bluuebunny/crossref_metadata_2025 huggingface dataset:
P86 Evaluation of a 10-week progressive resistance training programme for people with inflammatory arthritis
Authors: Skeates Jade , Pearson Jennifer , Derham Sandi , Palmer Shea
Published: April 2020

Background

Inflammatory arthritis [IA] has adverse effects on strength, function, fatigue and well-being. Guidelines recommend people with IA should exercise to improve strength and cardiovascular fitness. In 2015, our Rheumatology Physiotherapy Team introduced an evidence-based Progressive Resistance Training Programme [PRTP] for people with IA. This research aimed to evaluate its effectiveness within a United Kingdom National Health Service [NHS] setting.

Methods

A pre- to post-treatment evaluation was conducted. People with IA attending Rheumatology Physiotherapy were offered the supervised PRTP (1-hour x 10 weeks), performing 7 resistance exercises each session (70-80% 1RM, 3 x 8-12 reps). Pre- and post-treatment outcomes included Health Assessment Questionnaire [HAQ], EQ5D-5L, Self-Efficacy (SARAH Trial), 30 second Sit-to-Stand [STS], FACIT-F (fatigue scale) and Grip Strength. Changes in outcomes were analysed using Paired Samples t-tests and standardised mean difference (SMD) were calculated.

Results

201 patients commenced the programme between May 2015 and April 2019, with 121 participants completing it. Diagnoses included Rheumatoid Arthritis (n = 149), Psoriatic Arthritis (n = 42), Juvenile Idiopathic Arthritis (n = 5), Enteropathic IA (n = 2), Oligoarthritis (n = 1), Reactive Arthritis (n = 1) and Undifferentiated IA (n = 1). Age = mean 56.8 ± SD 14.8 years; number of sessions attended = 7.7 ± 3.4. There were no differences between participants not completing (n = 54; 72% women; age 55.0 ± 14.6 years; HAQ 0.99 ± 0.70) versus those completing the PRTP (n = 147; 78% women; age 57.5 ± 14.8 years; HAQ 0.86 ± 0.65). A pragmatic decision was made to analyse all available data for each outcome.

Conclusion

All outcome measures demonstrated statistically significant improvements. Notably, minimal clinically important differences were achieved in STS and FACIT-F. STS correlates to lower limb power, balance and endurance, and is a predictor of falls. Fatigue significantly impacts function in people with IA, often limiting confidence and willingness to participate in exercise activities. Effective evidence based PRTPs for people with IAs can be delivered in an NHS service. Improvements in function, wellbeing, self-efficacy, strength and fatigue are achievable, however, exploration of the clinical relevance of these observed changes is recommended. Further research exploring patients’ perspectives of the PRTP and adherence to long-term exercise is needed.

Disclosures

J. Skeates: None. J. Pearson: None. S. Derham: None. S. Palmer: None.
P108 Awareness of musculoskeletal disorders and its health impact among civil servants in Malaysia: a cross-sectional survey
Authors: Ariff Hairul Hadi , Shahril Nor Shuhaila , Eow Liu Hing , Musa Wan Rosmaiza Wan , Rajalingam Shamala , Jeffrizal Malek Faris Riza Feisal , Ramlan Azwarina Hanim , Selvadurai Shantene , Ang Diana Lee Min , Suahilai Dayang Masyrinartie , Isa Liza Mohd
Published: April 2020

Background

Work-related musculoskeletal disorders have been perceived as one of the reasons of declining work productivity in relation to absenteeism, sick leave or early retirement. We have determined the prevalence of musculoskeletal symptoms among current working civil servants and have assessed the health impact of musculoskeletal disorders towards them or other people surrounding them.

Methods

Participants were given a self-administered questionnaire consisting of demographic data, experience of musculoskeletal disorders, perceptions, knowledge and attitudes towards musculoskeletal disorders. Out of 174 participants, 147 returned completed forms (response rate: 84.5%). Data were analysed using SPSS Statistics v22.

Results

The average age of the respondents with standard deviation was 39.9 ± 9.82 years and a majority were female (78.2%). Mean body mass index between the participants were 26.36 ± 5.26, normal to obese range. Most of the participants described their type of job as active in nature (51.7%) with a majority working 5-8 hours per day. Mean duration for years of working in service were 16.20 ± 9.53. Half of them had musculoskeletal pain within the last 3 months prior to the study date, with highest frequency over the knee joint (29.9%) followed by lower back (21.8%) and shoulder area (21.1%). From the multivariate logistic regression analyses, only 2 factors in the knowledge section showed statistical associations regarding questions asking whether the participants knew what arthritis was (p = 0.005), and if they experienced arthritis themselves (p = 0.002). We found that there were no significant associations between the race, education level, marital status, type of work, duration of work or body mass index (BMI) with the prevalence of musculoskeletal pain within the participants.

Conclusion

The majority of respondents had knee pain followed by lower back pain and shoulder pain. Although there is strong correlation between knowledge of arthritis among participants, majority of them cannot specify the type of arthritis correctly. As such, continuous health education and promotion of the programme is vital.

Disclosures

H. Ariff None. N. Shahril None. L. Eow None. W. Wan Musa None. S. Rajalingam None. M. Jeffrizal None. A. Ramlan None. S. Selvadurai None. D. Ang None. D. Suahilai None. L. Mohd Isa None.
P109 Influenza vaccine uptake
Authors: Noureldin Basil , Erb Nicola
Published: April 2020

Background

Patients on immunosuppressive csDMARDs and bDMARDs for inflammatory and autoimmune conditions are more susceptible to infection. Viral infection in these patients is associated with an increased likelihood of severe outcomes such as bacterial pneumonia, hospitalisation and death. The influenza vaccine is a simple and effective measure to protect patients from seasonal flu. Traditionally uptake has been patchy in rheumatology patients for unclear reasons.

