of biosimilars prescribed has almost doubled to 69%.

Conclusion

Biologic prescribing patterns are largely in-keeping with current national and local guidelines. The vast majority of patients are on a biosimilar, which has resulted in significant cost-savings for the department.

Disclosure

R. Zubairi: None. A. Muhd Adiib Pg Suhaimi: None. L. Olsson: None. R. Smyth: None. D. Baxter: None. A. Laws: None. M.E. Perry: Honoraria; AbbVie, Celltrion Healthcare, Gilead, Lilly, Biogen, Jaansen, Fresenius Kabi.
P023 Comparative Utility of Ultrasound in Known Vs Query New inflammatory Arthritis - a Retrospective Case-Note Audit
Authors: Adikari Madura , Koutsianas Christos , John Holly , Klocke Rainer
Published: April 2022

Background/Aims

Ultrasound (US) imaging has become established in clinical Rheumatology practice to aid diagnosis and monitoring of inflammatory arthritis (IA). We firstly wanted to explore the utility of US in the assessment for active synovitis in subjects with known IA, but clinically uncertain disease control. Secondly we set out to compare this with the diagnostic contribution of US in patients presenting with new inflammatory joint symptoms and uncertain clinical synovitis.

Methods

Two contemporaneous samples of subjects were selected from consecutive, pre-Covid, Rheumatology Consultant-delivered Ultrasound Clinic lists in our department: (i) subjects with known IA where clinical disease activity was uncertain, and (ii) subjects without know IA who had symptoms with inconclusive signs of suspected IA. Both grey scale and power Doppler US imaging was used to determine a sonographic conclusion of active IA being present, absent or equivocal. Treatment changes/ decisions were ascertained from the next available clinic letter to explore diagnostic consequences following US.

Results

(i) In the sample of subjects with known IA (n = 30, mean age 53.9 years, 63% female, RA 76.7%, all on DMARDs [20% biologics]), 43.3%(n = 13) had US evidence of active IA, and 50% of inactive IA (and the remainder reported as equivocal). At clinic review (n = 30) only 6 of 13 subjects with active US IA had their DMARD treatment escalated (all within same DMARD) and 5 out of 15 subjects with inactive US IA their DMARD de-escalated. (ii) In the sample of subjects with suspected IA (n = 30, mean age 51.5 years, 73% female): 16.7% (n = 5) had US evidence of IA and 77.7% not (and remainder reported as equivocal). At the next clinic review seven patients were commenced on DMARDs: three patients with IA on US, and 4 without.

Conclusion

In our department, Rheumatology clinicians appear to be referring for diagnostic US in known IA from a situation approaching clinical equipoise which would suggest optimum referral practice. If we assume that this clinical equipoise also applies to the assessment and referral practice of new patients with arthralgia but uncertain clinical synovitis, our diagnostic sensitivity of US is approximately 16.7%, meaning: six patients with suspected IA need referral for US to identify one with sonographic IA. Irrespective of this, we observed that the sonographic diagnosis in known or suspected IA is commonly not followed by a concordant treatment decision, suggesting that the US diagnosis forms only part of the diagnostic ‘jigsaw’ decision process.

Disclosure

M. Adikari: None. C. Koutsianas: None. H. John: None. R. Klocke: None.
P028 An exploration of rheumatology patients’ perceptions and knowledge about sick day rules while using steroids for immunosuppression
Authors: Umair Hafiz M , Clark William , O'sullivan Rory , Fawthrop Fiona
Published: April 2022

Background/Aims

Steroids are commonly used for immunosuppression in the majority of rheumatology conditions. Patients on long-term steroids are vulnerable to adrenal insufficiency during acute illness or if steroids are stopped or weaned down abruptly. During the COVID-19 pandemic, this risk has further multiplied due to change in practice with inclusion of telephone consultations and less frequent hospital visits. Although our patients were routinely provided with steroid alert cards by pharmacy, we aim to ascertain the knowledge and understanding of sick day rules in patient who are on steroids for immunosuppression.

Methods

We designed a novel questionnaire consisting of 10 questions, designed to determine patients’ knowledge about steroid sick day rules. All questions were close-ended, either single best answer or yes/no except question about primary rheumatological condition and type of steroids. A total of 100 patients (including new and follow-ups) attending rheumatology clinics between January and June 2020 were screened and selected randomly. Questionnaires and consent forms were sent by post as agreed with clinical effectiveness team with return envelopes.

Results

29 completely filled questionnaires were received back. The majority of patients (96.5%; n = 28) were on prednisolone and only 3.44% (n = 1) were on hydrocortisone. The majority of the patients (95.6.6%; n = 29) were on steroids for duration between 1-6 months. Answering the question on steroid dose during an acute illness,10.3% (n = 3) patients had knowledge to take double dose of steroids, 55.1% (n = 16) responded to take regular dose, 3.44 (n = 1) answered by lowering dose to half, and strikingly 10.3% (n = 3) answered to stop steroids. For further question on when to seek medical advice during an acute illness while on steroids, 31.0% (n = 9) responded by answering correctly, 37.9% (n = 11) were unsure when to take medical attention, and 3.44% (n = 1) responded to wrong option. Despite providing steroids alert cards to everyone, only 65.5% (n = 19) answered yes on asking about carrying alert card with them.

