bluuebunny/crossref_metadata_2025 huggingface dataset:
P042 The impacts of rheumatic diseases in the workplace and employment
Authors: Beesley Richard P , Beesley Rebecca M , Middleton Kate , McBride Andrea
Published: April 2024

Background/Aims

Patients with rheumatic and musculoskeletal conditions report a range of impacts on their personal life, family, education and employment. Whilst reasonable adjustments are required in law to provide sufficient support to people with chronic health conditions, these are not always forthcoming or adequate to mitigate the impacts of disease on employment.

This collaborative study between three patient organisations explored the impact of disease on employment in a UK population.

Methods

Adults in the UK aged 18+ who had any diagnosis of a musculoskeletal or rheumatic condition were invited to complete an online survey. Respondents provided information about their diagnosis, experiences and attitudes across a range of themes and topics, including work and employment.

Results

In total, 532 respondents completed the survey (64% female; 68% White ethnicity). Overall, 371 (77%) reported that their arthritis affected them at work or in their daily duties and responsibilities, with a higher proportion of females experiencing this (82% compared to 65% of males, p<.001). The majority reported fatigue (75%) and impacts on their ability to do household chores (63%), and around a third had their choice of job limited (33%) or have had to reduce their working hours (30%) due to their arthritis, and 29% found their arthritis has not been recognised in employment. Overall, 16% reported their employer was not supportive when they needed to attend medical appointments, and 53% had found their arthritis affected them financially through having to reduce their hours at work, taking unpaid time off, paying to travel to appointments, paying for their prescriptions, or other reasons.

Conclusion

Arthritis brings a substantial burden to patients, including in their access to, and experiences of, the workplace. Whilst many patients have developed their own ways to circumvent the barriers they experience (such as choosing employment that is more accessible to them, reducing hours, or changing roles), these choices can impact them financially. Increased awareness of the impacts, and improved understanding, amongst employers, coupled with better support for patients to access employment and for employers to access support and guidance, may help reduce barriers and improve experiences for patients with arthritis.

Disclosure

R.P. Beesley: None. R.M. Beesley: None. K. Middleton: None. A. McBride: None.
P068 The Use of Virtual Reality Headsets instead of Entonox for Paediatric Patients undergoing Steroid Joint Injections or Venepuncture / Cannulation
Authors: Lee Helen C , Leach Samantha , Hawley Daniel , Barker Nicki
Published: April 2024

Background/Aims

Entonox has traditionally been used for patients with Juvenile idiopathic arthritis (JIA) who require intra-articular joint injections (IAIs). However, Entonox is now the third most misused drug especially in school age children and young people (CYP). Entonox also has an environmental impact. In addition, Entonox has side-effects including euphoria, disorientation, nausea and vomiting. Recently there has been increased awareness of the risks of Vitamin B deficiency associated with prolonged Entonox use which can lead to neurological toxicity. These factors have led us to consider virtual reality (VR) devices as an alternative for patients requiring IAIs. The VR headset we used is a class one medical device that can provide both reduction in anxiety levels and pain relief in patients needing anxiety-provoking or painful procedures such as IAIs. Aims: To trial the use of VR devices in a Paediatric Rheumatology Service and to assess effectiveness in reducing anxiety and pain when used during IAIs and cannulation / venepuncture.

Methods

A pragmatic pilot study of VR headset use was carried out from November 2022 until September 2023. All CYP undergoing IAIs without GA were offered either Entonox sedation or VR headset distraction. Each CYP using the VR headset was asked to score anxiety and pain levels before and after the procedure using a Likert scale. Patient demographics were also collected (age and gender).

Results

A total of 42 patients attended for IAI’s during the study window between the ages of 7 and 16. Thirty-three opted to use the VR headset. Nine opted for Entonox. An additional 22 patients opted to use the VR headset for venepuncture / cannulation. The 64 users of the VR headset reported an average 47.8% reduction in anxiety and a 0.8% reduction in pain.

Conclusion

The study demonstrated that the use of a VR headset reduces anxiety in CYP having painful procedures. A minimal reduction in pain however was reported. This may be due to some patients having low pre procedural pain scores. The terms of the headset loan limited the questions that could be set for data collection. It has therefore not been possible to separate results from children who underwent IAIs or venepuncture / cannulation. We also did not collect comparative scores from the Children and young people who chose to use Entonox. Funding has now been secured for the VR headset and we are carrying out a prospective evaluation, including feedback from patients and staff, into the role of VR devices in managing situations involving procedural anxiety.

Disclosure

H.C. Lee: None. S. Leach: None. D. Hawley: None. N. Barker: None.
P069 Moving more with Axial Spondyloarthritis - a short survey to help design future exercise studies
Authors: Roberts Matthew , Qooja Sepehr , Moorthy Arumugam , Bishop Lettie
Published: April 2024

Background/Aims

Axial Spondyloarthritis (AxSpA) is an inflammatory arthritis affecting 0.5-1.0% of people in the UK. Physical activity guidance for people living with AxSpA from the National Institute for Health and Care Excellence is vague. Individualised, structured aerobic exercise is recommended without any direction towards exercise type, frequency, intensity, or acknowledgement of physical limitations to an individual’s environment which may prevent exercise participation. Consequently, the proportion of people with AxSpA meeting the World Health Organisation physical activity recommendations (>150 minutes of moderate-intensity exercise per week) is significantly lower than the general population. Therefore, a short survey was administered to people with AxSpA to understand types of physical activities they would like to participate in, and any common barriers to exercise participation.