Methods

Aim: To assess the uptake of the influenza vaccine amongst at risk patients in a secondary care rheumatology department and investigate the factors that may affect uptake.

Methodology: This is a cross sectional retrospective study with a sample size of 200. Patients were invited to complete a paper survey when they attended their outpatient rheumatology clinic in May/June 2019 about the previous winter 2018/19 influenza season. Chi square tests were used to determine whether age, educational level and ethnicity had an impact on vaccine uptake.

Results

5% of the population were aged between 18 - 30, 21% between 31 - 50, 48% between 51 - 70, 25% between 71-90 and 1% were above 90. 56% attained secondary school level education, 13% completed college/A levels,18% had completed university,12% completed vocational education and only 1% attained primary school level alone. Most of the patients were Caucasian (93%) with only a small percentage of different ethnic groups represented in the sample. 62% of the patients were on DMARD treatment. Of those who were on DMARD treatment, 78% were vaccinated against influenza in the last season. 55% of those not on DMARD treatments were vaccinated. Chi square tests showed a significant relationship between age and vaccine uptake with older patients more likely to have the vaccine(p < 0.001). The tests also showed that higher education levels were associated with higher vaccine uptake(p < 0.02). Those on DMARDs were also significantly more likely to be vaccinated than those not on DMARDs (p < 0.001). The sample sizes in the different ethnic groups weren’t big enough to assess the effect of ethnicity on uptake. The top three reasons given by patients for not having the vaccine were that they didn’t feel it was necessary, worrying that they’d get sick afterwards and not finding the time to have it done.

Conclusion

Age, education level and being on DMARD treatment had an impact on influenza vaccine uptake. Further patient education on the importance and benefits of the influenza vaccine needs to be provided to patients to improve vaccination rates in at risk individuals. Influenza vaccine should be discussed with all patients at routine follow up visits, appropriate educational provided and general practitioners alerted to the need to place immunosuppressed rheumatology patients on call up schemes for influenza vaccination

Disclosures

B. Noureldin None. N. Erb None.
P117 Rituximab for IgG4-related disease: the Newcastle experience
Authors: Rayner Fiona , Griffiths Bridget , Nayar Manu , Oppong Kofi , Vila Josephine
Published: April 2020

Background

IgG4-related disease (IgG4-RD) is a multisystem immune mediated fibro-inflammatory condition characterised by the three histopathologic features of IgG4-RD lymphoplasmacytic infiltration, storiform fibrosis and obliterative phlebitis. The condition can be indolent with few symptoms or present with organ or life-threatening disease. First-line treatment with high dose corticosteroids is often effective, however when tapering steroids, the disease can relapse, and second line agents such as methotrexate (MTX), azathioprine (AZA) or mycophenolate (MMF) are not always effective or tolerated. In 2016, following evidence from observational studies, NHS England approved the use of rituximab (RTX) in refractory IgG4-RD according to strict criteria. In our unit we have used rituximab, with or without cyclophosphamide induction, in eight patients with IgG4-RD. Our aim was to assess effectiveness of rituximab treatment and adherence to NHS England guidelines.

Methods

Using our connective tissue disease database, patients with IgG4-RD were identified and their electronic notes were reviewed. Outcome after rituximab treatment was assessed by the evaluation of clinical and radiological responses.

Results

Between August 2017 and September 2019, 15 patients with IgG4-RD were seen in the rheumatology service. 8 patients went on to receive rituximab therapy, 4 with IV cyclophosphamide (CYP). 5/8 patients had head and neck disease and 3/8 had abdominal disease (pancreas, retroperitoneal, renal). By comparison, those patients that did not receive rituximab had a preponderance of abdominal disease (4/7 had abdominal disease, 2/7 head and neck, 1/7 breast). 8/8 patients receiving rituximab were discussed in a designated MDT and met NHS diagnostic guidelines. MDT treatment decisions were made based on ‘refractory’ or ‘organ critical’ disease criteria. In all patients, with available post treatment imaging, radiological response was demonstrated. In one case, imaging showed improvement in some areas and progression in other areas and response was described as ‘partial’.

Conclusion

In the patients treated to date in our unit, rituximab has been shown to be an effective treatment for IgG4-RD. Cyclophosphamide induction has been used in a subset of patients. Patients with head and neck disease were more likely to require escalation to rituximab therapy, compared with those with abdominal disease.

Disclosures

F. Rayner None. B. Griffiths None. M. Nayar None. K. Oppong None. J. Vila None.
P119 Characteristics and treatment of fibrosclerosing orbital inflammatory disease
Authors: Thanopoulou Vasiliki , Weller Alexander , Nigar Ezra , Marais Joseph , Lee Vickie , Marjanovic Branka , Ahmed Abdul , Balasundaram Indran , Hamdulay Shahir
Published: April 2020

Background

Orbital inflammatory disease (OID) encompasses a group of disorders which affect the orbit and neighbouring areas. Several multi-system inflammatory diseases including small vessel vascuilitides, Sarcoidosis and IgG4 disease can manifest as an OID. Treatment generally includes steroid therapy in combination with conventional immunosuppressant’s, cyclophosphamide or rituximab. Herewith we describe a series of non-vasculitic, fibroinflammatory OID.