Conclusion

Despite providing steroid alert card and verbal information, these data highlight a significant dearth of knowledge and understanding about sick day rules among rheumatology patients on steroids for immunosuppression. This knowledge gap increases the risk of potentially life-threatening emergency of adrenal crisis among this patient group. To bridge this knowledge gap, we started to provide steroid sick day rules written information leaflet to all new and old rheumatology patients on steroids to reduce risk of future adrenal crisis. We are aiming to re audit this after 1 year to check improvement in patient knowledge and understanding of sick day rules with this change in practice.

Disclosure

H.M. Umair: None. W. Clark: None. R. O'sullivan: None. F. Fawthrop: None.
P051 A rare mimic of inflammatory arthritis
Authors: Cox Miriam , Kazmi Muhammad F
Published: April 2022

Background/Aims

Rosai-Dorfman syndrome is a rare disorder, primarily affecting young males, characterised by overproliferation and accumulation of histiocytes. It commonly affects lymph nodes but can affect the nervous system, kidneys and skin. Bone involvement is rare (around 5%) and presents as lytic lesions. Diagnosis can be challenging as many cases spontaneously resolve. In severe cases steroids, radiotherapy or chemotherapy may be used.

Methods

We present a case of a 34-year-old gentleman with a 4-month history of fatigue, widespread arthralgia and unintentional weight loss. Pain was severe, nocturnal and involved joints and long bones. There was no joint swelling. He had recently had a self-limiting episode of headaches and night sweats that was presumed secondary to a viral infection. He had no rash and no features suggestive of connective tissue disease. He did not smoke or drink alcohol and had no recent travel history. His symptoms responded to NSAIDS but recurred quickly.

Results

On examination, he had a tender right elbow and tender bilateral tibia. There was no evidence of synovitis. He had no lymphadenopathy. X-rays of elbows and knees showed no effusion or erosions. Viral and autoimmune screens were negative. He had a normocytic anaemia with Hb 108. His CRP was rising at 57, having been 27 when initially referred; this was felt inconsistent with a reactive arthritis. LDH was normal along with normal WBC count. A PET-CT was requested to investigate for malignancy, this showed multiple foci of tracer uptake throughout the skeleton but no lymph node involvement. He was referred to haematology for tissue diagnosis and had two bone biopsies, one of which was suspicious for histiocytosis. A bone marrow biopsy showed non-necrotising histiocytic granulomas. Langerhan's Histocytosis was considered and a repeat PET arranged. This showed progressive increased uptake throughout the skeleton and bone marrow with new lytic lesions. There was tracer uptake in the skin, lung and kidneys, reported as possible Rosai-Dorfman disease. No evidence of primary malignancy was found after extensive investigations. He then developed frontal and occipital skin lesions. MRI head showed dural lesions, suspicious for meningioma. He was referred to dermatology for biopsy of skin lesions. However, the skin and dural lesions spontaneously resolved. This was associated with resolution of fatigue and arthralgia. His CRP settled to 2.8 and anaemia resolved 6 months after presenting. A diagnosis of spontaneously remitting Rosai-Dorfman disease was made in conjunction with the national histiocytosis advisory panel. He remains under surveillance.

Conclusion

This case highlights a rare presentation of a rare condition. As rheumatologists we often see cases which present a diagnostic challenge. Rosai-Dorfman disease has characteristic appearances on PET and should be considered as a diagnosis in patients with atypical joint pain and abnormal PET-CTs.

Disclosure

M. Cox: None. M.F. Kazmi: None.
P064 Impact of COVID-19 on physical and mental health of people with inflammatory conditions: the ICEPAC survey
Authors: Hider Samantha , Muller Sara , Gray Lauren , Manning Fay , Brooks Mike , Heining Dominic , Menon Ajit , Packham Jonathan , Raghuvanshi Subhra , Roddy Edward , Ryan Sarah , Scott Ian , Paskins Zoe
Published: April 2022

Background/Aims

Concerns about the risk of COVID-19 infection led to guidelines advocating shielding for many people with inflammatory conditions. We aimed to assess the impact of the pandemic on the self-reported physical and mental health of people with inflammatory conditions.

Methods

2024 patients with inflammatory conditions (RA, PsA, AS, SLE and other) were randomly selected from electronic health records. Survey invites were sent (August 2021 to coincide with relaxation of COVID restrictions) using a combination of SMS and postal approaches. Data collected included demographics, COVID infection and shielding status, physical (MSK-HQ) and mental health (PHQ8 and GAD7) and global impact on physical or mental health (4 options: none-severe). Ethical approval was obtained (REC Ref 21/PR/0867).

Results

639 people completed the survey, of whom 287 (44.9%) completed online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. The majority of people had RA although 57 (9%) reported more than one inflammatory condition. 349 (57.9%) of people were advised to shield. Rates of COVID infection were relatively low across the groups (Table 1). 254 (41.2%) reported moderate or severe impact of the pandemic on physical health, which impacted least in people with RA. 244 (39.4%) reported moderate or severe impact of the pandemic on mental health with 175 (28.7%) reporting moderate depression (PHQ8 ≥ >10) and 138 (22.6%) moderate anxiety (GAD-7≥10).