Methods

The National Axial Spondyloarthritis Society (NASS) invited subscribers to their e-newsletter with lived experience to complete a short online survey. Respondents were asked ‘which of the following activities would you like to include as part of your usual lifestyle?’ ‘What would prevent you from taking part in the activities above?’ and ‘Do you already include any of the physical activities in your usual lifestyle?’ Respondents were allowed to choose multiple options from a range of activities and barriers.

Results

266 people living with AxSpA (68% women, 31% men, 1% non-binary, 94% white British/Irish) responded. Walking was most selected for activities respondents would like to be included as part of their lifestyle (83%), followed by stretching/flexibility exercises (61%), swimming (46%), weight training and resistance exercise (41%), and cycling (33%). Only eight respondents (3%) stated hydrotherapy which is traditionally advocated as exercise therapy in AxSpA. Worries about pain and flare ups (57%), fatigue (45%), time (39%), cost (27%), not knowing enough about how much activity to do (22%), and lack of available facilities (20%) were common barriers.

Conclusion

To maximise reach and benefit, exercise guidance needs to relate to exercise that people with AxSpA would like to or already do; the benefits of exercise can only be realised if people want to participate. The responses emphasise the need for guidance relating to inclusive models of exercise. This includes exercise such as walking that is flexible and adaptable to limitations of time and does not require additional cost, equipment, or facilities. The results also highlight the importance of including outcome assessments of pain, flare frequency, and fatigue.

Disclosure

M. Roberts: None. S. Qooja: None. A. Moorthy: Consultancies; AM has received speaker fees from Lilly, Novartis, Galapagos, and UCB. L. Bishop: Grants/research support; NCB has received funding from NASS..
P070 Rheum to Empower: Home Spirometry and Oximetry Monitoring in Connective Tissue Related Interstitial Lung Disease
Authors: Ng Wan Lin , Howard Donough , Durcan Laura , Hurley Killian
Published: April 2024

Background/Aims

Interstitial lung disease (ILD) is a common cause of morbidity and mortality in connective tissue diseases (CTDs). Distinct challenges arise for individuals with impairments from rheumatic diseases, especially when coupled with respiratory symptoms. While home spirometry monitoring is valuable for patients with idiopathic pulmonary fibrosis (IPF), its applicability in CTD related ILD (CTD-ILD) is relatively unexplored. This study examines the feasibility and acceptability of home spirometry and oximetry monitoring in CTD-ILD patients compared with those with IPF.

Methods

Patients with CTD-ILD and IPF were recruited prospectively in a tertiary hospital. A portable handheld spirometer (MIR Spirobank Smart) and a Nonin finger oximeter linked to a smartphone app were provided, and patients were educated on its use. Spirometry and oximetry results were collated. At six months, a survey was conducted to assess patients’ perception of home monitoring.

Results

Fourty-one patients with CTD-ILD and 51 with IPF were recruited. The median ages were 66 and 71 years respectively (Table 1). 2946 FVC and 2787 oximetry readings were captured in the CTD-ILD cohort compared with 4984 FVC and 4778 oximetry readings in the IPF cohort. Among the 41 patients, 12 experienced Raynaud’s phenomenon. Only 7.32% (3/41) of CTD-ILD patients required an ear oximeter due to inaccurate oxygen saturation measurement caused by Raynaud’s phenomenon. Among the CTD-ILD cohort, 16.67% (6/36) experienced difficulty using the devices due to hand problems, while none of the IPF cohort encountered such issues. In the survey, patients reported barriers to long-term remote monitoring usage included forgetting to use, coughing or breathlessness. Less than one-third of patients indicated that spirometry and oximetry results contributed to health anxiety. A majority of patients found home monitoring useful and insightful, and would recommend this to others.

Conclusion

Our findings suggest the practicality of remotely monitoring FVC and oximetry in CTD-ILD patients, even with challenges like Raynaud’s phenomenon and impaired hand function. This not only underscores feasibility but also empowers patients through continuous monitoring despite physical limitations. Incorporating remote monitoring into standard care should be regarded as an essential approach for this understudied population, enhancing both clinical management and patient empowerment.

Disclosure

W. Ng: Grants/research support; StAR MD Scholarship, ISR Rheumatology Patient Initiative Fund. D. Howard: None. L. Durcan: None. K. Hurley: Grants/research support; Health Research Board, Ireland, Emerging Clinical Scientist Award (ECSA-2020-011).
P076 Exploring the correlation between body mass index and fracture risk in men
Authors: Nguyen Mai H , Bukhari Marwan
Published: April 2024

Background/Aims

There has been an increase in interest in identifying patients with high risk of fracture, due to the high mortality. In De Laet et al. (2005) meta-analysis on 60000 women and men, which analysed the effect of body mass index (BMI), bone mineral density (BMD), age and gender on risk of any fracture; low BMI is linked to significantly higher fracture risk (two-fold at BMI of 20) when compared with a BMI 25. On the same comparison, high BMI (30) reduced risk of fractures by 17% (RR 0.83). This was significant in women, but not in men. No newer large-scale study focused on the correlation between BMI and fracture risks in men. Therefore, we set out to investigate the relationship between BMI and different fractures in male patients.

Methods

5388 male patients referred for DEXA scan in the North West of England between 2004 and 2019 were included in the analysis. Logistic regression is performed for age, BMI, and BMD using R-4.3.1 for Windows.