Methods

We retrospectively reviewed records of 5 patients referred to rheumatology with inflammatory OID after malignancy, infection and Graves’ ophthalmopathy were excluded. General demographics, histology, MRI and treatment responses were reviewed.

Results

Patients were generally female (4:1) and of a young age (range 33-54). Proptosis and diplopia were the key symptoms with occasional sino-nasal symptoms. Inflammatory markers on presentation were marginally raised (CRP mean 11, ESR mean 37). All patients were negative for autoantibodies and had normal serum IgG4 levels. MRI showed fibrotic mass lesions in all cases with bone erosion/ destruction in 2 cases. Biopsy showed fibrosclerosis mixed with chronic inflammatory cells. 3 cases stained positive for IgG4 cells but only one of them achieved diagnostic levels (case 3). All patients were initially treated with high dose steroids (prednisolone 1mg/kg or IV methylprednisolone (MP)) with either methotrexate or cyclophosphamide (1g EUVAS protocol). Highly resistant cases were treated with rituximab (total 2g). There was a good clinical response to treatment in all cases but in 4 patients residual fibrosis persisted on follow-up MRI (Table 1).

Conclusion

We describe a series of fibrosclerosing OID with histology like IgG4 disease, but with normal serum IgG4 levels and negative tissue immunofluorescence (IF) in some cases. Most cases will respond well to steroids and second-line therapy, but residual fibrosis may persist with mild clinical sequelae. Early recognition and intensive therapy may minimise fibrotic complications.

Disclosures

V. Thanopoulou None. A. Weller None. E. Nigar None. J. Marais None. V. Lee None. B. Marjanovic None. A. Ahmed None. I. Balasundaram None. S. Hamdulay None.
P129 Adolescent knee pain and risk of knee osteoarthritis 50 years later
Authors: Clynes Michael A , Laskou Faidra , Edwards Mark H , Cooper Cyrus , Taylor Angela , Stokes Maria , Dennison Elaine M
Published: April 2020

Background

Adolescent knee pain is a common complaint which may be due to patellar dislocation, meniscal tear, Osgood-Schlatter’s disease or patellofemoral maltracking. We studied the association of such pain with knee osteoarthritis (OA) 50 years later using a retrospective cohort design.

Methods

This study was based in the Hertfordshire Cohort Study, a cohort of men and women born in 1931 - 9. Participants completed a questionnaire detailing recall of adolescent knee pain, self-reported OA, demographics, lifestyle and The Western Ontario and McMaster Universities Arthritis Index (WOMAC). Clinical OA was defined based on the American College of Rheumatology (ACR) criteria and assessed at a clinical visit where knee radiographs were also taken and graded according to the methods of Kellgren and Lawrence.

Results

Completed data were available for 135 men and 139 women. The mean age was 78.8 (SD 2.6) years and the mean (SD) BMI was 26.3 (4.0). Two percent of men (n = 3) and 5% of women (n = 7) reported adolescent knee pain, of which 2 men and 3 women sought medical advice for their knee pain. 1 man and 2 women reported that their pain had been constant since teenage years while 2 men and 4 women reported that it was intermittent in nature. A report of adolescent knee pain was associated with an increased risk of clinical (odds ratio (OR) 5.45, p-value 0.015, 95% confidence interval (CI) 1.39 - 21.36); radiological (OR 2.33, p-value 0.228, 95% CI 0.60 - 9.24) and self-report (OR 2.71, p-value 0.134, 95% CI 0.74 - 10.0) of knee OA in later life. After adjustments for age, sex and BMI, adolescent knee pain was associated with an increased risk of clinical (OR 4.80, p-value 0.047, 95% CI 1.02 - 22.53); radiological (OR 1.85, p-value 0.404, 95% CI 0.44 - 7.78); self-report (OR 3.23, p-value 0.10, 95% CI 0.80 - 12.94) although relationships were only significant for clinical knee OA.

Conclusion

Recalled adolescent knee pain was associated with a clinical diagnosis of knee OA in later life. The lack of association with self-report of OA suggests that this is not simply a consequence of recall bias and exploration in other data sets is now indicated.

Disclosures

M.A. Clynes: None. F. Laskou: None. M.H. Edwards: None. C. Cooper: None. A. Taylor: None. M. Stokes: None. E.M. Dennison: None.
P164 Can non-invasive techniques be used to image calcinosis?
Authors: Moore Tonia L , Marjanovic Elizabeth , Manning Joanne B , Dinsdale Graham , Wilkinson Sarah , Dickinson Mark R , Herrick Ariane L , Murray Andrea K
Published: April 2020

Background

A significant proportion of patients with systemic sclerosis (SSc, 20-40%) will develop subcutaneous calcinotic deposits which are painful and can perforate the skin, causing ulceration. The underlying aetiology is unknown and there is currently no effective treatment. Diagnosis is often made with plain radiography, which is not ideal for long-term monitoring. Identifying non-invasive techniques which do not involve ionising radiation will improve our understanding of calcinosis and how to monitor this over time, facilitating the development of potential treatments. The aim of this study was to assess several non-invasive imaging techniques to measure oxygenation (multispectral imaging), perfusion (thermography [a pseudo measure of perfusion] and laser speckle imaging) and size and depth (high frequency ultrasound) of the calcinoses. The hypothesis of the study was that there would be relationships between oxygenation, perfusion and calcinosis size and depth.

