bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions: a Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI)
Authors: Bulluck Heerajnarain , Paradies Valeria , Barbato Emanuele , Baumbach Andreas , Bøtker Hans Erik , Capodanno Davide , De Caterina Raffaele , Cavallini Claudio , Davidson Sean M , Feldman Dmitriy N , Ferdinandy Péter , Gili Sebastiano , Gyöngyösi Mariann , Kunadian Vijay , Ooi Sze-Yuan , Madonna Rosalinda , Marber Michael , Mehran Roxana , Ndrepepa Gjin , Perrino Cinzia , Schüpke Stefanie , Silvain Johanne , Sluijter Joost P G , Tarantini Giuseppe , Toth Gabor G , Van Laake Linda W , von Birgelen Clemens , Zeitouni Michel , Jaffe Allan S , Thygesen Kristian , Hausenloy Derek J
Published: April 2021

A substantial number of chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI) experience periprocedural myocardial injury or infarction. Accurate diagnosis of these PCI-related complications is required to guide further management given that their occurrence may be associated with increased risk of major adverse cardiac events (MACE). Due to lack of scientific data, the cut-off thresholds of post-PCI cardiac troponin (cTn) elevation used for defining periprocedural myocardial injury and infarction, have been selected based on expert consensus opinions, and their prognostic relevance remains unclear. In this Consensus Document from the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI), we recommend, whenever possible, the measurement of baseline (pre-PCI) cTn and post-PCI cTn values in all CCS patients undergoing PCI. We confirm the prognostic relevance of the post-PCI cTn elevation >5× 99th percentile URL threshold used to define type 4a myocardial infarction (MI). In the absence of periprocedural angiographic flow-limiting complications or electrocardiogram (ECG) and imaging evidence of new myocardial ischaemia, we propose the same post-PCI cTn cut-off threshold (>5× 99th percentile URL) be used to define prognostically relevant ‘major’ periprocedural myocardial injury. As both type 4a MI and major periprocedural myocardial injury are strong independent predictors of all-cause mortality at 1 year post-PCI, they may be used as quality metrics and surrogate endpoints for clinical trials. Further research is needed to evaluate treatment strategies for reducing the risk of major periprocedural myocardial injury, type 4a MI, and MACE in CCS patients undergoing PCI.
Lipocalins in Arthropod Chemical Communication
Authors: Zhu Jiao , Iannucci Alessio , Dani Francesca Romana , Knoll Wolfgang , Pelosi Paolo
Published: April 2021

Lipocalins represent one of the most successful superfamilies of proteins. Most of them are extracellular carriers for hydrophobic ligands across aqueous media, but other functions have been reported. They are present in most living organisms including bacteria. In animals they have been identified in mammals, molluscs, and arthropods; sequences have also been reported for plants. A subgroup of lipocalins, referred to as odorant-binding proteins (OBPs), mediate chemical communication in mammals by ferrying specific pheromones to the vomeronasal organ. So far, these proteins have not been reported as carriers of semiochemicals in other living organisms; instead chemical communication in arthropods is mediated by other protein families structurally unrelated to lipocalins. A search in the databases has revealed extensive duplication and differentiation of lipocalin genes in some species of insects, crustaceans, and chelicerates. Their large numbers, ranging from a handful to few dozens in the same species, their wide divergence, both within and between species, and their expression in chemosensory organs suggest that such expansion may have occurred under environmental pressure, thus supporting the hypothesis that lipocalins may be involved in chemical communication in arthropods.
Size-selective competition between cod and pelagic fisheries for prey
Authors: Kulatska Nataliia , Woods Pamela J , Elvarsson Bjarki Þór , Bartolino Valerio
Published: April 2021

Predators often predate on a limited size range of prey, which may or may not overlap with size ranges of same prey targeted by fisheries. When they do overlap, the effect of competition over that prey is immediate, as the predator removes prey, which are at the same time suitable for the fishery. However, if the predator consumes the same prey species as the fishery, but targets smaller prey sizes, this predation on smaller sizes may result in a potential loss of future, rather than current, fishing opportunities. Comparative analyses of predator size preference and fisheries selectivity are scarce, despite their relevance in the context of integrated management of fish populations. We evaluated how size-selective cod predation influences the dynamics of sprat and herring in the Baltic Sea, as well as the competition with pelagic fisheries through immediate and delayed effects. We found a large overlap (30–60%) between prey lengths targeted by cod and fisheries, which was largest in the 1970s–1980s,  when cod had higher abundance and was larger in size. Cod generally consumes herring and sprat, which are smaller than those caught by the fisheries, causing both immediate and delayed effects on prey biomass available for the fisheries.
The use of SNOMED CT, 2013-2020: a literature review
Authors: Chang Eunsuk , Mostafa Javed
Published: April 2021

Objective

This article reviews recent literature on the use of SNOMED CT as an extension of Lee et al’s 2014 review on the same topic. The Lee et al’s article covered literature published from 2001-2012, and the scope of this review was 2013-2020.

Materials and Methods

In line with Lee et al’s methods, we searched the PubMed and Embase databases and identified 1002 articles for review, including studies from January 2013 to September 2020. The retrieved articles were categorized and analyzed according to SNOMED CT focus categories (ie, indeterminate, theoretical, pre-development, implementation, and evaluation/commodity), usage categories (eg, illustrate terminology systems theory, prospective content coverage, used to classify or code in a study, retrieve or analyze patient data, etc.), medical domains, and countries.

