bluuebunny/crossref_metadata_2025 huggingface dataset:
P174 HLA B27 status and disease phenotype: a cohort study of 223 patients with enthesitis-related arthritis
Authors: Bouraoui Aicha , Fisher Corinne , Glanville James , Sen Debajit
Published: April 2022

Background/Aims

Enthesitis-related arthritis (ERA) is a subtype of juvenile idiopathic arthritis (JIA) accounting for 10-20% of patients with JIA. ERA is associated with a poor prognosis compared to other JIA subtypes. Whilst a high proportion of patients with ERA are HLA-B27 positive, the correlation between HLA-B27 status and disease phenotype is not well described. The aim of our study was to investigate the influence of HLA-B27 status on ERA phenotype.

Methods

Demographic and clinical data were collected and HLA-B27 positive and negative patients were compared. All subjects included met ILAR classification criteria. The data were analysed using R software (R version 4.0.4). Median and interquartile range (IQR) were calculated for continuous variables and frequency and percentage for categorical variables. Subgroup comparison was performed using the chi-squared test for qualitative variables, and Wilcoxon rank-sum for quantitative variables. P values less than 0.05 were considered significant.

Results

223 patients were included in this study. The median age of symptom onset was 12 years (IQR: 9-14). The median disease duration was 11 years (IQR: 7-14). 18% of patients had family history of HLA-B27-related disease and 67% had positive HLA-B27. 54% of patients were on conventional disease modifying anti-rheumatic drugs (cDMARDs). 80% were on biologic DMARDs (bDMARD). HLA-B27 positive patients (n = 148) and negative patients (n = 68) were compared. Our analysis revealed a higher proportion of male patients in the HLA-B27 positive cohort (74% [n = 111] versus 59% [n = 39], p = 0.02). HLA-B27 positive subjects developed ERA at an older age compared to the HLA-B27 negative group at 12 versus 11 years, respectively (p = 0.02). HLA-B27 positive patients also had a higher probability of an axial phenotype within 12 months of disease onset 51% (n = 75) in the HLA-B27 positive group versus 32% (n = 22) in the HLA-B27 negative group (p = 0.01). At any point of disease course, sacroiliitis was also more common in the HLA-B27 positive group (78% [n = 116] versus 63% [n = 43], p = 0.01), who also had a higher usage of bDMARDS (74% [n = 110] versus 56% [n = 38], p = 0.006). There was no significant difference between the two groups in terms of ethnicity, family history of HLA-B27 disease or the prevalence of extra-articular manifestations, including uveitis.

Conclusion

Our study revealed that patients with ERA who were HLA-B27 positive, were more likely to be male, developed disease at an older age and had a higher probability of axial phenotype at onset and later in disease. They also had an increased bDMARD requirement. These data suggest that HLA-B27 confers a worse prognosis clinically which is consistent with findings from other studies.

Disclosure

A. Bouraoui: None. C. Fisher: None. J. Glanville: None. D. Sen: None.
P185 Patients' and clinicians' perspectives on the clinical utility of the Rheumatoid Arthritis Foot Disease Activity Index
Authors: Hoque Anika
Published: April 2022

Background/Aims

Although patient-reported outcome measures (PROMs) are recommended in clinical practice, their application in primary care is limited. The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) is a validated PROM for assessing foot disease activity in rheumatoid arthritis (RA). This qualitative study aims to understand the clinical utility of the RADAI-F5 as a management tool for foot disease in RA.

Methods

Adult RA patients and rheumatologists, physiotherapists and podiatrists routinely involved in treating RA patients were recruited through convenience sampling. Recruitment continued until data saturation had been achieved. A 60-minute, semi-structured, one-on-one Microsoft Teams interview with participants was conducted. Interviews involved open-ended questions to explore barriers and facilitators to the clinical application of the RADAI-F5. These interviews were audio-recorded and transcribed verbatim, with each participant verifying the transcript to establish rigour and credibility. The transcripts were coded using Nvivo12, and inductive thematic data analysis was conducted to identify emerging themes.

Results

Eight RA participants: 7 females; mean [standard deviation, SD] age 52.4 [9.5], mean [SD] disease duration 16.1 [16.4] and eight clinicians; mean [SD] age 46.75 [5.3], mean [SD] years of clinical experience of 19.5 [2.21] participated. The RADAI-F5 has four key themes that support its clinical utility. These were as follows: ‘need for the RADAI-F5' because patients felt that feet were ignored during routine consultations and clinicians felt the need for a foot PROM that is accurate, short and quick to complete in clinical practice; ‘promoting patient-clinician communication' because it can identify areas of concern that may be under-recognized by clinicians; ‘guiding management' as implementing the RADAI-F5 could assist in the screening, monitoring foot disease status, and guiding future interventions; and ‘patient involvement,' since the tool may trigger patients to be more involved in their foot health self-management. Three themes were identified as potential barriers to implementation; ‘practical difficulties, including lack of time during appointments; ‘lack of validity', as clinicians were hesitant to use the RADAI-F5 until its validity is established further with the use of ultrasound imaging and clinical examination; and, ‘lack of an electronic database', since there is currently no electronic system for reporting RADAI-F5 results.