Results

Prior to adjusting for BMD, low BMI is a significant risk factor for femur fracture. On the other hand, low BMI is a protective factor against tibia-fibula fractures. There was no significant correlation detected in spine, rib, humerus, forearm and elbow fractures. After adjusting for BMD, higher BMI is associated with significantly higher odds of humerus, tibia-fibula and wrist fractures, but no statistically significant association with spine, ribs and femur fractures.

Conclusion

Our results show the correlation between BMI, adjusted for BMD, and different fracture site. Our findings corroborated with previous literature, suggesting that BMI is likely a risk factor that is dependent on BMD. Furthermore, we highlighted that higher BMI is a protective factor for some fractures whilst being a risk factor for others. It is unclear whether the difference between the fracture types are due to the mechanism of fracture or the difference in disease progression at the different fracture sites - this is a potential area for future research.

Disclosure

M.H. Nguyen: None. M. Bukhari: None.
P078 United Kingdom rates and determinants of romosozumab prescriptions, a need for greater action
Authors: Javaid Muhammad K , Jones Tim , Hepworth Stepehn
Published: April 2024

Background/Aims

Romosozumab rapidly reduces fracture risk and has been recommended as a first-line option for post-menopausal persons with severe osteoporosis and a recent major fracture from November 2020 (Scotland) and May 2022 (England, Northern Ireland and Wales). Aim: to describe hospital-level romosozumab prescriptions and the determinants across the four nations.

Methods

Hospital-level romosozumab prescription data were analysed by country. Potential predictors included surrogates of local patient need (the population of women aged 50 years and over), local FLS status (none, partial, full) and, in England and Wales, the number of patient records submitted to the mandatory national audits for Fracture Liaison Service (FLSDB) and National Hip Fracture Database (NHFD) in 2021. Spearman correlations and zero-inflated Poisson models identified independent determinants of: a) any prescription and b) the number of prescriptions or romosozumab.

Results

152 sites were included (England-126, N. Ireland-5, Scotland-14, and Wales-7) with 60 full and 28 partial FLSs. 63 sites recorded a least one romosozumab prescription in 2022. The proportion of hospitals with any prescription varied from 20% in Northern Ireland to 64.3% in Scotland. An estimated four million women aged 50+ lived in areas with no romosozumab delivery. No determinants of any prescription were identified. With England as the referent group, the number of prescriptions was greater in Scotland (p = 0.001) and lower in Northern Ireland (p = <0.001). After adjusting for the number of women aged 50 years and over (p = 0.008), a full FLS but not partial FLS predicted the number of prescriptions (Figure). In England and Wales both local NHFD (Rs = 0.19, p = 0.03) and FLSDB records (Rs = 0.25, p = 0.056) predicted the number of local prescriptions.

Conclusion

Even after inclusion in national guidelines, there is a care gap of at least four million women in the UK. In NHS sites that have started prescribing romosozumab, the patient numbers are significantly below expected rates. A national implementation strategy should be considered for decision makers, healthcare providers and patient groups to minimise the number of subsequent fragility fractures in the FLS setting by increasing the number of sites implementing romosozumab focusing on FLS first and matching local delivery to local population needs.

Disclosure

M.K. Javaid: Consultancies; MKJ has received honoraria, travel and/or subsistence expenses from: Amgen, Kyowa Kirin Hakin, UCB, Abbvie, Besin Healthcare, Sanofi. Grants/research support; MKJ has received unrestricted research grants Amgen, Kyowa Kirin Hakin, UCB. T. Jones: Corporate appointments; Employee of British and Irish BioPharma SPRL. S. Hepworth: Corporate appointments; Employee UCB BioPharma SPRL.
P088 Uveitis screening in Juvenile Idiopathic Arthritis: Are we following the guidelines?
Authors: Ahmad Junaid , Gupta Aashish , Bharadwaj Anurag , Olusanya Deborah
Published: April 2024

Background/Aims

Juvenile Idiopathic Arthritis (JIA) is the most common inflammatory arthritis in children. Uveitis is a common (8-30%) and potentially sight-threatening complication of JIA. Early detection and treatment of uveitis can prevent permanent visual impairment, making uveitis screening an essential part of the management of JIA patients. The purpose of this audit was to evaluate the referral and management of uveitis screening in JIA patients in our healthcare setting compared with Guidelines for Screening for Uveitis in Juvenile Idiopathic Arthritis (JIA) produced jointly by BSPAR and the RCOphth 2006.

Methods

The patients with a diagnosis of JIA at our District General Hospital (DGH) were reviewed retrospectively. The data was collected based on demographics, JIA diagnosis, subtypes, referral for uveitis screening, timing of uveitis screening, and screening outcome. Data was then analysed to assess if we met BSPAR and the RCOphth 2006 standards.