Results

After applying inclusion and exclusion criteria, 622 articles were selected for final review. Compared to the papers published between 2001 and 2012, papers published between 2013 and 2020 revealed an increase in more mature usage of SNOMED CT, and the number of papers classified in the “implementation” and “evaluation/commodity” focus categories expanded. When analyzed by decade, papers in the “pre-development,” “implementation,” and “evaluation/commodity” categories were much more numerous in 2011-2020 than in 2001-2010, increasing from 169 to 293, 30 to 138, and 3 to 65, respectively.

Conclusion

Published papers in more mature usage categories have substantially increased since 2012. From 2013 to present, SNOMED CT has been increasingly implemented in more practical settings. Future research should concentrate on addressing whether SNOMED CT influences improvement in patient care.
Logistification and Hyper-Precarity at the Intersection of Migration and Pandemic Governance: Refugees in the Turkish Labour Market
Authors: Nimer Maissam , Rottmann Susan Beth
Published: April 2021

This article analyses the governance of migration and the Covid-19 pandemic on precarious Syrian refugees in Istanbul. Drawing from a review of state policies and interviews with refugees before and after the pandemic, we argue that the intersecting governance of migration and the pandemic compounded inequalities. While refugees initially lost their employment without notice in lockdown periods, their partial lifting revealed unequal expectations towards their labour, as they were reincorporated within even more hyper-precarious labour relations. Unlike citizens who were somewhat protected by the state, refugees were under the limited care of international funders and subject to the whims of the market. Pandemic governance resulted in increased hyper-precarity and the need to rely on individual coping mechanisms for refugees. This research shows how shifting inclusion and exclusion shapes refugees' hyper-precarity related to Covid-19 governance, transforming Syrians into ‘market buffers’ to prevent or delay bankruptcies.
Emission lines from X-ray illuminated accretion disc in black hole binaries
Authors: Mondal Santanu , Adhikari Tek P , Singh Chandra B
Published: April 2021

X-ray flux from the inner hot region around central compact object in a binary system illuminates the upper surface of an accretion disc and it behaves like a corona. This region can be photoionized by the illuminating radiation, and thus can emit different emission lines. We study those line spectra in black hole X-ray binaries for different accretion flow parameters including its geometry. The varying range of model parameters captures maximum possible observational features. We also put light on the routinely observed Fe-line emission properties based on different model parameters, ionization rate, and Fe abundances. We find that the Fe-line equivalent width WE decreases with increasing disc accretion rate and increases with the column density of the illuminated gas. Our estimated line properties are in agreement with observational signatures.
N-body simulations of dark matter with frequent self-interactions
Authors: Fischer Moritz S , Brüggen Marcus , Schmidt-Hoberg Kai , Dolag Klaus , Kahlhoefer Felix , Ragagnin Antonio , Robertson Andrew
Published: April 2021

Self-interacting dark matter (SIDM) models have the potential to solve the small-scale problems that arise in the cold dark matter paradigm. Simulations are a powerful tool for studying SIDM in the context of astrophysics, but it is numerically challenging to study differential cross-sections that favour small-angle scattering (as in light-mediator models). Here, we present a novel approach to model frequent scattering based on an effective drag force, which we have implemented into the N-body code gadget-3. In a range of test problems, we demonstrate that our implementation accurately models frequent scattering. Our implementation can be used to study differences between SIDM models that predict rare and frequent scattering. We simulate core formation in isolated dark matter haloes, as well as major mergers of galaxy clusters and find that SIDM models with rare and frequent interactions make different predictions. In particular, frequent interactions are able to produce larger offsets between the distribution of galaxies and dark matter in equal-mass mergers.
O10 Characteristics of patients who discontinued baricitinib treatment within 12 months and reasons for discontinuation: real-world data
Authors: Lwin May Nwe , Holroyd Christopher , Edwards Christopher J
Published: April 2021

Background/Aims 

Baricitinib is an oral targeted synthetic disease-modifying anti-rheumatic drug (tsDMARD) recommended by the National Institute for Health and Care Excellence (NICE) in the UK for severe rheumatoid arthritis (RA) either as mono- or combination therapy. We wanted to observe the frequency of discontinuation in a real-world setting, the characteristics of patients who stop taking baricitinib, and the reasons for discontinuation. Objective: To describe the characteristics of patients who discontinue baricitinib treatment and the reasons for discontinuation.

Methods 

A real-world retrospective observational study of baricitinib use in RA patients at University Hospital Southampton using local advanced therapy database for data collection. We described the characteristics of patients discontinuing baricitinib therapy and divided patients into two groups. Group 1 (those who discontinued therapy within the first 12 months of use) and group 2 (who continued therapy beyond 12 months)

Results 

From October 2017 to July 2020, a total of 83 patients started baricitinib and were recorded in the database, 55 (66.27%) remain on treatment to date. Among 28 (33.74%) patients who stopped baricitinib, 21 had stopped within 12 months. The reasons for discontinuation were lack of efficacy (64.28%) and AEs (28.57% - 1 tooth infection, 1 urinary tract infection, 1 discitis, 2 chest infection, 1 personality change, 1 deranged liver function and 1 lymphoma). In group 1, the mean (±SD) age was 49.00 (13.65) years, 66.67% were female and 85.71% were previously biologic inadequate responders (IR), 42.86% were receiving monotherapy, with 57.14% being on combination therapy with a csDMARD and 9.52% were using a glucocorticoid. In group 2, 82.26% were female, 61.52 (10.94) years of age and 83.87% were previously biologic IR, 41.94% were on monotherapy and 58.06% on combination therapy with a csDMARD. Patients who discontinued appeared more likely to be younger and male. However, there was no significant difference regarding mono- or combination therapy, disease duration or seropositivity (p-value > 0.05) (Table 1).