Conclusion

Reported COVID infections were low in our cohort. The pandemic had significant effects on physical and mental health, which appeared less in people with RA than other inflammatory conditions.

Disclosure

S. Hider: None. S. Muller: None. L. Gray: None. F. Manning: None. M. Brooks: None. D. Heining: None. A. Menon: None. J. Packham: None. S. Raghuvanshi: None. E. Roddy: None. S. Ryan: None. I. Scott: None. Z. Paskins: None.
P074 Evaluation of incidence of COVID-19 infection and uptake of COVID-19 vaccine in sarcoidosis patients at a tertiary centre
Authors: Nagra Deepak , Gunawardana Shannon A , Bechman Katie , Birring Surinder , Patel Amit , Galloway James
Published: April 2022

Background/Aims

Sarcoidosis is a multi-system inflammatory disorder, characterised by the formation of non-caseating granulomas. In the UK, a decision was made to include sarcoid patients in the clinically extremely vulnerable group, and they were advised to shield during the COVID-19 pandemic. We investigated the incidence of covid-19 infection and uptake of COVID-19 vaccine within this patient group.

Methods

Consecutive patients attending the King’s College Hospital sarcoidosis clinic over 18 months between 1st January 2018 and 31st August 2020, and were still alive on 31st January 2020, were included in this report. Electronic primary care records and hospital records were reviewed for each patient to evaluate the incidence of RT-PCT confirmed covid-19 infection, hospitalisation, and vaccination status, defined as at least one vaccination. Hospitalisation data was available from four South-East London trusts.

Results

The King’s College Hospital database identified 416 patients with biopsy confirmed sarcoidosis. Of the complete cohort, the median age was 55.7 years, 193 patients (46%) were male, and 178 patients (43%) were of black ethnicity. A proportion of patients were taking prednisolone (n = 116, 28%) and DMARDs (n = 73, 18%). The incidence of RT-PCR confirmed covid-19 infection was 48/416 patients (12%). Of these infections, 16/48 (33%) were prior to vaccine availability, including one patient who required an intensive care admission. Post vaccine availability, 9/32 infections were in vaccinated individuals, 8/32 in unvaccinated and 15/32 were of unknown timing; there were 2 recorded hospital admissions but no intensive care admissions, neither patient was immunosuppressed and one was unvaccinated. Uptake of at least one covid-19 vaccine was 287/416 patients (69%). Of the cohort who opted not to have a vaccine (n = 129), the median age was 53.7 years, 60 patients (47%) were male, 58 (45%) were black ethnicity and 22 (17%) were white ethnicity. The only demographic variable to predict covid-19 vaccine uptake was ethnicity; patients of black ethnicity were less likely to have the vaccine than those of white ethnicity (OR = 0.56, p = 0.041). In vaccinated individuals, there were 9/287 cases (3%) of RT-PCT confirmed covid-19 infection, of which one patient required hospitalisation but not intensive care.

Conclusion

The incidence of covid-19 infection in our cohort is comparable to that of London (12%), despite an extremely clinically vulnerable population. Vaccine uptake was lower in sarcoid patients (69%) than the national comparator in adults (90%) and was especially low in the black ethnic population.

Disclosure

D. Nagra: None. S.A. Gunawardana: None. K. Bechman: None. S. Birring: None. A. Patel: None. J. Galloway: None.
P079 Building quality improvement capacity for rheumatology: outcomes from the first BSR national workshop
Authors: Sharp Charlotte A , Benson Rosalind , Baird Hannah , MacPhie Elizabeth
Published: April 2022

Background/Aims

Quality improvement (QI) is now an expected part of healthcare professional practice. After identifying a gap in available training and successfully delivering a QI course for 35 clinicians at the Northwest Rheumatology Club, trainee representatives were invited by the BSR invited to convene a national workshop.

Methods

The first BSR Quality Improvement Practical Methodology Workshop was held in March 2021 (online, due to COVID-19). Materials were adapted from the well-established Trainees Improving Patient Safety through Quality Improvement (TIPSQI) initiative. Plenaries covered the Model for Improvement, process mapping, SMART aims, driver diagrams, stakeholder engagement, illustrated using rheumatology-specific case-studies. Delegates (with mixed experience / professional role) practiced using tools in small, facilitated, breakout rooms. Pre-course surveys informed course design. Post-course and six-month follow up surveys evaluated impact. Because there are no validated tools to evaluate the impact of QI training, Kirkpatrick’s four-step hierarchical model, commonly used in this context, was employed.

Results

Of 30 delegates (consultants, trainees, pharmacists, nurses, physiotherapists), 28, 22 and 4 completed pre-course, post-course and six-month surveys, respectively (Table 1). For Kirkpatrick level 1, ‘reaction’, all respondents were ‘satisfied’, with 100% recommending to colleagues. Using driver diagrams as an exemplar to evaluate level 2, ‘learning’, pre-course, delegates were: not aware 16/28(57.1%), aware 9/28(32.1%), confident to use 3/28(10.1%), 0/29(0%) confident to teach. Post-course improvements showed confidence to use 22/22(100%), and teach 12/22(54.6%) (maintained at six months). Given low numbers of six-month respondents, assessing long-term impact is challenging. Evaluating level 3, ‘behaviour’, all 4/4(100%) respondents conducted QI post-course, with 2/4(50%) teaching. Delegates reported that the course gave confidence to use tools and support others. In evaluating level 4, ‘results’, 1/4(25%) felt the course had changed the impact of their work, with 3/4(75%) reporting time and institutional constraints as barriers to conducting QI.