Results

A total of 42 patients were identified with a diagnosis of JIA between January 2021 and January 2023. Based on our criteria, four patients were excluded and the final analysis was done with 38 patients. 34 patients (89%) with JIA were referred for uveitis screening. 31 of those patients (91%) were referred within six weeks, while three patients (9%) were referred after six weeks of diagnosis. Only nine patients (24%) were seen for uveitis screening within the six weeks after initial referral as per BSPAR and the RCOphth 2006 standards. Uveitis was diagnosed in five patients(13%). One out of 38(2.6%) patients was diagnosed with Uveitis prior to diagnosis of JIA. Regarding the distribution of JIA subtypes, there were 15 cases of Polyarticular JIA, 14 instances of Oligoarticular JIA, six occurrences of Psoriatic JIA, two instances of Enthesitis-related JIA, and 1 case of Systemic JIA. Out of the five patients diagnosed with Uveitis, two had Polyarticular JIA, two had Oligoarticular JIA, and one presented with Psoriatic JIA. Furthermore, two of these patients tested positive for ANA, one tested negative, while the ANA status remained unknown for the remaining two individuals.

Conclusion

The results showed the need for improvement to be fully compliant with the guidelines for screening uveitis in JIA patients. We aim to ensure that all patients are referred and reviewed within 6 weeks for uveitis screening, as early detection and treatment of uveitis can prevent permanent visual impairment. We recommend collaborating with the ophthalmology unit to streamline the referral pathway and explore the idea of doing MDT clinics. Education should be arranged to raise awareness among all relevant healthcare staff.

Disclosure

J. Ahmad: None. A. Gupta: None. A. Bharadwaj: None. D. Olusanya: None.
P089 Comprehensive comparison of current guidelines in the management of Systemic Lupus Erythematosus in children, with a focus on Lupus Nephritis
Authors: Day Josephine A , Beresford Michael W
Published: April 2024

Background/Aims

Lupus nephritis (LN) is a common complication of systemic lupus erythematosus (SLE); LN affects 50-60% of those with a diagnosis of childhood-SLE (cSLE). Currently one set of paediatric recommendations exists for the diagnosis and treatment of LN, published by the Single Hub and Access point for Paediatric Rheumatology in Europe (SHARE). This paper compares SHARE recommendations against two current sets of adult guidelines, published by the British Society of Rheumatology (BSR) and the European Alliance of associations for Rheumatology (EULAR). This paper aims to identify similarities and differences between the three sets of guidelines, and to evaluate the evidence base used to formulate them.

Methods

Paediatric SHARE recommendations were recorded within a spreadsheet. The recommendations were separated into recommendations for diagnosis and recommendations for treatment. The BSR paper was then examined for equivalent guidelines. The evidence level was recorded for each guideline. In the second phase, the EULAR 2019 guidelines were assessed for corresponding guidelines to the SHARE recommendations. EULAR levels of evidence were recorded. A Likert score of similarity (0-10) was assigned to each trio of guidelines (the trio consisting of one each from SHARE, BSR and EULAR). If a comparable guideline couldn’t be found in either the BSR or EULAR papers, this is made clear in the table.

Results

When comparing six diagnostic SHARE recommendations for paediatric LN with equivalent BSR and EULAR guidelines, the Likert similarity score ranged between 0-9. Only 50% of the 20 treatment SHARE recommendations had a Likert score ≥5 with their equivalent BSR and EULAR guidelines. Three SHARE treatment recommendations had no comparable guidelines, these are clearly identified in the results tables. All SHARE recommendations were based on level 3 or 4 evidence. Level 3 evidence comes from descriptive studies, whilst level 4 evidence comes from expert opinion and is considered the lowest level of evidence.

Conclusion

The quantity of differences noted in this paper leads to questioning whether transitional guidelines should be developed for care of young adults with LN to ensure safe transition as they move from paediatric to adult medical care. LN is a chronic condition that will impact a child’s entire life. Optimising care from as early in life as possible and continuing this into the future is essential to maximising quality of life and reducing adverse outcomes associated with renal involvement.

Disclosure

J.A. Day: None. M.W. Beresford: None.
P091 Is my arthritis part of who I am or something I have? Age of onset makes a difference
Authors: Beesley Richard P , Beesley Rebecca M , Middleton Kate , McBride Andrea
Published: April 2024

Background/Aims

Patients with rheumatic and musculoskeletal conditions experience a wide range of emotions, and reflect differently upon their diagnosis.

This collaborative study between three patient organisations explored how a diagnosis of a rheumatic condition affected a patient’s identity with the disease.

Methods

Adults in the UK aged 18+ who had any diagnosis of a musculoskeletal or rheumatic condition were invited to complete an online survey. Respondents provided information about their diagnosis, experiences and attitudes across a range of themes and topics. Respondents were asked to indicate how they felt about their condition, scoring between whether they felt their condition was “part of who I am” (score 0) or “something I have” (score 10).

Results

In total, 532 respondents completed the survey (64% female; 68% White ethnicity). The mean overall score was 6.28 (tending towards “something I have”). There was no difference between male and female respondents, nor between ethnic groups. However, there was a significant difference between patients with a diagnosis of Juvenile Arthritis (JA, including juvenile idiopathic arthritis, juvenile chronic arthritis, and juvenile rheumatoid arthritis) compared to other respondents, with JA patients more likely to consider their arthritis “part of who I am” (5.25 compared to 6.75; p<.05). By age band, older patients (aged 56+) were more likely to consider their arthritis “something I have” compared to younger patients (aged under 25, 26-35 or 36-45 p<.05), with a trend of increasing score based both on age and age at diagnosis.

Conclusion

A diagnosis of a rheumatic or musculoskeletal disease (RMD) has a substantial impact on patients, and can affect their sense of identity. Patients with earlier onset are more likely to consider their arthritis to be a part of who they are, rather than a condition they have. This may impact on motivations and expectations. Further research into this may help identify how to better support patients in relation to how they perceive their condition.