Conclusion 

In a real-world setting, baricitinib appears efficacious and well-tolerated in the first year of use by two-thirds of patients. Characteristics such as older age and female gender were associated with continued use.

Disclosure 

M. Lwin: None. C. Holroyd: Honoraria; Lily. Member of speakers’ bureau; Lily. C.J. Edwards: Honoraria; Abbvie, Biogen, BMS, Celgene, Fresenius, GSK, Janssen, Lilly, Mundipharma, Pfizer, Roche, Sanofi, UCB. Member of speakers’ bureau; Abbvie, Biogen, BMS, Celgene, Janssen, Lilly, Sanofi, Pfizer, Roche. Grants/research support; Abbvie, Biogen, Pfizer.
O14 Frequency and site of clinically unsuspected synovitis on whole-body MRI in juvenile idiopathic arthritis
Authors: Choida Varvara , Ciurtin Coziana , Bray Timothy J P , Sen Debajit , Fisher Corinne , Leandro Maria , Hall-Craggs Margaret A
Published: April 2021

Background/Aims 

Magnetic resonance imaging can facilitate the diagnosis of JIA, but is also increasingly used for monitoring disease activity in individual joints. This prospective study aims to measure the frequency of subclinical synovitis on whole-body MRI, in adolescent patients with JIA.

Methods 

JIA patients were recruited from a tertiary adolescent and young adult rheumatology clinic, between September 2019 and August 2020. All patients were examined by a senior rheumatology registrar, before undergoing a contrast enhanced whole-body MRI scan. Patients were assigned to a clinically active or inactive group, depending on their active joint count (AJC); active patients had AJC≥ 1, while the clinically inactive patients had an AJC =0. The post-contrast, water-only mDixon images were assessed for synovitis by one radiologist, blinded to clinical information. Only joints that were definitely abnormal were counted as synovitic. Eighty-one joints per patient were examined with both methods. The presence of subclinical synovitis in a patient was defined as synovitis in one or more joints on MRI, which were not active clinically.

Results 

Thirty-two patients aged 15 to 24 were included in the analysis. The patient characteristics and the frequency of subclinical synovitis are summarised in the table. Subclinical synovitis was detected in a similar proportion of JIA patients in both active and inactive groups (46.7% vs. 41.2%, P = 0.76). The most frequent region with subclinical synovitis was the hindfoot, detected in 22% (7/32) of JIA patients and 17.2% (11/64) of hindfoot joints assessed by MRI. The second most common joint with clinically unsuspected inflammation was the knee, found in 19% (6/32) of JIA patients and 14% (9/64) knee joints. Similarly, 16% (5/32) of the adolescent patients had active disease in the hip, ankle or midfoot joints. The frequency of elbow involvement was also considerable, with 12% (7/58) of joints with subclinical synovitis in 14% (4/29) of JIA patients.

Conclusion 

In conclusion, 43.8% of JIA patients had subclinical synovitis on whole-body MRI scan with no significant difference between the clinically active vs. inactive JIA patients. Large joints were predominantly affected. Further research is required to validate our findings in a larger cohort of JIA patients.

Disclosure 

V. Choida: None. C. Ciurtin: None. T.J.P. Bray: None. D. Sen: None. C. Fisher: None. M. Leandro: None. M.A. Hall-Craggs: None.
O28 'I’ve handed back my man card': experiences, coping styles, and support preferences of men with systemic sclerosis
Authors: Flurey Caroline A
Published: April 2021

Background/Aims 

Men with systemic sclerosis (SSc) have significantly reduced survival rates and report more severe disease than women. However, no previous psychosocial studies have focused solely on men with the condition. This study qualitatively explores experiences, coping strategies and support preferences of men with SSc.

Methods 

Seven focus groups in the UK and USA with men with systemic sclerosis to explore their experiences of SSc, coping mechanisms and ideas for effective support. Participants were purposively sampled to reflect a range of disease and demographic characteristics. Data were analysed using inductive thematic analysis.

Results 

25 male patients mean age 60years (SD: 9.3); disease duration 7years (SD 7.3); 77% diffuse cutaneous SSc; 70% Caucasian.

Four broad themes are proposed: “It’s a little embarrassing”: Erectile Dysfunction: Participants reported erectile dysfunction (ED) as an important symptom impacting quality of life, that felt ignored by clinicians (“I had to figure it out”). They reported needing prompting to feel comfortable discussing ED (“It’s important they ask the question first”). “You always think about how much this is going to shorten your life”: Mortality: Participants discussed the life-limiting nature of SSc (“I worry a lot about what’s happening on the inside”). They grieved for future events they may not be around for, and planned ahead for death (“I figured [my wife] better know how to do this”). “[My wife] makes more money than me”: Impact on masculinity: Loss of the breadwinner role impacted participants’ sense of self-worth (“I ask myself what am I here for?”). They were resigned to needing practical help, but found it hard to accept (“You know how hard it is to have your wife...put your underwear on?”) and often used humour as a shield (“I say ‘here, I turned in my man-card, open this for me’”). “I don’t harp on”: Social support: Participants reported not discussing SSc with their friends (“that’s my personal business”). Whilst they will discuss the practical impact with family, they often protected them from the emotional impact (“I wanna tell people...but I’ve gotta try and stay positive and focused for as long as I can because I’ve got [mum and wife] depending on me”.