Methods

Twenty-one patients with SSc (all female, median age 63 (IQR 55 to 70) years; disease duration since onset of first non-Raynaud’s feature 14 (9 to 23) years, Raynaud’s phenomenon duration 23 (12- 36) years; underwent imaging of calcinosis. Measurements of oxygenation, perfusion and vessel size and depth were performed at the site of calcinosis and adjacent skin.

Results

There was no difference in oxygenation at the site of calcinosis vs adjacent median 0.15 (IQR 0.07 to 0.22) vs. 0.16 (0.00 to 0.21) arbitrary units respectively; non-significant. There was a trend for skin temperature (perfusion) to be lower at the site of the calcinosis compared to the adjacent area (calcinosis, 31.4 (28.4 to 35.6) vs adjacent 32.8 (28.4 to 35.7) oC; p = 0.052. Perfusion as measured by speckle imaging was significantly reduced 107.3 [60.3 to 213.4] vs 312.1 [107.8 to 432.2] arbitrary perfusion units; p < 0.01. The mean depth of the calcinoses was 1.5 (1.11 to 2.07) cm and mean lesion area was 3.06 (2.33 to 4.62) cm2. No relationships were identified between perfusion, oxygenation or calcinosis depth and area.

Conclusion

Perfusion is reduced at the calcinotic sites, as measured by laser speckle imaging and also (although not significantly) as measured indirectly by thermography. That perfusion was decreased in the area of the calcinosis versus the adjacent skin may be due to the pressure on the skin leading to ischaemia, or it may be that calcinosis develops in areas which are under-perfused. This study has demonstrated the feasibility of imaging calcinosis properties. The ability to measure the depth and subcutaneous area with high frequency ultrasound may provide a useful outcome measure of treatment efficacy.

Disclosures

T.L. Moore None. E. Marjanovic None. J.B. Manning None. G. Dinsdale None. S. Wilkinson None. M.R. Dickinson None. A.L. Herrick None. A.K. Murray None.
P171 Factors determining sleep quality in SLE
Authors: Magro Rosalie , Camilleri Liberato , Borg Andrew A
Published: April 2020

Background

Poor sleep quality is common in systemic lupus erythematosus (SLE) and could contribute to fatigue, which is regarded as one of the most disabling symptoms in SLE. The Pittsburgh sleep quality index (PSQI) is a validated self-administered questionnaire that measures sleep quality over the previous month. The aim of this study was to analyse the relationship of sleep quality, measured by PSQI, with several variables including depression, anxiety, pain, disease activity, fatigue and functional disability in patients with SLE. A further aim was to establish the prevalence of poor sleep quality in SLE.

Methods

A cohort cross-sectional study was carried out including 92 SLE patients who fulfilled the SLICC classification criteria for SLE and who provided informed consent for participation. The patients were interviewed, and they were asked to fill in questionnaires including PSQI, Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS) for pain and modified Health Assessment Questionnaire (mHAQ). Blood and urine tests enabled the calculation of SLE disease activity index-2K (SLEDAI-2K). The study was approved by the University Research Ethics Committee.

Results

92.4% of the cohort studied were females, and the mean age was 46.9 years (range 19-79 years). 55.4% were noted to have poor quality sleep (PSQI >5), and the median PSQI was 6 (range 0-18). Sleep quality measured by PSQI, had a significant correlation with SLEDAI-2K (R = 0.254, p = 0.014), VAS pain (R = 0.515, p < 0.001), HADS-D (R = 0.605, p < 0.001), HADS-A (R = 0.375, p < 0.001), estimated glomerular filtration rate (eGFR) (R=-0.211, p = 0.044), FSS (R = 0.551, p < 0.001) and mHAQ (R = 0.559, p < 0.001). ANCOVA analysis showed that PSQI was significantly dependant on VAS pain (p < 0.001), HADS-D (p < 0.001) and eGFR (p = 0.003).

Conclusion

Poor sleep quality is highly prevalent in SLE patients. This study has shown that the strongest predictive factors for poor sleep quality are pain, depression and impaired renal function. Since poor sleep quality is significantly related to fatigue and functional disability, its identification and management is important for patients’ wellbeing.

Disclosures

R. Magro None. L. Camilleri None. A.A. Borg None.
P187 Not a headache clinic: giant cell arteritis fast track pathways (GCA-FTP) need not be overwhelming
Authors: Spray Luke , Reynolds Gary , Houghton Karolyn , Hargreaves Ben , Heaney Jonathon , Thompson Ben , Lorenzi Alice
Published: April 2020

Background

False positive and negative GCA diagnoses lead to significant morbidity. GCA Fast Track Pathways (GCA-FTP) are advocated in the NHS. Concern that these become ‘headache clinics’, lack of access to temporal artery ultrasound (TAUS) and biopsy (TAB) are cited as barriers to provision. We present prospectively collected data from referrals to our GCA-FTP demonstrating that this has not occurred in our service.

Methods

Rheumatology leads our GCA-FTP providing initial investigation, TAUS for all patients and long-term management when GCA is diagnosed. Ophthalmology is the point of access for patients with visual symptoms and, if required, TAB.