Conclusion

The results of this study suggest that the RADAI-F5 has significant potential as a clinical tool to aid foot disease management in RA. However, some barriers to implementation may need to be overcome to enable widespread uptake in rheumatology clinics.

Disclosure

A. Hoque: None.
P201 Sleep disturbance in early rheumatoid arthritis and fibromyalgia and its association with mood and quality of life
Authors: Wall Amanda J. W , Delmestri Antonella , Silva Naiduwa W. I. L , Soni Anushka
Published: April 2022

Background/Aims

Rheumatoid arthritis (RA) and fibromyalgia (FM) are common musculoskeletal conditions associated with pain, mood and sleep disturbance, functional limitations and poor health-related quality of life (QOL). Studies report sleep problems in 50-75% established RA and 70-90% FM. The aim of this study is to quantify the presence of sleep disturbance amongst patients with newly diagnosed RA or FM, to describe any association with measures of anxiety or depression, and to investigate the impact of sleep disturbance on QOL in this patient group.

Methods

Patients with a clinical diagnosis of early RA or FM were recruited from Rheumatology clinics over 12 months (ethics reference: IRAS Project 252762). Patients completed baseline patient reported outcome measures prior to commencing treatment: Insomnia Severity Scale (ISS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Physical Activity Calculator (PAC) and the Short Form-36 Health Survey (SF-36). Students t-test, Mann-Whitney and Chi-squared test were used to compare normal, non-normal and binary data respectively. Regression modelling was used to investigate the association between sleep disturbance and the general health subscale of SF-36 (GHSF-36), adjusting for age, sex and rheumatic condition.

Results

161 participants were recruited: 84 had a diagnosis of early RA and 77 had FM, mean age 50 (16) years, 118 (73%) females. Moderate-to-severe insomnia was present in 34/84 (41%) of early RA patients and 56/77 (72%) of FM patients. Table 1 shows further baseline characteristics according to rheumatological diagnosis. Overall, there was a significant relationship between insomnia severity and general health (r=-0.39, p < 0.001), anxiety (r = 0.49, p < 0.001) and depression (r = 0.64, p < 0.001). Regression analysis confirmed an association between baseline sleep disturbance and general health after adjusting for age, sex and diagnosis (ß=-0.79, 95% CI -1.22 to -0.36, p < 0.001).

Conclusion

Although there is greater sleep and mood disturbance in patients with FM, 41% of patients with early RA also reported moderate-to-severe insomnia at the time of diagnosis. Activity levels remain similar between the two groups and insomnia severity was significantly associated with reduced health related QOL. This highlights the importance of addressing sleep, and mood, in Rheumatology clinics to help improve health related QOL.

Disclosure

A.J.W. Wall: None. A. Delmestri: None. N.W.I.L. Silva: None. A. Soni: None.
P203 Prevalence of lower limb disease activity and walking disability in the first two years of rheumatoid arthritis: results from the Scottish Early Rheumatoid Arthritis inception cohort
Authors: Kelleher Nancy , Hendry Gordon J
Published: April 2022

Background/Aims

Lower limb synovitis and walking disability are reported as common in rheumatoid arthritis (RA), however there is a paucity of contemporary longitudinal studies reporting prevalence rates from disease onset. The aims of this study were to determine i) the prevalence of lower limb synovitis and walking disability from first presentation to 2 years, and ii) the prevalence of active foot/ankle disease amongst participants in Disease Activity Score-28 (DAS28)-remission.

Methods

The Scottish Early Rheumatoid Arthritis (SERA) study is an inception cohort of newly diagnosed inflammatory arthritis patients attending rheumatology units across Scotland. SERA data included demographics and 6-monthly clinical outcome data. Data from participants diagnosed with RA were included. Synovitis was determined using tender and swollen joint counts recorded at hips, knees, ankles and metatarsophalangeal (MTP) joints 2-5, and dichotomised as present (≥1) or absent (0). Walking disability was measured using the Health Assessment Questionnaire (HAQ) walking subscale (range 0-3) and dichotomised at present (≥1) or absent (0). Prevalence rates are expressed as percentages of participants. Subgroup analysis was performed to estimate the prevalence of foot/ankle joint swelling in participants who were in DAS28-remission (<2.6).