Disclosure

R.P. Beesley: None. R.M. Beesley: None. K. Middleton: None. A. McBride: None.
P109 Ocular manifestation of rheumatoid arthritis
Authors: Fenniche Insaf , Aydi Zohra , Somai Mehdi , Daoud Fatma , Dhaou Besma Ben , Kochbati Samir , Rachdi Imene , Boussema Fatma
Published: April 2024

Background/Aims

Ocular manifestation associated with rheumatoid arthritis (RA) is common and should be systematically investigated by an ophthalmological examination. It may precede or complicate the disease. It manifests as a dry-eye syndrome in 38% to 45% of cases, scleritis in 0.2 to 6.3% of cases, episcleritis in 0.17 to 3.7% of cases, and peripheral ulcerative keratitis in 3% of cases. The aim of this study was to describe ocular involvement in RA and to identify factors predictive of its occurrence.

Methods

This is a retrospective study of patients with RA defined according to the ACR- EULAR 2010 criteria, followed up in the internal medicine department between 2015 and 2022. Patients were divided into two groups: G0 including patients without ocular involvement and G1 including patients with ocular involvement.

Results

Eighty patients were diagnosed, 65 women and 15 men, giving a sex ratio (F/H) of 4.33. The mean age was 60.79 years [extremes: 30-90 years]. The mean age of disease onset was 46.34 years [extremes: 22-82 years]. Among our 80 patients, 20 had RA-related ocular involvement (25%). These included 18 women and two men. Ocular involvement consisted of dry-eye syndrome (17 cases), superficial punctate keratitis (4 cases), corneal perforation (one case), and unilateral diffuse scleritis (one case). The ocular examination had also revealed corticosteroid adverse effects: corticosteroid-induced cataract (four cases) and corticosteroid-induced glaucoma (three cases). Sjogren’s syndrome associated with RA was present in 76.47% of cases. There was no difference between the two groups in terms of age (62.25 vs. 44.22 years, p = 0.943), age of disease onset (47, 23 years vs. 44.22 years, p = 0.569), rheumatoid factor level (335.29 IU/L vs. 329.15 IU/L, p = 0.393) and anti-CCP antibody level (225.08 IU/L vs. 119.23 IU/L, p = 0.070). CRP was significantly higher in patients with no ocular involvement (225.08 mg/l vs. 118.23 mg/l, p = 0.007). erosive character was observed more in G0 than in G1, but without any significant difference, respectively 85.29% vs. 68.42%; p = 0.146.

Conclusion

According to our study, a quarter of patients followed for RA had ocular manifestations dominated mainly by dry syndrome. However, no predictive risk factor was found for this condition, be it clinical, immunological, or radiological.

Disclosure

I. Fenniche: None. Z. Aydi: None. M. Somai: None. F. Daoud: None. B. Ben dhaou: None. S. Kochbati: None. I. Rachdi: None. F. Boussema: None.
P120 Characteristics of difficult-to-treat rheumatoid arthritis: results from a systematic literature review
Authors: Chambers Sachin , Croft Adam P , Singh Ruchir
Published: April 2024

Background/Aims

Estimates predict between 10-20% of RA patients meet difficult-to-treat Rheumatoid Arthritis (D2T-RA) classification, representing a clinically distinct cohort. There is a significant unmet need in the identification and management of these patients. Discerning significant characteristics across cohorts may identify predictors for D2T-RA, which may prompt earlier clinical recognition and patient-tailored, holistic management to improve clinical outcomes. This review aims to describe the clinical characteristics of patients with EULAR-defined D2T-RA to help identify and manage predictors, contributory factors, or consequences of difficult-to-treat disease.

Methods

A systematic literature search of PubMed, Embase and Web of Science databases for studies pertaining to characteristics of D2T-RA was undertaken from database inception to May 2023. Results were screened against strict inclusion/exclusion criteria. Risk-of-bias (RoB) assessments were performed using the Newcastle-Ottawa Scale (NOS) and a modified version for cross-sectional studies (mNOS). Significant (p < 0.05) baseline characteristics between D2T-RA and non-D2T patients were extracted for comparison following thematic analysis. Where there was conflict in the direction of the extracted characteristics; the number and quality of studies were used to resolve evidential disagreements.

Results

1687 studies were identified, of which seven fulfilled the inclusion criteria. Included studies were observational, published between 2021 and 2023, with mean D2T and non-D2T sample sizes of 83 and 417 patients, respectively. Five of the seven cohorts were European, with two from Japan. Following RoB and dispute resolution, all seven identified studies were included for analysis. Key themes elucidated are shown in table 1. Of note, significant characteristics included female sex, autoantibody positivity, greater annual bone erosion progression, interstitial lung disease, mental health conditions, and non-adherence.

Conclusion

Greater awareness of clinical characteristics of D2T-RA patients will assist clinicians by promoting the assessment of traits associated with poor treatment response. This is the first review to systematically describe characteristics of D2T-RA patients across multiple cohorts. Several commonly recorded, modifiable characteristics were associated with D2T-RA. Evidential disagreements and heterogeneous study designs were analytical barriers, and clinical intervention studies are needed to determine if addressing these factors in the routine clinical setting improves clinical outcomes and prevention in D2T-RA.