Conclusion

The QI course has been commissioned as a BSR annual ‘core educational’ offering, with feedback showing it was needed, wanted, and effective in delivering core QI principles. In response to six-month feedback, additional post-course-support is planned in future, aiming to capacity build expertise in QI and embed a sustainable culture of improvement across the rheumatology community.

Disclosure

C.A. Sharp: None. R. Benson: None. H. Baird: None. E. MacPhie: Other; EM is the North West Rheumatology Club secretary and meetings have been sponsored by MSD, UCB, Abbvie and Lilly.
P080 Self-management individualised learning environment in rheumatoid arthritis
Authors: Bosworth Ailsa M
Published: April 2022

Background/Aims

An important but insufficient aspect of care in people with inflammatory arthritis (IA) is empowering them to acquire a good understanding of their disease and build their ability to deal effectively with the practical, physical and psychological impacts of it. This extends beyond drug therapy and emphasises the ability to self-manage, with the right support, as an essential component of care. Good self-efficacy and coping skills benefit and reduce health and financial burden to the individual as well as the health service, benefitting society overall. Provision of excellent supported self-management education is at the heart of what NRAS does and it was due to the difficulty of getting Commissioners to fund our group self-management that led to our deciding to build an e-learning programme to replace our 6- week face-to-face programme.

Methods

In 2019 with initial funding in place, we partnered with an e-learning platform provider who would help us realise our goal of developing a state-of-the art e-learning experience in a modular format for people with RA. We wanted the programme to be 1) simple to use; 2)interactive; 3)engaging; 4)able to measure impact through learning objectives and use of a validated patient reported outcome measure. The programme also had to be integrable with our Salesforce database within NRAS enabling us to target resources to individuals, driven by identified need.

Results

The pandemic delayed progress, however, we launched with 4 modules on 17th September, 2021. The four modules comprise: Foundation Module covering the importance of self-management which has the RA Impact of Disease PROM embedded; Newly Diagnosed; Meet the Team and Managing Pain and Flares. A fifth module on Medicines in RA will be launched by end 2021. SMILE meets NICE Quality Statement 3, against which teams are audited, and aligns with EULAR Recommendations for implementation of self-management strategies in IA. Since launch 3 weeks ago, nearly 300 people have registered. Well over 100 baseline RAID PROMs have been completed and we are starting to collect valuable data which will enable us to target more resources where they are needed.

Conclusion

SMILE-RA provides patients with a unique, engaging educational resource which they can watch and watch again with their family. It is also a useful resource for AHPs new to rheumatology. Further modules will be added in 2022 and beyond. Many modules on a wide range of topics are planned and so this is an on-going project which has input from health professionals and people with lived experience at its heart. Patients and HCPs have welcomed this new resource at a time when the rheumatology workforce is in crisis. We will be presenting more data in Q1 2022 which will be available for congress.

Disclosure

A.M. Bosworth: None.
P094 Occupation and work productivity in individuals with early inflammatory arthritis: results from the National Early Inflammatory Arthritis Audit
Authors: Bechman Katie , Cook Emma , Houssien Abdullah , Amlani-Hatcher Paul , Ledingham Jo , Galloway James , Walker-Bone Karen
Published: April 2022

Background/Aims

To continue working, work in the same occupation or work the same number of hours is one of the most important outcomes for individuals with inflammatory arthritis but is often diminished during the very early phases of disease. Our objectives were to describe occupation and work status in individuals with early inflammatory arthritis (EIA) from the National Early Inflammatory Arthritis Audit (NEIAA) and assess the impact of occupation and treatment response on work disability.

Methods

NEIAA is an observational cohort of adults with newly diagnosed EIA seen in rheumatology services in England and Wales between May 2018 and March 2020. Self-reported occupation was coded using the UK Standard Occupational Classification and classified using the National Statistics Socio-Economic Classification (NS-SEC). Work disability was assessed at diagnosis, 3 months, and 12 months, using the work productivity and activity impairment (WPAI) score, with absenteeism data dichotomized between those who reported any sick-leave and those who did not. Multilevel mixed-effects linear regression models were used to examine associations between occupation and WPAI score at baseline and over 12 months. Variables for adjustment were decided a priori and included only age and sex.

Results

There were 12,663 individuals with EIA, with 5999 (48%) in paid work defined as greater than 20 hours per week. Occupation data were available for 3720 individuals, with the highest proportion of patients in lower managerial, administrative, professional (n = 773) and semi-routine (n = 761) roles. At diagnosis, 171 patients (4.7%) had stopped work and 336 (9.2%) had changed jobs because of their EIA. Absenteeism was reported by 685 patients (29.5%). Compared to the higher managerial, administration and professional occupation group, the other occupational types demonstrated a greater level of productivity loss due to presenteeism and overall work impairment. Individuals in semi routine and routine occupations were more likely to stop work due to EIA. In the 12 months after diagnosis, absenteeism, presenteeism and overall impairment improved across all occupations. Achieving a good EULAR response at 3 months, but not occupational type, was associated with improvement in work outcomes over time (p value <0.001).