Results

A total of 932 participants (65.9% female) with a median (interquartile range [IQR]) age 59.5 years (49.5-68.1) were included, dropping to 391 at 2 years. Prevalence rates for lower limb synovitis and walking disability are reported in table 1. At 6 months, 138/816 (28.6%) participants met DAS28-remission criteria, followed by 124/691 (31.9%) at 1 year, 118/522 (39.2%) at 18 months, and 88/391 (39.5%) at 2 years. For those in DAS28-remission the prevalence of foot/ankle joint swelling was 10.3% at 6 months, 13.5% at 1 year, 17.6% at 18 months and 12% at 2 years.

Conclusion

Prevalence rates for knee, ankle and MTP joint swelling are initially high then stabilise, with largest reductions observed at 6 months. Joint tenderness prevalence rates follow a similar course but are consistently higher than joint swelling. Walking disability affects a significant proportion of patients throughout the first 2 years of RA. Clinically important rates of active foot/ankle disease are present amongst those classed in DAS28-remission.

Disclosure

N. Kelleher: None. G.J. Hendry: None.
P205 Patient preference for different devices for delivery of subcutaneous methotrexate when switching from oral therapy: findings from a pilot study comparing a button-free auto-injector pen and a button-activated auto-injector pen
Authors: Lartey Janet
Published: April 2022

Background/Aims

Subcutaneous (SC) injection of methotrexate (MTX) can offer advantages when compared to oral MTX in the management of rheumatic diseases such as rheumatoid arthritis (RA). Patient choice is an important factor to consider when initiating new treatments as it may lead to improved compliance. This pilot study evaluated patient preference between two MTX auto-injector pens and the important features that influenced the choice of device.

Methods

Rheumatology patients making the switch from oral MTX to SC MTX were invited to take part in structured consultation (using a 3-page questionnaire) to discuss their preferences regarding the use of a pre-filled, auto-injector pen. Patients were shown a button-free dummy pen and a button-activated dummy pen and asked to indicate their preference. Patients were asked to rate the relative importance of 7 features of their chosen auto-injector pen on a scale of 1 to 4 where 1 = “not important” and 4 = “very important”. The nurse leading the consultation alternated the order in which the auto-injector pens were presented to minimise bias.

Results

Thirty patients have switched to SC MTX to date. The majority of patients were female (80%) and aged over 40 years (73%). The majority (60%) had been prescribed MTX for the treatment of rheumatoid arthritis (RA) and been using oral MTX for more than 12 months (60%). The main reasons for switching to SC MTX were concerns about treatment side effects (50%) and/or effectiveness (50%). Twenty-five (83%) patients chose the button-free, auto-injector pen and 4 (13%) chose the button-activated, auto-injector pen. One patient had no preference but decided to use the button-free, auto-injector pen. Twenty-eight (93%) patients ranked “button/no button to press to activate the injection” as important (“important” or “very important”) when choosing. Of these, 22 (79%) indicated a preference for “no button” to activate the injection. Ninety percent of patients ranked a “system of recognition at the start and end of the injection process”, “easy to grip”, and “easy to uncap” as highly important; 84% ranked “visibility/invisibility of the needle” as highly important. Simplicity and ease-of-use were described as the main advantages by those patients choosing the button-free option (n = 25, 52% and 32% respectively).

Conclusion

The findings of this pilot patient preference study show that ease of use of the auto-injector pen is an important factor when patients are switching from oral MTX to SC MTX. Although multiple features contribute to ease of use, the absence of a button was identified as the most important feature and likely contributed to a greater preference for use of the button-free, auto-injector pen.

Disclosure

J. Lartey: None.
P207 NRAS Virtual Groups
Authors: Bwalya Naomie , Brewer Janet
Published: April 2022

Background/Aims

NRAS Groups have long provided an opportunity for those with RA to meet others in a similar situation for mutual benefit. Attendees have told us how they enjoy meeting in a non-clinical environment to learn more about the condition and receive encouragement from others. When COVID-19 hit and NRAS groups were unable to meet in person and most people living with RA had to shield this intensified the feelings of isolation. NRAS responded to this need by establishing online regional groups and JoinTogether virtual groups.

Methods

1. NRAS offered training and support to facilitate online group meetings to its regional groups’ leaders. Volunteers were provided with a dedicated NRAS email address, access to an Office 365 portal and Zoom account and GDPR training. NRAS colleagues attended introductory meetings to support the Group Leaders and continue to provide technical support, promotion via website and social media as well as general advice. 2. Recognising a need to reach a wider audience who were not accessing the regional groups - i.e. younger and perhaps “time poor” due to working etc. - NRAS took advantage of the move to online engagement and also initiated the exclusively online JoinTogether topic-based groups, using a Volunteer Lead model.