Results

Referral numbers for calendar years 2014 through 2018 were 70, 97, 134, 180 & 175 respectively. TAB was requested for 29, 43, 49, 57 and 41 patients and GCA diagnosed in 29, 34, 33, 43 & 40 patients per year. In 2017-18, TAUS without biopsy supported a diagnosis of GCA in 58 and excluded it in 199. Across 2017 and 2018 we received 356 referrals: 43.5% from ophthalmology, 34.3% primary care and 11.0% medicine. 59.3% were on corticosteroids. Mean age was 71 years, 73.3% were female. GCA was diagnosed in 83 (23.3%). Mean duration of symptoms at first review was 38 ±4.4 days in GCA patients and 58 ±6.4 days in non-GCA patients. Characteristic GCA clinical features were significantly higher in the GCA group (Table 1). Non-GCA final diagnoses were ophthalmic (NIAON) (13.8%) and musculoskeletal related (12.2%). 7.0% of patients received a primary headache diagnosis. In 41.4% no cause was recorded, and patients were discharged to their GP with corticosteroids stopped.

Conclusion

A GCA-FTP can be a predictable service to manage. Clinical review by an experienced doctor distinguishes many non-GCA presentations from GCA when seen promptly. Most patients with GCA will be seen by rheumatology during their disease course. Distinguishing non-GCA diagnoses at later time points is significantly more challenging and means patients are exposed unnecessarily to high dose steroid, often for many months. TAUS and TAB are useful adjuncts to diagnosis and required for use of high tariff drugs. Lack of access need not however mean deferring setting up a GCA-FTP.

Disclosures

L. Spray None. G. Reynolds None. K. Houghton None. B. Hargreaves None. J. Heaney None. B. Thompson None. A. Lorenzi None.
P188 Tocilizumab for giant cell arteritis: real world experience in a single UK centre
Authors: Reynolds Gary , Griffiths Bridget , Houghton Karolyn , Thompson Ben , Lorenzi Alice R , Heaney Jonathan
Published: April 2020

Background

Tocilizumab was approved for the treatment of giant cell arteritis (GCA) by NICE in April 2018. This decision followed the GiACTA (Giant Cell Arteritis Actemra) study, a randomised control trial that demonstrated a beneficial effect of tocilizumab in reducing the frequency of disease flare and overall prednisolone requirements. However, as noted in the NICE appraisal, the extent to which the patient population in the GiACTA study reflects the population it is eventually used for in UK clinical practice is not clear. To address this, we analysed the records of all patients started on tocilizumab treatment for GCA in a single centre since its approval.

Methods

We performed a retrospective analysis of the clinical records of all patients started on tocilizumab for GCA at the Freeman Hospital in Newcastle. All patients are discussed in a regional connective tissue disease MDT prior to the initiation of therapy to ensure they fulfil NICE guidelines. At each subsequent visit adverse events related to both tocilizumab and corticosteroids and any flares of GCA or ischaemic events are recorded.

Results

In total 14 patients started tocilizumab since June 2018, with a cumulative exposure of 8 patient-years. The mean age was 74 years, slightly older than the average age in the GiACTA trial (69 years). In contrast to GiACTA where 48% of patients were newly diagnosed, all our patients had established disease. In our cohort 36% of patients had CT PET evidence of large vessel vasculitis, similar to the rate in GiACTA (40%) but higher than the national average of around 5%. Incidence of visual loss in our treated patients was higher at 29% than recorded in the general GCA population in the DC-VAS study (7.9%). In those treated for relapsing disease around half (56%) had recorded previous significant adverse events with steroids, including heart failure, hypertension and mood changes. Five patients had infections requiring antibiotics (cellulitis/ulcer in three, chest infection in one, urinary tract infections in two), with two serious infections requiring hospital admission (both urinary tract infections). No patients had further ischaemic events while on treatment. All patients were on a lower dose of prednisolone following treatment with an average of a 63% reduction in steroid dose.

Conclusion

The modest number of patients receiving tocilizumab for GCA suggests we are not treating everyone at first relapse. The higher rates of large vessel vasculitis, visual loss and previous steroid-induced complications suggest a preference for saving tocilizumab for a more severely affected subset of patients. In this preliminary data there were reassuringly no recorded ischaemic events following treatment and steroid doses were successfully reduced in all patients.

Disclosures

G. Reynolds None. B. Griffiths None. K. Houghton None. B. Thompson None. A.R. Lorenzi None. J. Heaney None.
P203 Oral glucocorticoid use is associated with hypertension in patients with RA
Authors: Costello Ruth E , Jani Meghna , Yimer Belay B , Dixon William G
Published: April 2020

Background

Oral glucocorticoids (GC) are frequently prescribed to patients with rheumatoid arthritis (RA), however GC use is associated with several potential side effects. Hypertension is cited as a possible side effect, but few studies have specifically investigated GC-associated hypertension in patients with RA with conflicting results. The aim of this study was to determine whether GCs were associated with an increased risk of incident hypertension in a cohort of patients with RA.

Methods

A retrospective cohort of patients with incident RA and no hypertension at RA diagnosis were identified from UK primary care electronic health records (Clinical Practice Research Datalink). GC prescriptions were used to determine time-varying GC use and dose, categorised as: no use, >0-4.9 mg/day, 5-7.4 mg/day, 7.5-14.9 mg/day, ≥15mg/day. A 3-month risk attribution model was used where patients continued to remain at risk for 3 months after the end of prescriptions. Hypertension was identified if a patient had either: 1) 2 consecutive systolic blood pressure (BP) measurements >140mmHg within a year, 2) 2 consecutive diastolic BP measurements >90mmHg within a year or 3) antihypertensive prescriptions on at least two occasions and a Read code for hypertension. Unadjusted and adjusted Cox proportional hazards (PH) regression models were fitted to determine if there was an association between GC use and hypertension.