Conclusion

Work disability is prevalent in individuals with EIA at diagnosis, with variation across occupation types. In the first 12 months after diagnosis improvements in all work outcomes are seen, with the greatest change in those who achieve a good EULAR response.

Disclosure

K. Bechman: None. E. Cook: None. A. Houssien: None. P. Amlani-Hatcher: None. J. Ledingham: None. J. Galloway: Consultancies; Sanofi, Novartis, Pfizer, Janssen, UCB. Grants/research support; Eli Lilly. K. Walker-Bone: None.
P096 Analysis of frailty in rheumatoid arthritis and its relationship with disease activity, hospitalization and mortality: findings from the Scottish Early Rheumatoid Arthritis cohort and UK Biobank
Authors: Hanlon Peter , Morton Fraser , Siebert Stefan , Jani Bhautesh , Lewsey Jim , McAllister David , Mair Frances
Published: April 2022

Background/Aims

Frailty is present in relatively young people with rheumatoid arthritis (RA) but its association with longitudinal outcomes is unclear. This study aimed to assess the prevalence of frailty in RA and its association with disease activity, all-cause mortality, and hospitalisation.

Methods

People with RA identified from Scottish Early Rheumatoid Arthritis cohort (recruited at diagnosis, mean age 58.2) and UK Biobank (identified using diagnostic codes occurring prior to baseline assessment, mean age 59). Frailty was quantified using the frailty index approach (a cumulative count of age-related deficits, assessed in both datasets) and the frailty phenotype (based on low grip strength, weight loss, low physical activity, exhaustion and slow walking speed, assessed in UK Biobank only). Disease activity was assessed using DAS28-score in SERA. Relationship between baseline frailty and all-cause mortality and unscheduled hospitalization was assessed adjusted for age, sex, socioeconomic status, smoking and alcohol (model 1), plus DAS28 in SERA (model 2). In SERA, changes in frailty index, DAS28, self-rated health and HAQ-DI were reassessed after 6 months.

Results

Using the frailty index, frailty was common in SERA (12% moderate, 0.3% severe) and UK Biobank (20% moderate, 3% severe). In UK Biobank 23% were frail using the frailty phenotype. Frailty index was associated with DAS28, age and female sex. Both the frailty index and frailty phenotype were associated with all-cause mortality and unscheduled hospitalisation. In SERA, the relationship with hospitalisation was attenuated after adjusting for DAS28 (table). In SERA, as DAS28 fell over time with treatment, 46% of moderately frail participants improved to mildly frail or robust states after 6 months. However, despite these improvements, participants with moderate or severe frailty at baseline had higher mean DAS28, greater functional impairment, poorer self-rated health, and still had higher mean frailty index than people who were robust or mildly frail at baseline.

Conclusion

Frailty is common in early and established RA and associated with hospitalisation and mortality. Frailty in RA is dynamic and, for some, may be ameliorated through controlling disease activity in early disease. Future work should explore how best to identify individuals likely to benefit from specific treatment strategies.

Disclosure

P. Hanlon: Grants/research support; Medical Research Council Clinical Research Training Fellowship (MR/S021949/1). F. Morton: None. S. Siebert: None. B. Jani: None. J. Lewsey: None. D. McAllister: None. F. Mair: None.
P102 The hidden face of Behcet’s syndrome; central nervous system involvement, a single-center experience
Authors: Yıldırım Reşit , Dinler Mustafa , Arslan Ayşe E , Bilge Nazife S. Y , Kaşifoğlu Timuçin
Published: April 2022

Background/Aims

Neurologic involvement in Behcet’s syndrome (BS) remains an unelucidated area that needs further attention. In this study, we aimed to analyze the patterns of neurologic involvement and evaluate their association with other clinical features.

Methods

800 patients with BS diagnosis according to The International Criteria for Behcet’s Disease (ICBD) followed in our center were retrospectively screened and 55 patients with central nervous system involvement and 20 patients with non-vascular BS were enrolled in this study. These patients were classified as sinus vein thrombosis (SVT), parenchymal involvement, and mixed (SVT and parenchymal). These groups were compared in terms of demographic and clinical features.

Results

Thirty-two (58,2%) of the patients were male. Distribution of neurologic involvement were as follows; 22 (40%) with isolated sinus vein thrombosis (SVT), 25 (%45) with isolated parenchymal, and 8 (%15) with mixed pattern. Central nervous involvement was the diagnostic feature of BS in 25 patients. Headache was the most common symptom followed by neurologic deficits and dizziness (44%, 25%, 16%). The most common sites of involvement were subcortical and periventricular areas followed by brainstem (63% vs 37%). In SVT group, positive family history of BS (p < 0.001) and previous deep vein thrombosis (DVT) (p:0.004) were found higher. Smoking history, erythema nodosum, cardiac and pulmonary involvement were significantly higher in parenchymal group (p < 0.001) (Table 1).