Conclusion 

SSc impacts male patients’ masculine identity and roles. Some men withhold emotional impact from their family to maintain a protector role, which may limit their social support. Clinicians should be aware male patients report erectile dysfunction as an ignored symptom, and need prompting to feel comfortable discussing this.

Disclosure 

C.A. Flurey: None.
P002 Real-world experiences of biologic tapering
Authors: Rutter-locher Zoe , Man Yik Long , Marsh Lydia , Mercer Scott , Menon Bina , Cope Andrew
Published: April 2021

Background/Aims 

Biologic therapy and treat to target have significantly improved patient outcomes and we now have a proportion of patients on biologic therapy who remain in clinical remission. NICE guidance suggests “cautiously reducing drug doses or stopping drugs in those who have maintained the treatment target”. Despite this guidance, little is known about current clinical practice of biologic tapering in UK rheumatology centres. We aimed to illustrate current practice and success rates in biologic tapering in a real-world setting in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS).

Methods 

We identified patients who were potentially suitable for biologic tapering 1 week prior to their follow up appointment using the following criteria - any anti-TNFα biologic ≥ 1 year, RA patients (DAS28 CRP<3.2, CRP normal), PSA patients (no swollen joints, CRP normal, no extra-articular manifestations), AS patients (BASDAI<4, CRP normal). We then analysed how many patients were successfully tapered at one year. Tapering schedule was decided by the supervising rheumatologist.

Results 

From December 2018 to February 2019, 66 patients were identified as being suitable for biologic tapering. 3 patients did not attend and were excluded from further analysis. Tapered group: 20 (32%) patients were tapered. Based on the retrospective review of clinic letters, the “tapering schedule” was inconsistent and the information provided to patients if they flared was also inconsistent - 9 (45%) patients were advised to return to their normal dose and only 1 (5%) patient was advised to contact the helpline. After 12 months of follow up, 11 (55%) patients remained on the tapered dose, 7 (35%) patients returned to their prior dose and 2 (10%) patients were lost to follow up. Non-tapered group: 43 (68%) patients were not tapered. The reasons for not tapering were divided into 6 broad categories: active disease (n = 15, 35%), patient choice (n = 5, 12%), DMARD was tapered instead (n = 5, 12%), discuss at next visit (n = 3, 7%), reason not mentioned (n = 12, 28%), other (n = 3, 7%)

Conclusion 

This Quality Improvement Project has highlighted the inconsistencies in biologic tapering in a UK real-world setting. In response to this inconsistency, we have developed a departmental guideline which provides stringent criteria to identify patients at lowest risk of flaring and standardises a tapering schedule and clinical pathway. We also created a patient information leaflet that could be distributed. Only half of the patients remained on the tapered dose after 1 year, suggesting a significant proportion of patients flare following dose reduction. However, our findings may be limited by small sample size. National guidance and a thorough audit based on this guidance is welcomed.

Disclosure 

Z. Rutter-locher: None. Y. Long Man: None. L. Marsh: None. S. Mercer: None. B. Menon: None. A. Cope: None.
P005 Rheumatology virtual clinics during COVID-19: are our patients satisfied?
Authors: Altamimi Fajer A , Martin Una
Published: April 2021

Background/Aims 

Telemedicine can be broadly defined as the use of telecommunication technologies to provide medical information and services. It can be audio, visual, or text. Its use has increased dramatically during the COVID-19 pandemic to ensure patient and healthcare worker safety. Any healthcare professional can engage with it. It carries benefits like reduced stress and expense of traveling, maintenance of social distancing, and reduced risk of infection. There are some potential drawbacks such as lack of physical examination, liability and technological issues.

Methods 

A questionnaire was sent to 200 patients, selected from different virtual clinics (new and review, doctor and ANP led) run between March and May 2020 in the rheumatology department of University Hospital Waterford. We formulated 14 questions to cover the following aspects: demography, the purpose of the consult, punctuality, feedback, medico-legal concerns, and free text for comments. A self-addressed return envelope was included.

Results 

83 responses were received. 2 were excluded. The ratio of females to male respondents was 59: 41, with the majority over 60 years old. The main appointment type was review 67 (83%). 80% of patients were called either before or at the time of their scheduled appointment. The vast majority (98.8%) of our patients had confidence in our data protection and trusted our system to maintain their confidentiality. 95% stated that they felt comfortable, were given enough time to explain their health problem and felt free from stress. The respondents who preferred attending the clinic in person (17 in total) compared to the virtual were mostly follow up patients- 12 vs. 5 new.

Conclusion 

Patient satisfaction among those surveyed was high, despite having to introduce the service abruptly during the COVID-19 pandemic. There are many improvements we can adopt to improve our service and even maintain after the pandemic as a way of communicating with our stable patients. As we are covering a large geographical catchment, we can continue to implement the virtual clinic for some appointments. We should prioritize our efforts on identifying the right patient and the type of service we can offer, further training of staff, and increasing awareness of the patients as to how to get the most out of a virtual appointment.