Results

There were 17,760 patients with incident RA and no hypertension. The cohort had a mean age of 56.3 ± 12.7 years and were predominantly female (68%). 7,421 (42%) were prescribed GCs during follow-up. There were 6,243 cases of incident hypertension. The Cox PH model indicated that recent GC use was associated with a 17% increased hazard of hypertension (hazard ratio: 1.17 (95% CI 1.10 to 1.24)). When categorised by dose, only doses above 7.5mg were significantly associated with hypertension (Table 1).

Conclusion

In this large cohort of patients with RA and without hypertension, recent GC use was associated with incident hypertension. Doses ≥7.5mg were associated with hypertension while the association with lower doses was inconclusive. Clinicians need to consider cardiovascular risk when prescribing GCs and ensure BP is regularly monitored.

Disclosures

R.E. Costello None. M. Jani None. B.B. Yimer None. W.G. Dixon None.
P232 Effectiveness of adalimumab biosimilar switching: real world data from a London rheumatology centre
Authors: Vigneswaran Shivanee , Galloway Megan , Hanlon Samuel , Tynan Aoife , Singh Animesh
Published: April 2020

Background

Biologic drugs have revolutionised the management of many rheumatological diseases with remission or low disease activity now the realistic targets for treatment. However, given the chronic nature of most rheumatological disease and the need for long term treatment, there has been a significant increase in the cost associated with disease treatment. The advent of biosimilars offers an attractive target in reducing drug costs for payers. Biosimilar medications are thought to be equally efficacious as originator drugs. Real world data in adalimumab biosimilar switching is limited. In this audit we aim to examine the real-world outcomes from switching from originator Humira to biosimilar Amgevita in a London teaching hospital.

Methods

A list of all adult rheumatology patients on Amgevita was obtained through pharmacy records. All patients had been switched from Humira to Amgevita from February 2019. Using clinic letters and an in-house biologics database, data was collected on the underlying disease and the date of switch. Outcomes reviewed were disease activity scores pre and post switch, documented side effects and flare of disease activity following switch including decision to revert to originator Humira or change treatment.

Results

There was a total of 289 adult patients on Humira who switched to Amgevita. Of these patients, 28 in total discontinued treatment - 13 with rheumatoid arthritis, 10 with psoriatic arthritis and 5 with ankylosing spondylitis. 22 had to be switched back to Humira, with a further 4 patients approved to switchback and awaiting to restart. Two additional patients were switched to alternative biologic therapy due to inefficacy. A further 3 patients refused to switch onto Amgevita. Sixteen patients had documented flares, with one requiring admission and ten requiring local or systemic corticosteroid therapy to control activity. Seven patients had documented side effects which included chest pain, headache, rash and site reactions and one patient developed shingles post switch.

Conclusion

A total of 9.6% of patients switched to Amgevita had disease flare or side effects resulting in a switchback to Humira or alternative biologic therapy. For a biosimilar to be approved, efficacy and safety profiles needs to be comparable to the originator biological therapy and usually looks at two treatment naïve groups, rather than direct switch. Thereby, data on switches in therapy is limited. One systematic review looking at 11,053 patients with inflammatory arthritis treated with Etanercept and switched to Benepali, found 768 reverting to original therapy giving a lower total of 6.9%. We find that although no previous data of Amgevita, our figure of 9.6% appears high in the context of previously controlled inflammatory disease with Humira.

Disclosures

S. Vigneswaran None. M. Galloway None. S. Hanlon None. A. Tynan None. A. Singh None.
P245 Relationship between symptoms and imaging in axSpA
Authors: Taylor Jodie , Gullick Nicola
Published: April 2020

Background

Axial spondyloarthritis (axSpA) is an inflammatory condition affecting the axial skeleton, which includes the sacroiliac joints (SIJ) and the spine. Common symptoms include back pain which often radiates to the hip/buttocks and morning stiffness that is relieved by exercise. Treatment includes physiotherapy, non-steroidal anti-inflammatories (NSAIDs) or in severe cases with biologic agents. In the UK, patients can access biologics if they are unresponsive to NSAIDs and BASDAI is > 4.

Methods

Patients under care of a rheumatologist with a diagnosis of axSpA, with an MRI of the axial skeleton, CRP or ESR and BASDAI within 3 months of imaging were included in the study. MRIs (T1 and STIR) of the spine and sacroiliac joints were scored using the ASspiMRI-a (Berlin modified) and SPARCC SIJ methods. Data from a total of between 35-53 patients was used for the project, depending on available data for the scoring method. Due to incomplete data sets for spinal MRIs, the scoring was sub-grouped as follows: - BerlinC2: C2/3 to L5/S1 VU (maximum score 69) - BerlinT1: T1/2 to L5/S1 VU (maximum score 51) - BerlinT10: T10/11 to L5/S1 VU (maximum score 24) Kendall’s tau-b correlation coefficient was used for statistical analysis. The p value of significance was also corrected using the Bonferroni adjustment to 0.00192 due to multiple statistical analysis.

Results

The median and interquartile ranges for each of the scoring methods were relatively low in relation to the maximum possible score. These were 5(11) for SPARCC, 5(5.5) for BerlinC2, 4.5(8) for BerlinT1 and 3(3) for BerlinT10. The ranges for the collected scores were also low compared to the maximum possible score for each method. These were 0-45 for SPARCC (maximum 72), 0-23 for BerlinC2 (maximum 69), 0-18 for BerlinT1 (maximum 51) and 0-8 for BerlinT10 (maximum 23). A total of 26 correlations were evaluated from 10 variables. These variables were the SPARCC, BerlinC2, BerlinT1, BerlinT10, BerlinC2 + SPARCC, BerlinT1 + SPARCC, BerlinT10 + SPARCC, CRP, ESR. and BASDAI. None of the correlations were significant.