Conclusion

Although brainstem involvement is considered as more characteristic in BS, white matter and periventricular involvement were also found as common in our study. Notably, these subgroup analyses may suggest the speculation that BS shows clusters even within the neuro-vascular involvement.

Disclosure

R. Yıldırım: Other; Reşit Yıldırım is a member of Rheumatology journal as an associate editor. M. Dinler: None. A.E. Arslan: None. N.S.Y. Bilge: None. T. Kaşifoğlu: None.
P114 A service evaluation of the Myositis clinic at London North West University Healthcare Trust
Authors: Welding Imogen , Isaacs Anthony
Published: April 2022

Background/Aims

The idiopathic inflammatory myopathies (IIM) are a heterogeneous group of rare diseases, primarily characterised by inflammation of skeletal muscle which leads to muscle weakness, but often involving several other organ systems. The myositis service at London North West University Healthcare Trust (LNWUH) was created in 2017 with the aim of standardising care and improving clinical outcomes for patients. The International Myositis Assessment and Clinical Studies Group (IMACS) established disease activity core set measures to validate clinical response to treatment in studies, but the optimal treatment and real world data on clinical outcomes for patients with IIM is not well described. We undertook a service evaluation to understand the cohort, assess the effectiveness of the service, and in order to inform future service improvements for patients with IIM.

Methods

We performed a retrospective analysis of the IIM cohort at LNWUH as of January 2021, which consisted of 40 patients. Data were gathered from electronically stored notes and results.

Results

65% of our cohort were female, 35% were male. The age range was 18-85. The most common subgroup was dermatomyositis (22.5%). The presenting symptoms included muscle weakness (82.5%), dysphagia (32.5%) and interstitial lung disease (ILD) (27.5%). The most common primary antibody was HMG-CoA reductase, followed by anti-Jo1. More than one antibody was present in 47.5% of patients. three patients had no detectable antibody. 1 in 5 patients had a normal creatine kinase (CK) at baseline. 89% had a raised troponin at baseline, with only two of these having confirmed cardiac involvement on imaging (echocardiogram or cardiac MRI). 30% of the cohort are currently taking mycophenolate mofetil (MMF), 27.5% are taking methotrexate, and 20% are taking hydroxychloroquine. 30% of patients have received rituximab, 20% intravenous immunoglobulin (IVIg), and 7.5% cyclophosphamide. Normalisation of CK was seen in 80% of patients, compared with 20% for pulmonary function tests (PFTs). 63% of patients were in clinical remission one year after diagnosis. Three patients died, two from MDA5-positive rapidly progressive interstitial lung disease.

Conclusion

In our cohort of patients with IIM, most patients had a significant improvement in their CK and muscle strength with treatment, but there remain challenges. We have established a baseline demographic and clinical outcome data for our cohort that will be used to make service improvements in line with the BSR guideline in development “Adult patients with idiopathic inflammatory myopathy”, and to assess future performance of the service.

Disclosure

I. Welding: None. A. Isaacs: None.
P118 Drive-through phlebotomy - is this the future?
Authors: Begum Julie , Nisar Muhammad K
Published: April 2022

Background/Aims

Centralised phlebotomy services have been an integral part of providing blood monitoring facility for people with chronic diseases prescribed vital therapies. However, the patient experience is not always optimal due to the issues of congestion, parking, long waiting times; this has been accentuated during COVID-19 pandemic with the need for minimising physical contact. In response to the growing pressure on phlebotomy service at our institution enhanced by the COVID-19 pandemic, our rheumatology service implemented a drive-through phlebotomy clinic to provide the option for patients and families to stay in their vehicles whilst having venepuncture.

Methods

At our large university teaching hospital, we set up a drive-through phlebotomy service provided by a senior HCA supervised by the lead nurse. Patients were identified from the departmental database and were offered the facility via telephone. Eligibility was assessed using a standardised proforma focusing on logistics such as ability to drive and access to a mobile phone. Appointments were scheduled in advance with patients choosing this care option. All the data was prospectively collated with patients’ consent and anonymised for analysis. In addition to demographics, diagnosis and drug record, duration of visit and patient feedback was collected.

Results

112 patients were offered the service during a 12-week pilot. Mean age of the participants was 49.5 yrs (19-91) with 73 (65%) women. 74 (65%) were of Caucasian and 28 (25%) of Asian origin. 94 (84%) had inflammatory arthritides and all were prescribed DMARDs and/or bone active agents. 69 (61%) had blood samples taken using this service. Most common reason to decline was an already arranged appointment with standard phlebotomy (n = 14, 12.5%). Six (5%) could not be bled due to difficult venepuncture. Mean duration of appointment was 12.5 mins (5-60). 68 (60%) provided feedback with 61 (90%) rating 5/5 and 60 (89%) rating it better than standard phlebotomy. All would like to have the option for future and 67 (98%) were highly likely or likely to recommend the service to family and relatives.