Results

Regional Groups: Almost half of the regional groups signed up to the online training. Many found that the online meetings brought very positive benefits e.g. they were able to reach a wider audience as attendees were not put off by having to travel and could still attend if they were feeling fatigued. Many reported it was easier to attract NHS rheumatology health professionals to give talks as they did not have to travel and could even join meetings from home in the evenings. Some groups in adjoining areas joined forces so they could expand their offerings. JoinTogether Groups: Volunteer Lead, with NRAS support, has now set up 5 topic-based groups, each led by two co-ordinators. Topics are: Exercise & Back to Sport; Parenting With Inflammatory Arthritis; 18-35 year olds with RA or JIA: Working with Inflammatory Arthritis and Parents with children with JIA. These groups are thriving and attracting new audiences. They are very much volunteer led and attendees play a key role in directing the development of the JoinTogether groups to suit their needs.

Conclusion

NRAS virtual groups have allowed those living with RA or JIA to maintain contact with a community, with shared experiences, throughout the pandemic. They have also been instrumental in attracting attendees from audiences NRAS had traditionally found harder to access. The Volunteer Lead model that has been successfully implemented for the JoinTogether groups can now be expanded to other areas, enabling NRAS to increase capacity for delivering vital services.

Disclosure

N. Bwalya: None. J. Brewer: None.
P212 Understandings and responses to joint pain: preliminary findings from a rapid ethnographic assessment in Northern Tanzania
Authors: Msoka Elizabeth F , Bunn Christopher , Msoka Perry , Yongolo Nateiya M , Laurie Emma , Wyke Sally , McIntosh Emma , Mmbaga Blandina
Published: April 2022

Background/Aims

Musculoskeletal disorders (MSKD) are an important global health problem, but we know little about how it is understood and explained in Tanzanian communities. This understanding is crucial for developing culturally competent interventions and services for MSKD which avoid unintended impacts. This study aims to examine how joint pain is understood, explained, and responded to in rural and peri-urban communities in northern Tanzania.

Methods

We conducted rapid ethnographic assessment (REA) in two communities in Kilimanjaro region (one peri-urban, one rural) to document the language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts the pain has and how people respond to it. The REA included 60 short interviews with community leaders, traditional healers, community members, and pharmacists. The research team also wrote detailed field notes and, with written consent, took photographs which were used to develop ‘thick descriptions’ of the phenomena in each community. Thematic analysis of interview notes, thick descriptions and photographs was conducted using QDA Miner (v5.0) software.

Results

The dominant concepts of joint pain and its cause were named as Ugonjwa wa baridi - cold disease; Ugonjwa wa uzee - old age disease; rimatizim - disease of the joints and gauti - gout. Causes mentioned included exposure to the cold - walking bare foot, working in cold conditions - old age, alcohol and red meat consumption, witchcraft, demons, settling in one position, sex, injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. The impacts of joint pain included loss of mobility, economic and family problems, death, reduction in sexual functioning, and negative self-perceptions. Responses to joint pain blend biomedical treatments, exercise, herbal remedies, consultations with traditional healers and religious ritual.

Conclusion

Understandings of and responses to joint pain in the two communities are ‘syncretic’ - mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong ‘lay epidemiology’ in these communities. The impacts of joint pain are wide ranging, extending beyond the individual affected, and suggest that there are unmet needs which can be targeted by future interventions and services.

Disclosure

E.F. Msoka: None. C. Bunn: None. P. Msoka: None. N.M. Yongolo: None. E. Laurie: None. S. Wyke: None. E. McIntosh: None. B. Mmbaga: None.
P217 Describing the evolution of concordance/discordance between DAS28-ESR and ultrasound power Doppler synovitis in a treatment-naïve early RA cohort
Authors: Shukla Rudresh , Selby David A , Emery Paul , Plant Darren , Buch Maya H
Published: April 2022

Background/Aims

Discordance between DAS28-ESR and ultrasound (US)-detected power Doppler synovitis (PDUS) can lead to unnecessary DMARD cycling. Using DAS28-ESR and PDUS in an early RA trial cohort, we aimed to identify and describe concordance and discordance at diagnosis and evaluate their proportional change in response to treatment.

Methods

The ‘VEDERA’ trial randomised 120 treatment-naïve, new-onset RA patients to first-line etanercept + methotrexate (ETN+MTX) or methotrexate treat-to-target (MTX-TT) with escalation to ETN+MTX if not in DAS28-ESR remission at week 24. Clinical and US assessments were completed at baseline, weeks 12/24/48. Remission was DAS28-ESR ≤2.6 and active disease was DAS28-ESR >2.6. PDUS presence was defined as total PDUS score ≥ 1. Active concordance was defined as active disease with PDUS while active discordance was defined as active disease without PDUS. Remission concordance was defined as remission without PDUS while remission discordance was defined as remission with PDUS. Descriptive analyses were undertaken to address the above aims.