Disclosure 

F.A. Altamimi: None. U. Martin: None. C. Sheehy: None.
P069 Results of an online survey exploring the effects of shielding during the COVID-19 pandemic on patients with spondyloarthritis (SpA)
Authors: Naja Meena , Amarnani Raj , Castelino Madhura
Published: April 2021

Background/Aims 

The COVID-19 pandemic has created many challenges for patients with chronic rheumatological diseases. SpA - which includes ankylosing spondylitis (AS), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and enteropathic arthritis - often affects young people who are otherwise fit and able. Many SpA patients take immunosuppressive medications and therefore were advised to shield. In view of this, we conducted a survey to better understand how shielding has affected the physical activity and symptoms of SpA patients during the pandemic.

Methods 

An online anonymised survey was created and advertised via social media from 4th June to 4th July 2020. Patients with SpA were invited to complete the survey which included 18 questions exploring the impact of the pandemic on their symptoms, physical activity levels and medication use.

Results 

There were 136 survey respondents, of whom 74.3% were female, with an age range from under 25 to over 75 years. The underlying diagnoses were PsA (60.5%), AS (28.4%), axSpA (10.5%) and enteropathic arthritis (0.8%). The majority (66.7%) of respondents were shielding; 44.1% were on disease modifying anti-rheumatic drugs (csDMARDs) and 56.6% were on biologics (bDMARDs). Most (94.1%) had continued their DMARDs throughout the shielding period. Non-steroidal anti-inflammatory drug (NSAID) use was reported to be increased in 18.6% of respondents, and unchanged in 69.0%. Compared to before the pandemic, 54.8% reported worsening joint stiffness and 45.6% reported worsening joint pain.

Most respondents (67.6%) reported reduced levels of physical activity, the commonest reasons being: shielding (54.6%); increased fatigue (45.8%); concerns around social distancing (45.4%); poor sleep quality (38.6%); working from home (28.6%) and low mood (28.6%). Only 14.7% had attended a virtual exercise class.

Conclusion 

Approximately 2 in 3 patients with SpA reported they were shielding during the first wave of the pandemic. Similar numbers of patients reported reduced physical activity levels and increased joint stiffness over this time. It is important to acknowledge that given the nature of the anonymised survey, we cannot be certain if the same patients who were shielding were the same as those who had reduced levels of physical activity or worsening symptoms. We have, however, shown that over half of the surveyed patients attributed their reduced physical activity levels to shielding. Taking into account that social restrictions (either self-imposed or government advised) are likely to be ongoing, we believe that a focus should be placed on supporting patients to maintain their activity levels, through initiatives such as specialist virtual exercise classes.

Disclosure 

M. Naja: None. R. Amarnani: None. M. Castelino: None.
P076 Adherence to COVID-19 risk stratification during the peak of pandemic: a District General Hospital experience
Authors: Azam Salma , Thompson Eils , Costello Natalie , Ahmed Ashar , Nune Arvind , Ahmed Hamza
Published: April 2021

Background/Aims 

During the peak of COVID-19 pandemic, there were growing concerns that rheumatology patients could have an increased risk of contracting coronavirus due to the immunosuppressive drugs that they were taking. British Society for Rheumatology (BSR) recommended in its risk stratification guide in March 2020 that vulnerable patients should be either shielded or isolated according to their level of risk. The purpose of this survey is to evaluate the compliance to the risk stratification advice among rheumatology patients in a single centre.

Methods 

Risk stratification guidance was sent out to 401 patients recommending either to shield or to isolate. Patients were contacted over the telephone between 14 September and 18 October 2020 to ensure they had received a postal letter with risk stratification advice. If received, it was checked whether they had followed the guidance. Responses received from all participants were analysed.

Results 

93% (373) of patients confirmed that they had received the guidance; however, 8 patients suggested they hadn’t received and we were unable to contact 16 patients, despite trying multiple times. Four patients died but they did not have confirmed coronavirus. 267 confirmed they were shielding and 83 were isolating, but 21 patients decided not to follow the guidance despite the recommendation and two patients stopped taking the drugs due to fear of contracting the coronavirus. Total 258 females and 143 males with the mean age 59. Most common diagnoses were rheumatoid arthritis (227), psoriatic arthritis (97) and axial spondyloarthritis (59). It was noted that out of 7 patients who had symptoms suggestive of COVID-19, only three patients were confirmed to have COVID-19 positive PCR test. Three most commonly used drugs were Benepali (128) followed by Amjevita (100), then Rituximab (56).

Conclusion 

Although uptake of postal communication was high in this study, it was difficult to establish how rapidly the guidance was delivered. We realise the need to employ better ways of communicating with the patients. Innovative ways such as text messaging and social media have an important role in the delivery of a rapid mass communication during the pandemic. It was reassuring to note that only a very small number of patients had COVID-19 among the patients who followed the government advice to either shield or isolate. But, it would be interesting to see whether the incidence of COVID-19 cases rise since rheumatology patients are no longer shielding.