Disclosure

S. Chambers: None. A.P. Croft: None. R. Singh: None.
P136 KL6 and IL-18 levels are negatively correlated with respiratory function tests and interstitial lung disease extent assessed on high-resolution computed tomography in patients with systemic sclerosis-related interstitial lung disease
Authors: Santos Cristiana Sieiro , Calleja Antolín Sara , de la Calle Lorenzo Javier , Bollo de Miguel Elena , Díez Álvarez Elvira
Published: April 2024

Background/Aims

Serum biomarkers have been suggested as indicators for pulmonary damage with clinical value in the diagnosis and prognosis of SSc-ILD. We aim to investigate the role of serum biomarkers (Krebs von den Lungen-6 KL-6, IL-18 and IL- 18BP) as potential biomarkers reflecting the severity of SSc-ILD as assessed through high-resolution computed tomography (HRCT) and pulmonary function tests (PFT).

Methods

A cross-sectional study including patients with SSc fulfilling the 2013 ACR/EULAR criteria was performed. Patients were classified according to disease duration and pulmonary involvement. All SSc patients underwent chest HRCT scans and pulmonary function test at baseline. Serum concentration of KL-6, IL8 and IL18BP were determined usingsandwich ELISA technique (solid phase sandwich Enzyme Linked-Immunosorbent Assay), with kits from MyBiosource for KL-6 and from Invitrogen for IL18 and IL18BP. A semiquantitative grade of ILD extent was evaluated through HRCT scan (grade 1, 0-20%; grade 2, >20%). Extensive lung disease was defined as > 20% of lung involvement on HRCT, and FVC <70% predicted and limited lung involvement as ≤ 20% of ILD involvement on HRCT,and an FVC ≥70% predicted.

Results

74 patients were included, 27% were male, with a mean age of 57.5±15 years. 28 patients had ILD (38%). 64 % of patients had <20% of ILD extent classified through HRCT scan. SSc-ILD patients had elevated serum KL- 6 and IL-18 levels compared to patients without ILD (p = 0.003 and p = 0.04). A negative correlation between KL-6 levels and %FVC (β=-0.25, p 0.037) and %DLCO (β=-0.28, p 0.02) and between IL-18 levels and %FVC (β=-0.20, p 0.03) and %DLCO (β=-0.14, p 0.04) were found. Serum KL-6 and IL-18 levels successfully differentiated grades I and II (p = 0.028 and p = 0.021). Semiquantitative grades of ILD on the HRCT scan were significantly proportional to the KL-6 (p 0.01) and IL-18 (p = 0.03). A positive correlation between extensive lung disease and KL-6 (β = 0.61, p 0.007) but not with IL-18 was found.

Conclusion

Serum KL-6 levels and IL-18 were increased in patients with SSc-ILD and showed a positive correlation with ILD severity as measured using a semiquantitative HRCT grading scale and a negative correlation with PFT parameters.

Disclosure

C. Sieiro Santos: None. S. Calleja Antolín: None. J. de la Calle Lorenzo: None. E. Bollo de Miguel: None. E. Díez Álvarez: None.
P142 Effect of Atorvastatin on vascular endothelial function in early Systemic Sclerosis: An open label Randomized Controlled trial
Authors: Das Anna C , Thabah Molly M , Mariaselvam Christina Mary , Vijayan Rubini , Anantharaj Avinash , singh Negi Vir
Published: April 2024

Background/Aims

Systemic Sclerosis (SSc) is driven by early endothelial dysfunction, leading to loss of endothelium-dependent vasodilatation. This predisposes to increased stiffness of large arteries. Prospective studies have found a conflicting role of statins in improving vascular function in established SSc. We undertook this study to explore if statins influence endothelium dependent vasodilation in early SSc

Methods

In this single center open label randomized controlled trial between July 2021 to January 2022, SSc patients (ACR-EULAR 2013) between 18-65 years, with duration < 3 years from the first non-Raynaud’s symptom were included. Those with complicated Raynaud’s, overlap syndromes and cardiovascular comorbidities were excluded. Participants were randomized into statin (atorvastatin 40 mg/day/A40) or no -statin arm. Both groups received stable doses of immunosuppression, during the study period. The primary outcome of flow-mediated dilation (FMD %) of brachial artery, measured by single assessor and secondary outcomes of common carotid intima medial thickness (CIMT), modified Rodnan Skin score (mRSS), Raynaud’s visual analogue scale (RayVAS:0-10), hs CRP, von Willebrand factor and oxidized low-density lipoproteins were measured at baseline and 16 weeks. All patients provided written informed consent; study protocol was approved by IEC(JIP/IEC/2020/026). Considering a change in FMD of 1% between arms as clinically meaningful, sample size was calculated to be 144. Analysis was performed using SPSS v.19.CTRI registration no: REF/2020/07/03495

Results

Total 71 eligible patients were randomized into statin(n = 36) and no-statin(n = 35) arms. Baseline parameters were comparable between arms. Baseline mRSS was 14.25. On per-protocol analysis of statin (n = 28) and no-statin (n = 32) arms, there was no significant difference in FMD either at baseline or at 16 weeks (table 1). At week 16, basal brachial artery diameter increased (p = 0.008) in statin arm. Ray VAS scores improved in the statin arm,not achieving significance(p = 0.15). An increase in mRSS from 14 to 16 was noted in no-statin arm , whereas it remained stable in the statin arm (14.5). Secondary endpoints were not met. No adverse events were noted.