Results

At baseline all patients had active disease - 67% (81/120) were concordant and 33% (39/120) were discordant. Baseline DAS28-ESR and individual components were higher in the concordant compared to discordant group.

In the active concordant group, from baseline to weeks 24 and 48 respectively, 30% (24/81) and 20% (16/81) persisted, and 26% (22/81) and 38% (31/81) became remission concordant; while 30% (24/81) and 35% (28/81) shifted to active discordance at weeks 24 and 48 respectively and 14% (11/81) and 7% (6/81) became remission discordant.

In the active discordant group, from baseline to weeks 24 and 48 respectively, 72% (28/39) and 49% (19/39) persisted and only one and two patients were remission discordant; while 8% (3/39) and 15% (6/39) shifted to active concordance at weeks 24 and 48 respectively and 18% (7/39) and 31% (12/39) became remission concordant.

Conclusion

Discordance of DAS28 is typically associated with later RA. In this report, a third of patients shifted from active concordance to discordance following DMARD treatment early in the RA pathway. Further study is needed to understand how these patients compare to those that started and persisted with active discordance, and also later discordant RA patients.

Disclosure

R. Shukla: None. D.A. Selby: None. P. Emery: None. D. Plant: None. M.H. Buch: None.
P224 Anti-PARP1 as a novel autoantibody in myositis
Authors: Riddell Victoria , Betteridge Zoe , Bowler Elizabeth , Chinoy Hector , Gordon Patrick , Wedderburn Lucy , Bagby Stefan , Mchugh Neil , Tansley Sarah
Published: April 2022

Background/Aims

Idiopathic inflammatory myopathies (IIM) are multisystem diseases characterised by muscle inflammation. Over 60% of patients with IIM have a myositis-related autoantibody. Our laboratory specialises in autoantibody testing. We offer an extended spectrum autoantibody testing diagnostic service and have also screened over 3000 myositis patients enrolled in research studies for the presence of autoantibodies. We noticed a recurring pattern following K562 cell radio-immunoprecipitation that was present in several myositis patient sera and in a handful of samples that came to us via the diagnostic service. We set out to determine the antigenic target of this novel autoantibody.

Methods

We have previously screened 1319 serum/plasma samples from IIM patients enrolled in the UKMyoNet and 380 from patients with juvenile onset IIM enrolled in the JDCBS for autoantibodies by immunoprecipitation. Additional cohorts similarly investigated include >150 healthy control sera and >400 SLE patient sera. Patients with the novel autoantibody of interest were identified by a distinctive 120kDa band associated with a ‘smear’ on autoradiography following K562 cell immunoprecipitation and separation of autoantigens by SDS PAGE. ESI-QTOF mass spectrometry was used to identify the antigenic target in an example serum. Using a commercial anti-PARP1 antibody as a control, western blotting of K562 and PARP1 overexpressed cell lysate was used to confirm the antigenic target in remaining samples of interest. Indirect immunofluorescence was performed on HEp-2 cells according to manufacturers’ instructions.

Results

11 patient samples were identified as having the 120 complex ‘smear’ pattern of interest: six had been received via the diagnostic service and five were enrolled in UKMyoNet. Prevalence in the UKMyoNet cohort was 0.4%. Mass spectrometry identified PARP1 as the antigenic target. This was confirmed in all remaining samples by western blot. Table 1 shows available clinical data.

Conclusion

PARP1 is an autoantigen target in myositis patients in addition to those with other rheumatic diseases. Where data was available, patients with anti-PARP1 had features suggesting an anti-synthetase syndrome phenotype, but this may primarily relate to the other autoantibodies present. Further work is needed to determine the prevalence of anti-PARP1 in other cohorts and its clinical associations.

Disclosure

V. Riddell: Grants/research support; Bath Institute of Rheumatic Disease. Z. Betteridge: None. E. Bowler: None. H. Chinoy: None. P. Gordon: None. L. Wedderburn: None. S. Bagby: None. N. Mchugh: None. S. Tansley: None.
P248 Tuberculosis is still a major contributor to serious infection in juvenile SLE
Authors: Chatterjee Rudrarpan , Pattanaik Sarit Sekhar , Gupta Latika , Misra Durga P , Agarwal Vikas , Lawrence Able , Aggarwal Amita
Published: April 2022

Background/Aims

Infections are a major cause of morbidity and mortality in juvenile systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in juvenile SLE.