Disclosure 

S. Azam: None. E. Thompson: None. N. Costello: None. A. Ahmed: None. A. Nune: None. H. Ahmed: None.
P087 Mortality trends from systemic lupus erythematosus in Cuba: 2001-2014
Authors: Negrín Halbert Hernández
Published: April 2021

Background/Aims 

There is little research on the mortality of Cuban patients with systemic lupus erythematosus (SLE), with not enough impact to recognize SLE as a health problem in the country. Our aim was to identify time trends and geographic variability in the mortality of Cuban patients with SLE.

Methods 

Mortality data of decedents over 15 years old were retrieved from the Cuban Ministry of Public Health mortality database, based on International Classification of Disease (ICD), Tenth Revision (ICD-10, code M32). We computed age-standardized mortality rate (ASMR) for each year and province as the estimated number of deaths per million inhabitants and its 95% confidence interval (95% CI) using World Health Organization reference population. The 2001-2014 time trends were analyzed using Jointpoint software.

Results 

Between 2001 and 2014, 1,054 deaths from SLE were found, mostly women (89.0%), white (54.4%) with a median age of 43 years (interquartile range: 34-53). In 2014 the ASMR caused by SLE per million inhabitants was 14.4 (95% CI: 10.9 to 18.4) in women and 1.3 (95% CI: 0.5 to 3.2) in men. A growing time trend was identified in the ASMR by SLE throughout the period (average annual percentage change [AAPC]: 1.6; 95% CI: 0.6 to 2.6), highest in males (AAPC: 5.6; 95% CI: 1.7 to 9.7) than in females (AAPC: 1.2; 95% CI: 0.3 to 2.0). The highest mortality in women was concentrated in the provinces of Camagüey, Las Tunas and Granma, and in the case of men, in Havana and Ciego de Ávila.

Conclusion 

The variation in the magnitude of the risk of dying from SLE over time and geographic areas indicates the possible influence of biological, environmental, socioeconomic and health systems factors. The growing trend in SLE mortality in Cuba demands its recognition as an important health problem and immediate actions that help mitigate it.

Disclosure 

H. Hernández Negrín: None.
P089 The cost of repeat ANA testing in north west London pathology services
Authors: Colquhoun Matthew , Mouyis Maria
Published: April 2021

Background/Aims 

The anti-nuclear antibody (ANA) test is commonly used to screen for autoimmune connective tissue (CTD) disease. It is a test that should be used judiciously and should only be requested if a patient presents with symptoms suggestive of a CTD and should not be used as a screening test for vague musculoskeletal symptoms. Recent studies have demonstrated that it is often repetitively requested in those patients both with a known positive and known negative ANA with little value in altering a diagnosis. With this information in mind, we sought to examine the frequency and associated cost of repeat ANA testing in hospital trusts served by North West London Pathology Services (NWL).

Methods 

The trusts included in the study were Imperial College Healthcare NHS Trust, Chelsea and Westminster Hospital Foundation Trust and Hillingdon Hospitals NHS Foundation Trust. Data was obtained regarding how many patients had repeat ANA testing in total between these trusts between 2017-2019. The data was obtained via a freedom of information request.

Results 

In total, there were 6,799 instances of repeated ANA testing in the same patient across three trusts over three years. This included one patient who had 16 ANA tests in a single year in 2017. The cost of an ANA test is £12.27. The total cost of repeat ANA testing in the three years across three trusts was £83,423.73 (£27,807.66 per year on average). Data is provided in tabular form and gives a breakdown of the number of repeat ANA tests per year and how many times the test was repeated in the same patient.

Conclusion 

The requesting of unnecessary tests can add to a hospital pathology workload and is associated with significant cost. It has been previously demonstrated in the literature that repeat ANA testing is of little value and rarely alters the diagnosis of a rheumatic disease. There is a large burden of repeated ANA testing in North West London Pathology Services and this is associated with significant expense. More judicious use of ANA testing can result in significant cost saving. This is the first study to specifically examine the cost of repeat ANA testing in the NHS.

Disclosure 

M. Colquhoun: Other; MC has received support to attend conferences from Pfizer. M. Mouyis: None.
P124 Are chronic pain syndromes associated with a unique cytokine profile? A systematic review and meta-analysis
Authors: O'Mahony Luke Furtado , Srivastava Arnav , Mehta Puja , Ciurtin Coziana
Published: April 2021

Background/Aims 

The aetiology of primary chronic pain syndromes (CPS) is highly disputed. One theory suggests that pain is due to a pro-inflammatory cytokine milieu leading to nociceptive activation. We performed a systematic review and meta-analysis aiming to assess differences in cytokines levels in CPS patients versus healthy controls (HC).

Methods 

Human studies published in English from PubMed, MEDLINE/Scopus and Cochrane databases were searched from inception up to January 2020. We included full text cross-sectional or longitudinal studies with cytokine measurements in CPS patients and HC. We excluded studies with underlying organic pathology. Quality assessment was completed using a modified version of the Newcastle-Ottawa Scale. Random-effects meta-analysis models were used to report pooled effects and 95% CIs. Study registered with PROSPERO (CRD42020193774).