Conclusion

In early SSc, atorvastatin 40 mg/day, added to background immunosuppression, failed to improve endothelial function, assessed using brachial FMD, at 16 weeks. Stabilization of skin tightening was noted in the statin arm.

Disclosure

A.C. Das: None. M.M. Thabah: None. C. Mariaselvam: None. R. Vijayan: None. A. Anantharaj: None. V. Negi: None.
P178 CXCL12/CXCR4-mediated osteogenic precursor cells recruitment: a key mechanism in ankylosing spondylitis-associated pathological bone formation
Authors: Cui Haowen , Liu Hui
Published: April 2024

Background/Aims

Ankylosing spondylitis (AS) is a debilitating condition characterised by severe spinal deformities, inflammation, and excessive bone formation, imposing significant socioeconomic burdens. Current treatments alleviate symptoms but fail to address bone structural damage. Pathological bone formation often occurs at entheses, where tendons and ligaments connect to bone. Osteogenic precursor cells (OPCs) play a crucial role, but their migration to new bone sites is poorly understood. C-X-C motif chemokine ligand 12 (CXCL12) is implicated in cell migration and bone-related processes, but its role in AS remains unclear. This study explores CXCL12/CXCR4 signalling in OPC recruitment and new bone formation, providing insights into AS pathogenesis and potential therapeutic targets.

Methods

We established mouse models, including the DBA/1 model, lipopolysaccharide-induced spondyloarthritis model, and Achilles tendon semi-transection model to confirm the role of CXCL12-Induced OPCs migration in pathological new bone formation. Additionally, genetically edited mouse models were generated to confirm the underlying mechanism of OPCs migration and their spatiotemporal phenotypes of differentiation, including DBA1;CXCL12 col2 transgenic mice, CXCL12hi/hi;Col2a1-creERT mice, and CXCR4fl/fl;Prx1-creERT mice.

Results

In this study, we have identified CXCL12 as a crucial contributor to the initiation of pathological new bone formation by recruiting OPCs. CXCL12 was highly expressed in regions predisposed to pathological bone development, attracting OPCs to these upregulated areas. Inhibiting the CXCL12/CXCR4 axis with AMD3100 or the conditional knockout of CXCR4 effectively reduced OPC migration and subsequent pathological bone formation in animal models of AS. Overexpression of CXCL12 in genetically engineered animals with a DBA/1 background demonstrated a stable joint ankylosis phenotype, providing a valuable model for the study of AS. Furthermore, our research revealed the indispensable role of Rac1 in OPC migration and the ensuing pathological bone formation.

Conclusion

This study elucidates the novel role of CXCL12 in AS and offers potential strategies for targeting the CXCL12/CXCR4-Rac1 axis to prevent the progression of axial skeletal ankylosis.

Disclosure

H. Cui: None. H. Liu: None.
P181 Clinical assessment of radiologically defined clinically isolated aortitis in a single centre study
Authors: Jain Sahil , Muñoz-Urbano Marcela , Khormi Abdulrahman , Sangle Shirish , D'Cruz David
Published: April 2024

Background/Aims

Aortitis may occur in the absence of systemic vasculitis and is termed clinically isolated aortitis (CIA). Our purpose was to describe a cohort of patients with CIA and compare their characteristics with aortitis patients associated with rheumatic diseases.

Methods

We conducted a retrospective analysis of 32 patients with non-infectious aortitis evaluated in our centre. Online records were analysed. We included demographic variables, symptoms, laboratory data, imaging, treatment, outcomes, and mortality. The description of quantitative variables was made using percentages and medians with interquartile range (IQR).

Results

Out of 32 patients, 10 were classified as CIA and 22 had other inflammatory diseases (approx. 1:2 ratio) - fourteen had giant cell arteritis, 4 had Takayasu's arteritis, 2 with granulomatosis with polyangiitis, 1 each with IgG4 related disease and ankylosing spondylitis, classified according to the ACR/EULAR criteria for each disease. All patients underwent PET-CT imaging confirming isolated aortitis; none had an artery biopsy. Table 1 shows the main clinical characteristics. Among the CIA patients, the median duration of follow-up was 65 months (IQR 42-72). Three patients were asymptomatic and seven had constitutional symptoms (fever, weight loss, sweats, fatigue). Only one patient reported abdominal, back pain. The diagnosis was incidental in two cases. All patients had negative infection screen and serological markers for other rheumatologic conditions. Six (60%) patients had involvement only of the abdominal aorta, 2 had only thoracic aorta, and 2 had abdominal and thoracic aortitis. Six patients (60%) were treated with glucocorticoids (GCs) and methotrexate, 2 with GCs alone, 1 with GCs and mycophenolate mofetil, and 1 patient had resistant disease requiring tocilizumab. Four patients had follow-up PET-CT imaging: 2 showed reduction in FDG avidity, 1 had a stable tracer uptake, and 1 had no evidence of persistent aortitis. All the CIA patients demonstrated clinical and biochemical (ESR/CRP) improvement and at follow-up.

Conclusion

Our CIA patients had a male predominance, between the sixth and seventh decades, consistent with the previous literature. Aneurysms are more common in CIA patients than in those with GCA or TAK. There is no fixed protocol for CIA but conventional DMARDs and glucocorticoids are helpful.