Methods

We carried out a retrospective review of 175 patients of juvenile SLE (ACR 1997 criteria) with age <18 years visiting the rheumatology clinic at a single centre between 2010 and 2020. Clinical details were retrieved from clinical case records and supplemented with data from the hospital's electronic health records. Major infections (defined as need for hospitalization, prolonged antibacterial therapy >1 week, resulting in disability or death) were recorded. Predictors of infection and their outcomes were determined using multivariate logistic regression and Kaplan Meier survival analysis.

Results

Among 175 patients (154 were girls) with a mean age of 14.79±3.1 years, there were a total of 52 major infections in 43 patients with an incidence rate of 8.83 per 100 person-years. The respiratory tract (19) was the most commonly involved site followed by skin and soft tissue (10), gastrointestinal tract (6), systemic bacteremia (5), ear nose and throat (4), disseminated infection (3), urinary tract (2), central nervous system (1), joint (1) and dengue shock syndrome (1). Organisms isolated were Mycobacterium tuberculosis (11) which was the most common and predominantly extrapulmonary, followed by enterobacteria (12), Staphylococcus aureus (5), cytomegalovirus (3), Herpes zoster (2), Herpes simplex (1), MRSA (1), and Candida (1).

Gastrointestinal involvement (OR 4.21), major organ involvement (OR 2.5), use of cyclophosphamide (OR 7.63), higher baseline SLEDAI (16[11.5-21] vs 12[8.75-16.25]) and a higher daily dose of prednisolone (16.1±15.1mg vs 6.1±5.8mg) at the time of the infection were predictors of a major infection. On multivariate analysis, only higher daily doses of corticosteroids (OR1.09, 95% CI 1.05-1.14) and gastrointestinal involvement (OR 4.98, 1.05-23.65) were significant predictors.

Major infection-free survival at 1 year and 5 years was 82.5% (95% CI 76.8-88.7) and 72.5% (95% CI 65-80.9) respectively. There were eight deaths with five directly attributable to infection. Overall survival was worse in those who had an episode of major infection.

Conclusion

The risk of major infections in juvenile SLE is significant and associated with higher daily corticosteroid use and gastrointestinal involvement at baseline.

Disclosure

R. Chatterjee: None. S. Pattanaik: None. L. Gupta: None. D.P. Misra: None. V. Agarwal: None. A. Lawrence: None. A. Aggarwal: None.
P257 Are there regional variations in access to biological disease modifying anti-rheumatic drugs for the treatment of psoriatic arthritis in England?
Authors: Vivekanantham Arani , Coates Laura , Tillett William
Published: April 2022

Background/Aims

There are regional variations in access to biologic disease modifying anti-rheumatic drugs (bDMARDs) for patients with rheumatoid arthritis in the UK, with relative under-treatment according to established best practice. Similar concerns exist for access to biologic therapies for patients with psoriatic arthritis (PsA). In this study we set out to understand regional variations in access to bDMARDS for the treatment of PsA in England.

Methods

Formularies are mandated to be published by the National Institute for Health and Care Excellence (NICE). ValueBase, a personalised business intelligence company specialising in healthcare, tracks every change for every drug on every published formulary every day with data from January 2017 in 184 formularies. The Availability Index (AI) is used to standardise individual formulary listing differences. It is scored from 0-100 and calculated by dividing the ‘base score’ for prescribing initiators by the ‘prescribing position’. The ‘base score’ values included 0 (not recommended), 5 (unlisted/under review), 30 (restricted availability), 45 (specialist/hospital only), 65 (initiated by specialist, continued in primary care) and 100 (all prescribers). We would expect the optimal score to be > 45 as these are specialist medications. The ‘prescribing position’ included where the drug is ranked on the formulary (e.g., first line).

Results

For anti-TNFa, the mean AI was 45 ([standard deviation] SD 16, minimum 0, maximum 100). For the IL-17 inhibitors, the mean AI was 48 (SD 17, the minimum 0, maximum 100). For the IL-23 inhibitors, the mean AI was 48 (SD 18, minimum 30, maximum 100). For the JAK inhibitors, the mean AI was 24 (SD 22, minimum 0, maximum AI 50). For the other monoclonal antibodies, the mean AI was 45 (SD 14, minimum 0, maximum 100). The rate of formulary adoption for new drugs approved since 2016 varied considerably (Table 1).

Conclusion

There are regional variations in access to bDMARDs for treatment of PsA in England. Such differences have also been demonstrated in other countries (e.g., Sweden) and call for further improvement towards delivering equitable PsA care, both nationally and internationally.