Conclusion

There was no significant correlation between BASDAI and inflammation as assessed by imaging in axial spondyloarthropathy. The subjectivity of the items of the BASDAI may contribute to this finding and as such, should be a point for further research to assess the suitability of the BASDAI in evaluating disease activity and response to treatment in axial spondyloarthropathy.

Disclosures

J. Taylor None. N. Gullick None.
P246 Predicting non-response to biologic therapy amongst patients with axSpA: results from the British Society for Rheumatology Biologics Register
Authors: Dean Linda E , Pathan Ejaz , Jones Gareth T , Macfarlane Gary J
Published: April 2020

Background

Biologic therapies have transformed treatment for axial spondyloarthritis (axSpA). However, although studies report overall benefits, these are average effects. There remains a subset of patients in whom response is not achieved. Here, we aimed to identify characteristics of patients who may need additional therapeutic approaches to optimise outcome.

Methods

The British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS) is a prospective cohort of axSpA patients recruited from 83 centres across Great Britain. All patients were biologic-naïve at recruitment, however those in the “biologic” cohort commenced a biologic therapy shortly thereafter, or during follow-up. Clinical data was collected from medical records, and socio-economic/patient reported outcomes via questionnaires. Response was assessed at first follow-up, between 10 weeks and 9 months from therapy commencement, and defined in four ways: ASAS20 and ASAS40 criteria, ≥1.1 reduction in ASDAS, and achieving moderate/inactive ASDAS (<2.1). Factors associated with non-response were assessed by logistic regression and parsimonious models identified using stepwise methods. The ability to predict non-response was assessed by positive predictive value (PPV).

Results

335 biologic participants provided information at a median follow-up of 14 weeks (inter-quartile range (IQR) 12-17). Median age was 47 years (IQR 36-56), 69% were male and 61% met AS modified New York criteria. The proportion meeting response varied by criteria: ASAS20 52%, ASAS40 33%, ASDAS reduction 47% and ASDAS <2.1 35%. Socio-economic circumstances predicted non-response, specifically (in all models) work status and (in some models) fewer years of education (Table 1). Poorer mental health and high number of co-morbidities was associated with non-response across multiple (but not all) outcomes, while body mass index, enthesitis and gender were included in models for a single outcome. Disease-specific factors were largely not associated with non-response. All models demonstrated a good level of fit and were effective at predicting non-response (PPV 65%-77%).

Conclusion

We have identified factors which predict non-response to biologic therapy, some of which may be modifiable and others which identify patients who are unlikely to benefit from biologic therapy alone. In such patients additional/alternative treatment strategies should be considered to maximise the benefits which others gain from biologic therapy.

Disclosures

L.E. Dean None. E. Pathan Other; E.P. has recieved salary funding from Jansen (2019) and Merck (2018). G.T. Jones None. G.J. Macfarlane None.
P251 Pattern of mortality for patients with axSpA: a retrospective UK database analysis
Authors: Morgan Christopher L. I , White Abigail , Tomlinson Mark , Scott Amie , Tian Haijun
Published: April 2020

Background

This study characterises mortality for patients with axial spondyloarthritis (axSpA) and compares mortality rates with a matched, non-axSpA population.

Methods

The Clinical Practice Research Datalink, a large routine primary care database in the UK, was used to conduct this study. Patients with an incident diagnosis of axSpA from 2003-2017 were identified and matched to non-axSpA patients according to age, sex, primary care practice and concurrent practice registration. The date of first axSpA diagnosis defined the index date, and patients were followed up until death or censored at the end of follow up. Crude mortality rates were calculated and time to death from index date was analysed using the Kaplan-Meier estimator. For patients from primary care practices linked to the Office of National Statistics (ONS), cause-specific unadjusted rate ratios are presented. Two adjusted Cox proportional hazard models were conducted: 1) to assess relative mortality between axSpA patients and non-axSpA controls; and 2) to assess disease-specific factors associated with mortality for the axSpA population only. Only patients whose record could be potentially linked to ONS mortality data were included in the cause of death analysis.

Results

4,136 incident axSpA cases were identified and matched to non-axSpA controls. Crude mortality rates were 18.9 and 11.5 per 1,000 patient-years, respectively. The most common causes of death in the axSpA cohort were coronary heart disease, cerebrovascular disease and malignant neoplasm of the bronchus and lung (Table 1). For all-cause mortality, there was a significantly increased hazard ratio (HR) of 1.531 (95% confidence interval [CI] 1.291-1.816; P < 0.001) for axSpA vs non-axSpA patients. Age (HR 1.083 [95% CI: 1.074-1.093]; P < 0.001), history of infection (HR 1.358 [95% CI: 1.082-1.705]; P = 0.008), Charlson Comorbidity Index (HR 1.194 [95% CI: 1.137-1.253]; P < 0.001) and current smoker status (HR 1.853 [95% CI: 1.396-2.461]; P < 0.001) were all significantly associated with time to death.

Conclusion

In this study, we have shown that the presence of axSpA is associated with increased mortality compared with controls. Prior infection, comorbidity and current smoker status were associated with the greatest increased risk of mortality in patients with axSpA.