Conclusion

To our knowledge, this is the first study to demonstrate the utility of drive-through phlebotomy for people with rheumatic diseases prescribed DMARDs. Excellent feedback of the participants confirms the need and desire for such innovation in health care. In post COVID-19 services reconfiguration, the availability of drive-through appointments and the close physical proximity to the clinic made it an appealing option for a vulnerable group of patients evidenced by their outstanding experience and feedback. Overall, an HCA-delivered, nurse-supervised drive-through pathway is highly effective, safe and provides an innovative solution to strained phlebotomy services.

Disclosure

J. Begum: None. M.K. Nisar: None.
P132 Does weight-bearing physical activity track through the lifecourse? Findings from the Hertfordshire Cohort Study
Authors: Zhang Jean , Jameson Karen , Westbury Leo , Fuggle Nicholas , Ward Kate , Cooper Cyrus , Dennison Elaine
Published: April 2022

Background/Aims

Physical activity is known to be beneficial for musculoskeletal health across the lifecourse. We have previously demonstrated that regular participation in weight-bearing physical activity (WBPA) at the time of peak bone mass acquisition is associated with higher hip bone mineral density in late adulthood in women. Understanding how WBPA tracks across the lifecourse may help us develop interventions to promote WBPA for musculoskeletal benefit; we consider these relationships here.

Methods

The study population consisted of 128 men and 130 women from the Hertfordshire Cohort Study. Questionnaire data on participation in sports and leisure time exercise involving WBPA e.g. running, racquet sports, football, rugby, hockey and dancing, but not walking, cycling or swimming were collected for the following age bands: <18 years; ages 18-29 years; ages 30-49 years; and ≥50 years. Responses were coded as none/ once a month/ once a week/ ≥once a week. Data on current lifestyle and physical activity levels were also collected.

Results

The mean age of participants was 75.4 (SD 2.5) years in men and 75.7 (SD 2.6) years in women. Men tended to report higher levels of past WBPA throughout the lifecourse, with significant differences in WBPA up to the age of 18 years (p = 0.006) and 18-29 years (p < 0.001). Table 1 shows kappa statistics of relationships between reported WBPA levels at different ages. These decreased over time, and while broadly similar, the tracking was generally stronger in women than men. For example, we observed that participants who were active at 30-49 years were more likely to remain active in late adulthood with kappa in men 0.393 (95%CI: 0.295-0.442) and kappa in women 0.492 (95% CI: 0.400-0.555).

Conclusion

WBPA decreased with advancing age in both sexes, though was generally higher in men than women in this retrospective cohort study. The correlation between WBPA at different stages of the lifecourse weakened as time between the measurements increased in both sexes. Our results highlight the need for further work to understand the drivers to encourage WBPA at different stages in the lifecourse and to facilitate development of appropriate interventions to promote WBPA for musculoskeletal benefit.

Disclosure

J. Zhang: None. K. Jameson: None. L. Westbury: None. N. Fuggle: None. K. Ward: None. C. Cooper: None. E. Dennison: None.
P152 A rare case of necrotising vasculitis presenting with calf swelling in a 15-year-old female
Authors: Earl Susannah C , Smith John-Paul , Ramanan Athimalaipet
Published: April 2022

Background/Aims

We present the case of MF, a 15-year-old female who presented to the paediatric clinic with swelling and pain affecting her right calf. She was previously fit and well.

Initial imaging was suggestive of localised myositis but a subsequent muscle biopsy was in keeping with necrotising vasculitis.

Methods

In May 2021, MF presented to a general paediatric clinic with a 6-week history of right lateral calf pain and swelling to the lateral border of the right proximal fibula. She was systemically well. Blood tests and an x-ray were normal. An ultrasound scan of the right calf showed fusiform thickening of the peroneus longus muscle proximally. There was no discrete mass. The appearance was thought to be an inflammatory process such as myositis. An MRI scan was advised. Over the course of the next few weeks, the swelling and pain to the right calf progressed and she was unable to fully weight bear. Repeat blood tests were normal except CRP 11. CK was normal. At the end of June, an MRI scan of the right lower leg showed significant swelling and oedema along the length of the peroneus longus musculature as demonstrated on ultrasound. Florid oedema extended to involve the soleus and to a lesser extent the lateral head of gastrocnemius. There was thickening and oedema through the subcutaneous fat circumferentially compared to the left side (see images). The appearances were thought to be consistent with myositis but an inflammatory malignancy could not be fully excluded and an opinion from the Birmingham team was recommended. The Birmingham MDT advised that malignancy was unlikely but a CT scan was recommended. The CT scan confirmed the MRI findings (see image).

Results

MF's symptoms progressed rapidly over a short period of time with diffuse swelling of the right lower limb with associated pain and numbness. She also developed purpuric lesions around the ankle (see photos). The CRP increased to 59 and then 123. CK remained normal. Local rheumatology opinion was sought once malignancy had been excluded. The initial impression was of a focal myositis but a muscle biopsy was requested urgently. IV steroids were administered followed by high dose oral prednisolone as a reducing course. The symptoms improved rapidly. The subsequent biopsy showed a florid necrotising vasculitis affecting the small-medium arterial vessels. There was no evidence of myositis (see image). ANCA was negative and CT renal and abdominal angiogram was normal. Nerve conduction studies showed a very severe sensory lesion of the right sural nerve, which explained the persistent numbness. Mycophenolate mofetil was added and clinical improvement is ongoing.