Disclosure

A. Vivekanantham: None. L. Coates: None. W. Tillett: Consultancies; WRT has received research funding, consulting, or speaker fees from Abbvie, Amgen, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer and UCB.
P278 Baseline characteristics and treatment response to ixekizumab categorised by sex in radiographic and non-radiographic axial spondylarthritis patients through 52 weeks: data from three phase III, randomized, controlled trials
Authors: Kiprianos Allan , van der Horst-Bruinsma Irene E , Bolce Rebecca , Hunter Theresa , Calderon David Marcelino Sandoval , Zhu Danting , Geneus Vladimir , Lisse Jeffrey R , Liu-Leage Soyi , Magrey Marina
Published: April 2022

Background/Aims

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease of the axial skeleton comprising two subtypes within the same spectrum: radiographic (r-axSpA) and non-radiographic (nr-axSpA). Previous studies have shown that clinical presentation and treatment response of males and females may differ despite similar disease burden. Ixekizumab (IXE), a high-affinity monoclonal antibody that selectively targets interleukin-17A, has demonstrated superior efficacy to placebo in the treatment of patients with r-axSpA (COAST-V/W [bDMARD-naïve/TNFi-experienced]) and nr-axSpA (COAST-X [bDMARD-naïve]). Here we report baseline characteristics and treatment response to IXE categorised by sex in patients with r-axSpA and nr-axSpA for up to 52 weeks.

Methods

Patients fulfilled the ASAS classification criteria for r-axSpA or nr-axSpA. Patients were randomized to receive 80 mg subcutaneous IXE every two weeks (Q2W) or four weeks (Q4W), or to placebo (PBO; 16 weeks COAST-V/W; 52 weeks COAST-X). Baseline characteristics and treatment outcomes were assessed. Patients were categorised by sex; missing data were controlled for using non-responder imputation (NRI) and modified baseline observation carried forward (mBOCF) analysis was conducted on continuous efficacy variables.

Results

At baseline, females were older, with significantly higher pain and fatigue scores and peripheral joint symptoms. ASAS40 response rate with IXEQ4W was achieved in 39% of males with r-axSpA by week 16, and 44% by week 52. Females achieved 16.7% at week 16, and 33.3% at week 52. In nr-axSpA, 46% of IXEQ4W males achieved ASAS40 at week 16 and 30% at week 52. 23.9% of females achieved ASAS40 at week 16, increasing to 30.4% at week 52.

Conclusion

This analysis demonstrates that, for the axSpA disease spectrum, females present with higher disease burden as reflected by higher scores in fatigue/tiredness, and spinal pain at night. Our findings indicate that males and females respond to IXE; however, females experience this benefit later in their treatment course, with a more prolonged attainment of peak response.

Disclosure

A. Kiprianos: None. I.E. van der Horst-Bruinsma: None. R. Bolce: Shareholder/stock ownership; Eli Lilly and Company. T. Hunter: Shareholder/stock ownership; Eli Lilly and Company. D. Marcelino Sandoval Calderon: Shareholder/stock ownership; Eli Lilly and Company. D. Zhu: Shareholder/stock ownership; Eli Lilly and Company. V. Geneus: Shareholder/stock ownership; Eli Lilly and Company. J.R. Lisse: Shareholder/stock ownership; Eli Lilly and Company. S. Liu-Leage: Shareholder/stock ownership; Eli Lilly and Company. M. Magrey: None.
P296 Giant cell arteritis/large vessel vasculitis with normal inflammatory markers: a case series of 15 patients in south Manchester
Authors: Chua Ezolene P
Published: April 2022

Background/Aims

An elevated ESR is a criterion for giant cell arteritis (GCA) in the 1990 ACR classification. An international case series of GCA with normal inflammatory markers has been described. We describe characteristics and estimate the incidence of patients with GCA/large vessel vasculitis (LVV) with normal or minimally elevated inflammatory markers in south Manchester.

Methods

Temporal-axillary artery ultrasound (TAUS) has been the first line investigation modality in the local GCA fast track pathway (FTP) since 2019. TAUS, performed between April 2019 and May 2021, were reviewed. Clinical notes were reviewed if patients had scan findings positive for hypoechoic halos. Basic demographics and clinical details were further collected for cases with ESR <50mm/hr or CRP <20mg/dL to characterise their clinical profile.