Results 

Initial search yielded 324 papers, 36 studies (3229 participants) eligible for systematic review and 26 studies (2048 participants) suitable for metaanalysis. There were reproducible findings supporting trends of cytokine levels comparing CPS patients with HC. Eotaxin (chemokine) however was consistently raised in CPS. Meta-analysis showed significantly increased tumour necrosis factor (TNF) (SMD=0.39, p = 0.0009, %95I=0.16-0.63, p < 0.001; I2=70%, Q2 p < 0.001), interleukin (IL)-6 (SMD=0.15, 8 (SMD=0.26, p = 0.01, 95%CI =0.05-0.47; I2=61%, Q2 p = 0.005) and IL-10 (SMD=0.61; %95 = 0.34-0.89, p < 0.001; I2 = 10%, Q2 p = 0.34) in CPS compared to HC.

Conclusion 

We found significant differences in peripheral blood cytokine profiles of CPS patients compared to HC. However, the distinctive profile associated with CPS includes both pro-inflammatory (TNF-α, IL-6, IL-8), and anti-inflammatory cytokines (IL-10) in pooled analysis, as well as chemokine (eotaxin) signatures.

Disclosure 

L. Furtado O'Mahony: None. A. Srivastava: None. P. Mehta: None. C. Ciurtin: None.
P137 Epidemiological study of influenza vaccination and RA
Authors: Juber Nirmin , Wannasri Arnat , Do Tam Minh , Chen Hsin-Jen , Chuang Yi-Fang , Liu Jason J
Published: April 2021

Background/Aims 

Rheumatoid arthritis (RA) has been known as an autoimmune and inflammatory disease. Previous studies found individuals with RA had a two-fold increased risk of infections compared to general population. For infectious disease as influenza, vaccination may confer protection. However, whether or not influenza vaccination is safe to be given to genetically predisposed individuals with RA still on debate since there is an evidence that influenza vaccine as inflammatory stimulus could induce RA.

Methods 

This study aims to provide an up-to-date epidemiological evidence between influenza vaccination and RA among American adults from 18 years old.

Methods 

With case-control study design using 2014 Full year consolidated data in Medical Expenditure Panel Survey (MEPS), the association between influenza vaccination and RA among adult 18 years old and above were assessed using logistic regression analysis adjusted for potential covariates (age, sex, comorbidity, body mass index (BMI), education, smoking status, and insurance status) to estimate odds ratio (OR).

Results 

In the crude model, individuals who reported receiving influenza vaccine were 2.02 (95% CI: 0.97-4.22) times more likely to develop RA, although the association were not significant. In the full adjusted model, the magnitude of association was decreased to 0.25 (95% CI: 0.06-1.05), but the significance was still not reached.

Conclusion 

Analysing a comprehensive and large-scale population-based survey dataset (MEPS 2014) with adjustment for potential confounders suggested that receiving influenza vaccine did not increase the risk of RA and we have no evidence to suggest that influenza vaccination is not safe to be given to genetically predisposed individuals with RA. Further studies with more complete confounders, such as physical activity level and nutrition intake are strongly recommended.

Disclosure 

N. Juber: None. A. Wannasri: None. T. Do: None.
P138 Developing a digital remote assessment for monitoring rheumatoid arthritis disease activity
Authors: Donadoni Francesca , Gionfrida Letizia , Clarke Benjamin , Galloway James
Published: April 2021

Background/Aims 

In an era of increasingly stretched health care resources, accompanied by pressures to deliver more care for people with long term conditions remotely, we need innovative solutions to measure disease activity. In the case of monitoring rheumatoid arthritis (RA), a robust method of capturing reliable Disease Activity Score (DAS-28) information remotely could reduce patient visits to hospitals and free up clinic space. Information would ideally be captured from a home setting by a patient. However, self-reporting of DAS-28 has limited reliability especially at moderate or high levels of disease activity. A mechanism for remotely ascertaining DAS-28 which is both accurate and precise would improve remote management for people living with RA.

Methods 

We undertook a study to assess patient attitudes regarding a novel remote RA monitoring platform, which uses images and video captured movements to estimate DAS-28. The study involved a semi-structured 30-minutes video interview. Participants were adults with RA living in the UK. The interviews focused on these key areas: i) an overview of their history with the condition, ii) familiarity with DAS-28, iii) relationship with the clinical team, iv) relationship with technology and telemedicine, v) feedback on the RA monitoring platform.

Results 

Eleven subjects participated in the study. They reported a median disease duration of 11 years (range: 4 to 35), and all had experienced flares, with 10/11 familiar with the DAS-28 prior to the study interview. Since the start of the COVID-19 pandemic, most patients only had contact with clinicians or healthcare facilities over the phone, with only one patient having visited a hospital for a reason not directly related to RA, and one patient having no contact at all. Overall, patients expressed enthusiasm towards the RA monitoring platform and were confident that they would be able to use it at home. Access over the Internet was not perceived as a barrier, and the advantages of tracking disease progression regularly, sharing data with the consultant and saving time travelling to appointments far outweighed the disadvantages. Participants generally reported that they would most benefit from a blended interaction with the clinical team, combining face-to-face appointments with use of the platform at home rather than seeing the platform as a complete alternative to face-to-face assessment.

Conclusion 

This study provides the first insight into the perception and acceptance of the RA monitoring platform in a small sample of RA patients. Results are positive, and support further evaluation of the platform. Evidence to understand how technology can improve the quality of telemedicine for people with RA is urgently needed as the pandemic continues.