Disclosures

C.L.I. Morgan: Other; Employee of: Pharmatelligence. A. White: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. M. Tomlinson: Consultancies; Novartis. A. Scott: Consultancies; Novartis. H. Tian: Other; Employee of: Novartis.
P256 Reproductive health outcomes in women with PsA
Authors: Murray Kieran , Moore Louise , Young Francis , McAulliffe Fionnuala , Veale Douglas J
Published: April 2020

Background

There is quality data showing rheumatoid arthritis (RA) improves in pregnancy and flares postpartum and that active disease is associated with adverse foetal outcomes. For psoriatic arthritis (PsA), the data is less clear, with previous studies giving contrasting results. We prospectively monitored disease control, maternal and foetal outcomes in women with PsA attending our multidisciplinary service.

Methods

Age, medications, disease control, maternal and foetal outcomes were reviewed and descripitive statistics applied.

Results

14 patients were reviewed. 12 became pregnant. There were 20 pregnancies in total. Eight patients had 1 pregnancy. Two patients had 3 pregnancies, 1 patient was pregnant twice and 1 patient had 4 pregnancies and is currently pregnant. Two patients failed to become pregnant.

There were 13 live births (one set of twins), 7 vaginal deliveries and 5 Caesarean sections. There were 6 intrauterine deaths (4 1st trimester, 2 2nd trimester). Two patients had postpartum complications (grade 4 vaginal tear and Caesarean wound infection). Mean foetal birth weight was 3.54kg (national average 3.49kg). 8 infants (55%) were breastfeeding at 6 weeks (national average 62%). 14 patients were on a DMARD (including oral steroids) in pregnancy. There were 8 pregnancies on a bDMARD alone, one on a bDMARD plus prednisolone. The bDMARDs used were certolizumab (five times), adalimumab (twice), infliximab (once) and etanercept (once). Two patients were on prednisolone alone. One patient on sulfasalazine plus prednisolone. One pregnancy on sulfasalazine plus hydroxychloroquine, 1 on sulfasalazine alone. Two patients were on NSAIDs. Disease activity was measured using DAS28-CRP 3 as this is validated for use in RA during pregnancy. Overall, the mean disease activity scores decreased during pregnancy and increased postpartum. After applying the European League Against Rheumatism-defined response criteria disease activity, almost half of the women had at least a moderate response during pregnancy and more than one-third had at least a moderate flare post partum, particularly at 6 weeks. The postpartum flare may be underestimated as medication use was remarkably increased after delivery. At 6 weeks, in five cases the bDMARD therapies had already been restarted. In two cases, the patients missed this appointment. One patient was started on methotrexate at their 6-week review.

Conclusion

Disease activity generally improved during pregnancy and flared postpartum. Miscarriage rates were higher than the general population (32% v 20%). Birth weights and breastfeeding rates at six weeks were similar.

Disclosures

K. Murray None. L. Moore None. F. Young None. F. McAulliffe None. D. Veale None.
P258 Real-world secukinumab retention, response rates and adverse events in the treatment of PsA and axSpA
Authors: Tindell Alistair , Batool Saira , McGucken Andrew , Siebert Stefan
Published: April 2020

Background

Secukinumab, an IL-17A inhibitor, has been licensed for use in the United Kingdom for both axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) for several years. Despite this there is minimal published data on its use out with randomised controlled trials. We present here the collated real-world rheumatology experience of secukinumab use in Glasgow.

Methods

Patients who have ever received secukinumab for any rheumatology indication were identified using available medical records (from 14/05/2012 to 18/09/2019). Diagnosis, baseline demographics, disease activity at baseline and at 6 months, and whether patients are still currently on secukinumab was recorded. Primary inefficacy was defined as stopping treatment due to inefficacy ≤6 months. Reasons for discontinuation were also recorded. As disease activity scores were variably recorded, the primary outcome was retention rate as a surrogate for efficacy and lack of adverse event. Patients only included in disease scores if scores available both at baseline and 6 months.

Results

352 patients (with 530 patient-years of exposure) identified. 251 (71.3%) patients currently remain on secukinumab. 301 of 336 (89.6%) patients remained on drug at six-month review (16 await review). Characteristics and response of two main diagnostic groups listed in Table 1 (Note: 3 patients had SAPHO, 5 had Juvenile Idiopathic Arthritis, 1 had reactive arthritis). Common adverse events were infections (11 patients), rash and/or pruritis (6 patients), mood change and/or fatigue (4 patients). Three patients developed inflammatory bowel disease (IBD) subsequent to starting secukinumab. Five patients had pre-existing IBD, none of which flared on secukinumab. Two patients required hospitalisation for abscesses whilst on secukinumab. One patient had a stroke and one patient had a myocardial infarction whilst on secukinumab - both patients had multiple risk factors for cardiovascular disease. No malignancies identified. Three patients died, with none felt related to secukinumab (cerebellar haemorrhage in warfarinised patient with high INR; pneumonia six months after switching from secukinumab to tocilizumab; one out of hospital death over one year after stopping secukinumab).

Conclusion

In this real world cohort of patients with axSpA and PsA, secukinumab retention rates at 6 months are high with no new safety signals identified.

Disclosures

A. Tindell None. S. Batool None. A. McGucken None. S. Siebert Consultancies; S.S. has received speaker or consultation fees or honoraria from AbbVie, UCB, Janssen, Boehringer Ingelheim, Novartis, Celgene. Honoraria: S.S. has received speaker or consultation fees or honoraria from AbbVie, UCB, Janssen, Boehringer Ingelheim, Novartis, Celgene. Grants/research support; S.S has received funding for research/ grants from Pfizer, Janssen, BMS, Celgene, UCB, Boehringer Ingelheim, Novartis, GSK.