Conclusion

We present a rare case of localised vasculitis in the right calf. A literature review indicates this is the first case presented in an adolescent.

Disclosure

S.C. Earl: None. J. Smith: None. A. Ramanan: Grants/research support; Abbvie.
P157 Poverty and paediatric rheumatology
Authors: Crosby Laura
Published: April 2022

Background/Aims

30% of UK children live in poverty, which is associated with a multitude of long-lasting adverse outcomes. Healthcare workers have a vital role in addressing the psychosocial wellbeing of children, which extends to identifying children living in poverty and how this impacts upon their health. Navigating this is challenging. This project reviews the literature to present how poverty impacts child health, with particular reference to patients with juvenile idiopathic arthritis (JIA). Practical suggestions are outlined to signpost and support children and families in need.

Methods

Information was sought from resources such as the Royal College of Paediatricians, British society of Rheumatology and Child Poverty Action Group. Further literature was sought via sequential PubMed searches with relevant terms. This project provides a report, rather than systematic review, of the literature.

Results

Poverty disproportionately affects children with JIA from diagnosis to adulthood. A US study demonstrated that children living in deprived areas were significantly more likely to experience delays in presenting to a paediatric rheumatologist. In the UK poorer children are more likely to present via the emergency department, reflecting potential areas to improve the patient journey. Low socioeconomic status is a strong predictor of poor medication adherence and appliance poverty may prevent appropriate drug storage. Families that are experiencing in-work poverty may also be ‘time poor’, which could result in suboptimal appointment attendance and engagement. JIA places an additional financial stressor on families in poverty due to the cost of travel, parking, childcare and loss of income. Additionally, JIA may impact on the earning potential of young people themselves. JIA impacts school attendance and achievement and is associated with reduced employment. The impact of JIA on education is likely to be amplified for children living in poverty, which has a strong link with absenteeism. Children with JIA from low socioeconomic groups experience more severe disease outcomes and are more likely to have a poorer health reported quality life. Lower socioeconomic status in childhood is also associated with higher prevalence of chronic pain in both childhood and adulthood.

Conclusion

It is vital that we think beyond the investigations we order and drugs we prescribe, and consider social investigation and prescribing as part of our practice. An ‘Ask, Action, Advocate’ strategy is recommended. Evidence suggests that families welcome healthcare staff asking about financial difficulty during consultations. Professionals can take action by signposting families to the wealth of resources available to help meet basic needs, increase income, and provide social and emotional support. Advocating for the most vulnerable families by considering where your service could be improved for those in financial hardship is crucial. Professionals are encouraged to learn more, and share knowledge.

Disclosure

L. Crosby: None.
P159 The potential impact of whole-body MRI on the rheumatologists’ disease activity assessment and treatment plan for patients with juvenile idiopathic arthritis
Authors: Choida Varvara , Tattersall Rachel S , Manson Jessica J , Sen Debajit , Ciurtin Coziana , Hall-Craggs Margaret A
Published: April 2022

Background/Aims

To assess the potential for whole-body MRI (WBMRI) to modify rheumatologists’ impression of disease activity and treatment management in adolescent patients with JIA.

Methods

Two rheumatology consultants experienced in managing people with JIA reviewed anonymised clinical data from an opportunistic sample of 30 patients with JIA (aged 15-24), not under their care. The cohort were clinically assessed by a senior rheumatology fellow before undergoing a research WBMRI scan, reported for musculoskeletal inflammation by a radiologist blinded to clinical information. The clinical findings and patient-reported outcomes recorded on that visit, alongside the patients’ present and past treatments, imaging and laboratory results were included in the clinical summaries examined by each rheumatologist. They then independently rated their impression of disease activity (See Table 1) and documented their resulting treatment recommendations per patient, in a two-stage approach. The first stage data analysis did not include the WBMRI reports. In stage two, the rheumatologists re-rated disease activity and treatment suggestions in light of WBMRI findings. The responses without and with the WBMRI findings were compared for each consultant and between them.

Results

Disease activity ratings were changed after reviewing the WBMRI reports in 16/30 and 17/30 patients by the rheumatologist A and B respectively. The activity category (‘active’ to ‘inactive’ or vice versa) changed in 7/16 and 4/17 cases, respectively. The certainty in the activity status increased for both rating clinicians (from ‘likely’ to ‘definitely’ in the same category or from ‘not sure’ to any other category) in 7/16 and 11/17 cases, respectively, whilst decreased for both in two cases. Disease activity assessments and treatment recommendations with and without WBMRI, are summarised in Table 1. Inter-rater agreement without and with WBMRI regarding disease activity (active/inactive) was 84.00% and 82.1% respectively, and regarding the intention to change treatment (yes/no) was 63.3% and 83.3%, respectively.

Conclusion

WBMRI scan findings changed the rheumatologists’ impression or level of certainty regarding disease activity in about half the patients and treatment plan in about one-third. Therefore, a larger study involving a greater number of rheumatologists across the country, should be considered to validate these results.

Disclosure

V. Choida: None. R.S. Tattersall: None. J.J. Manson: None. D. Sen: None. C. Ciurtin: None. M.A. Hall-Craggs: None.