Disclosure 

F. Donadoni: None. L. Gionfrida: None. B. Clarke: None. J. Galloway: None.
P153 Characteristics of anti-melanoma differentiation-associated gene 5 positive dermatomyositis in Singapore
Authors: Low Jia Zhen , Chua Choon Guan , Lim Wei-Yen , Koh Li Wearn , Manghani Mona
Published: April 2021

Background/Aims 

Anti-melanoma differentiation-associated gene 5 (MDA5) Ab positive associated dermatomyositis (DM) patients with rapidly progressive-interstitial lung disease (RP-ILD) have poor survival rates. The aim of this study was to determine the various characteristics in Singaporean patients with anti-MDA5-Ab associated DM.

Methods 

A chart review was undertaken of 84 DM patients with positive myositis specific antibodies, diagnosed between January 2015 to July 2019, at a major tertiary centre in Singapore. All had confirmed probable or definite DM according to the Bohan and Peter criteria, and only those with an International Myositis Classification Criteria score of at least 55% (probable idiopathic inflammatory DM) were included.

Results 

18 out of 84 were anti-MDA5-Ab positive (See Table 1 for summary).

Features more common in the anti-MDA5 Ab positive vs. the anti-MDA5 Ab negative cohort included: inverse Gottron’s papules (27.8% vs. 3%, p = 0.001) palmar papules (27.8% vs. 0%, p < 0.001), violaceous rash (55.6% vs. 16.7%, p = 0.001), cutaneous ulcers (66.7% vs. 6.1%, p = <0.001), clinically amyopathic DM (50% vs. 22.7%, p = 0.023) and polyarthritis (38.9% vs. 12.1%, p = 0.0009).

The anti-MDA5 Ab positive cohort had a lower median creatine kinase (IU/L) versus the anti-MDA5 Ab negative cohort; 328 [60-3254] vs. 1318 [61-36776], (p = 0.0027). ILD was more common in the anti MDA5 Ab positive vs. anti-MDA5 Ab negative cohort (61.1% vs. 34.8%; p = 0.044). Of these anti-MDA5 Ab positive with ILD, 45.5% had RP-ILD, 27.3% had either chronic ILD or asymptomatic ILD respectively. In contrast, only 17.4% had RP-ILD in the anti-MDA5 Ab negative cohort. The mortality rate in the anti-MDA5 Ab positive vs. negative cohort was higher (33.3% vs. 24.2%). Patients with both Ro-52 and MDA5 Ab positivity had a higher incidence of cutaneous ulcers, pneumothorax, ILD and mortality. Of those anti-MDA5-Ab positive cases that survived, treatment included either rituximab and/or tofacitinib.

Conclusion 

In our population, anti-MDA5 Abs associated DM is a distinct clinical subset of DM and associated with increased mortality. Better recognition of these distinct clinical features will enable early diagnosis, risk stratification and aggressive treatment to improve survival.

Disclosure 

J. Low: None. C. Chua: None. W. Lim: None. L. Koh: None. M. Manghani: None.
P159 Factors associated between SLE and work amongst South Asian people: an explorative qualitative study
Authors: Ubhi Mandeep , Dubey Shirish , Reynolds John , Gordon Caroline , Adizie Tochukwu , Sheeran Tom , Allen Kerry , Jordan Rachel , Sadhra Steven , Adams Jo , Daji Rashmika , Kumar Kanta
Published: April 2021

Background/Aims 

Systemic lupus erythematosus (SLE) affect patients from minority ethnic backgrounds, with many patients experiencing symptoms that affect their daily lives despite receiving long-term controller medication. Work is a large part of most people’s lives, yet little has been explored into how people from minority ethnic backgrounds cope at work whilst living with SLE. We conducted a study to understand the impact of SLE on working lives of South Asian patients. The aim was to identify and develop support mechanisms that could assist them with remaining at work.

Methods 

Semi-structured interviews were conducted with ten patients of South Asian origin with SLE to explore their work experiences. Patients were recruited from three rheumatology centres in the West Midlands, UK and were interviewed between November 2019 and March 2020. Interviews were audio-recorded and typed by an independent transcribing company. Returned transcripts were analysed using thematic analysis and QSR NVivo 12 software was used to organise and manage the data.

Results 

The majority (n = 8) of patients were female. Eight patients were from an Indian background, and two were from a Pakistani background. Half of all patients were educated to degree level. The age range of patients was 23 - 58 years old (S.D = 10.79), and disease duration varied between 3 months-33 years (S.D = 9.52). All patients had permanent jobs; six were in full-time employment, and four were in part-time employment. Four main themes emerged from the data: 1) Disease related factors; impacting work ability; 2) Employment related factors; impacting work ability; 3) Personal and cultural related factors; impacting work ability; 4) Recommendations for improvement were made by patients.

Conclusion 

In this novel study we highlight patients’ experiences of being at work. This study reports low awareness of SLE and mixed support in the workplace. Patients discussed work to varying degrees with their clinicians and needed further information for employers that was not available nor provided by their clinicians. The study reports cultural barriers in understanding SLE that could lead to lack of family support to remain in employment. Moreover, recommendations made in this study require further investigation and could be used by clinicians and Lupus UK to support patients of South Asian origin at work.

Disclosure 

M. Ubhi: None. S. Dubey: None. J. Reynolds: None. C. Gordon: None. T. Adizie: None. T. Sheeran: None. K. Allen: None. R. Jordan: None. S. Sadhra: None. J. Adams: None. R. Daji: None. K. Kumar: None.