Disclosure

S. Jain: None. M. Muñoz-Urbano: None. A. Khormi: None. S. Sangle: Other; Principle Investigator for HAVEN Trial. D. D'Cruz: Consultancies; GlaxoSmithKline, CSL Vifor. Grants/research support; Medical Research Council, National Institute for Health and Care Research. Other; Principal Investigator Clinical trials with Pfizer. Eli Lilly, AbbVie, Syneos, Idorsia.
P190 Protocolised ultrasonography led pathway has a high sensitivity for diagnosis of primary large vessel vasculitis
Authors: Mukhtyar Chetan B , Ducker Georgina , Beadsmoore Clare , Sisson Katherine , Jones Colin
Published: April 2024

Background/Aims

Ultrasonography (US) for diagnosis of large vessel vasculitis (LVV) is a recommended first line diagnostic procedure. Our county has an annual incidence of 57.5/million for primary LVV (giant cell arteritis (GCA) 48.3/million; Takayasu 2.5/million; unclassified LVV 6.4/million). Our protocolised fast-track US pathway has reduced visual loss from 18.7% to 11.5%. We present the results of our first 1000 unique referrals.

Methods

Unique requests for US from January 2017 were analysed. Protocolised US examination of the arteries includes superficial temporal artery (STA) and its rami, followed by the entire axillary artery, followed by other arteries as necessary. Halo sign in at least two different arteries was needed for diagnosis of LVV. A temporal artery biopsy (TAB) or positron emission tomography (PET) were requested if the US was negative AND CRP was ≥20mg/L (or missing) AND an alternate explanation for the raised CRP was not immediately apparent. For those where a second test was not requested OR if it was negative, prednisolone was tapered rapidly, and a patient-initiated follow-up allowed rapid re-assessment. If referring physician or patient did not want a second test, GCA was diagnosed on clinical grounds alone and the pathway was considered to have failed.

Results

Median age was 73 (IQR 13); 11/1000 referrals were for people <50 years of age. The median delay for the procedure was 4 (IQR 4) days. Prednisolone had been started a median of 4 (IQR 5) days previously. 279/1000 (28%) US scans demonstrated vasculitis. Pre-steroid CRP was ≥20mg/L in 283 cases and unavailable in 7. An alternate explanation for the raised CRP was found in 102 cases, 181 were referred for a second test, and 7 received a clinical diagnosis of GCA without a second test. The second test was diagnostic in 31/181 (17%) - 24/139 (17%) TAB, 7/42 (17%) PET. 3/150 cases with a negative second test and 4/431 cases with CRP <20mg/L were diagnosed with GCA on patient-initiated follow-up. The delayed diagnosis did not result in visual loss. 202/279 (72%) US positive cases had bilateral STA involvement. The addition of axillary artery imaging picked up a further 53 (19%) cases; 24/279 (9%) cases needed imaging of other arteries. The sensitivity and negative predictive value of the pathway are 96% (310/324) and 98% (683/690) respectively.

Conclusion

Our protocolised US led pathway for diagnosis of LVV is highly sensitive and allows disease exclusion with high certainty. Routine US of the superficial temporal artery and its rami, and the entire axillary artery provide diagnosis in 91% of cases but ability to scan more arteries improves yield in a further 9% of cases. Composite testing with US plus second test, stratified by CRP levels, can be recommended as a gold standard diagnostic tool for LVV.

Disclosure

C.B. Mukhtyar: None. G. Ducker: None. C. Beadsmoore: None. K. Sisson: None. C. Jones: None.
E004 Question of the month; a simple method of patient engagement
Authors: Waller Rosemary
Published: April 2024

Background/Aims

Patient involvement at every stage of service development is key to driving forward meaningful change. It can however, be difficult to engage a broad demographic. Focus groups can gain in depth information but are time consuming and will only involve a small number of people. Questionnaires are often poorly completed or have a low return rate. Asking a ‘question of the month’ is a simple method of collecting a large amount of data on a single topic. We have recently reinstated patient education sessions following a break in their provision due to Covid-19 and were keen to optimise these by finding out what patients wanted.

Methods

A poster was place in the waiting room asking ‘What was the most useful information you were given when you were diagnosed with arthritis’. Patients were given a post-it note and asked to write an answer on it and stick it onto the poster. The same question was asked in paediatric, adolescent and general adult clinics to all follow up patients with inflammatory arthritis during September 2023. The question of the month concept was developed by the Rubis QI Team as part of the JIALearn project. Thematic analysis was performed for the three age groups separately.

Results

Themes common to all age groups: 1. Knowing that there are a range of effective treatment options available. 2. Hope: “it is not life changing”, “expect a long journey and try and remain positive” In paediatrics, effective, accessible communication was a dominant theme in “any concerns are important and are listened to” In adolescents and young adults being given hope and knowing that there were treatment options were the most dominant themes: “it doesn’t have to affect your life”, “knowing I had different choices out there to help me” In adults the most dominant theme was around self management, particularly around regular exercise, diet and weight loss. “I can manage my problem”, “allows you to stay in control”. Some patients used this project as an opportunity to leave positive feedback about their care to date. Clinicians involved reported good clinical engagement and an improved therapeutic relationship with patients. These themes will be used to guide future patient education sessions targeted at specific age groups. The results of this project will be developed into a poster for the waiting room to demonstrate that comments have been listened to and acted upon.

Conclusion

Adults newly diagnosed with arthritis place a strong emphasis on self management. The themes of open communication and hope emerged in children and young adults. The comments provided will help to guide and shape future patient education sessions. Question of the month is a simple way of engaging with a broad number of patients.

Disclosure

R. Waller: None.