Results

15 patients had positive TAUS with ESR <50mm/hr or CRP <20mg/dL. 10 patients were male (66.7%) and 5 were female (33.3%). 14 (93.3%) patients were of Caucasian race, while 1 was of African Black origin (6.7%). Median age at presentation was 66 years (63-74). Median BMI was overweight at 29kg/m2. Headache was the most common symptom in 13 patients (86.7%), followed by jaw and ocular complaints in 7 patients each (46.7%), and polymyalgia rheumatica in 3 patients (20%). Fevers and weight loss were each noted in 1 patient (6.7%). Median duration of symptoms before referral to our centre was 21 days (7-51). Formal ophthalmology assessment did not identify any patient with ocular damage. Median ESR was 17mm/hr (10- 21) and CRP 3.5g/dL (2-4.8). Median duration of steroids before TAUS was 0 days. In 1 patient, diagnosis of LVV was further confirmed by PET scan, while in another, it was further confirmed by MR and CT aortogram. 2 cases (13.3%) were relapses of GCA - 1 of which was previously confirmed on histology. All patients indicated symptom response to corticosteroids. Repeated TAUS in 8 patients noted 3 resolution, 3 improvement, 1 unchanged and 1 slight worsening. 6 (40%) patients required DMARDs (2 tocilizumab and 4 methotrexate).

Conclusion

TAUS facilitates early diagnosis of atypical GCA/LVV in patients who present with relatively normal inflammatory markers - our time-to-scan from steroid treatment was a median of 0 days. Early definitive treatment may explain the absence of ophthalmic morbidity amongst our patients. With an estimated population of 137,000 in south Manchester, these 15 cases suggest an incidence of atypical GCA/LVV to be 5.5 per 100,000 people. The elevated median BMI of our patients challenges the traditional notion that baseline ESR should be adjusted in patients with increased body mass. Relatively prolonged symptom duration (median 21 days) before referral to our FTP also challenges the notion that normal inflammatory markers in GCA/LVV reflects the window period of early presentation before disease evolution with subsequent inflammatory rise.

Disclosure

E.P. Chua: None.
P302 Trends in hospital admissions in patients with ANCA-associated vasculitis before and during the COVID-19 pandemic
Authors: Odingo Myron , Rutter Megan , Lanyon Peter , Grainge Matthew , Groves David , Bythell Mary , Aston Jeanette , Stevens Sarah , Pearce Fiona
Published: April 2022

Background/Aims

People with ANCA-associated vasculitis (AAV) have high rates of hospital admissions. They may have emergency admissions at the time of diagnosis, or day case admissions to receive immunosuppressive treatment. We describe the trends in emergency and day case admissions over the past 9 years, and the effect of the COVID-19 pandemic.

Methods

We extracted hospital episode statistics available publicly from NHS Digital for 2012/13 to 2019/20 and added provisional data from the National Congenital Anomaly and Rare Disease Registration Service for 2020/21 under their legal permissions (CAG 10-02(d)/2015) because the publicly available data had not yet been released. We extracted all emergency and day-case admission rates with ICD codes for each AAV subtype (M301, M313 and M317, in the primary position denoting main admission diagnosis). We used England population estimates from the Office for National Statistics as the denominator for rates. We calculated Poisson confidence intervals to quantify the difference in rates between 2019/20 and 2020/21 financial years.

Results

Rates of day case admissions per 1,000,000 for AAV increased from 49.1 (47.2 - 50.9) in 2012/13 to 63.3 (61.2 - 65.4) in 2019/20, then decreased by 26.4% to 48.6 (46.7 - 50.4) in 2020/21 (Table). The trends in emergency admissions were relatively unchanged between 2012/13 and 2019/20 (mean 6.7 per 1,000,000), and there was no significant decrease in emergency admissions during the COVID-19 pandemic.

Conclusion

Day case admission rates increased between 2012/13 and 2019/20 but decreased during the COVID-19 pandemic. Emergency admission rates for patients with AAV remained relatively unchanged, despite the context of the significant disruption and reconfiguration of healthcare services. Further work on patient-level data is needed to establish whether the day case reduction is due to fewer new patients or relapsing patients being diagnosed (and therefore fewer remission induction infusions) during this period or altered clinical practice leading to postponement of planned remission maintenance treatment that would have usually been given. Alternatively, this change may reflect a change in clinical practice to preferentially use oral rather than IV agents. All of this may have future consequences both for clinical practice and individual patient care and outcomes post-pandemic.

Disclosure

M. Odingo: None. M. Rutter: None. P. Lanyon: Grants/research support; Grants/research support; PCL has received funding for research from Vifor Pharma. M. Grainge: None. D. Groves: None. M. Bythell: None. J. Aston: None. S. Stevens: None. F. Pearce: Grants/research support; Grants/research support; FAP has received funding for research from Vifor Pharma.
P305 Validating diagnostic GCA ultrasonography skills against an expert sonographer
Authors: Coath Fiona L , Mukhtyar Chetan
Published: April 2022

Background/Aims

Ultrasonography has become the recommended first line investigation for suspected giant cell arteritis (GCA). However, it is still not yet widely available in the UK due to a paucity of skilled rheumatologists. Effective training programmes have been developed, but subsequent hands-on practice is needed to become truly proficient. There is no consensus on the logistics of gaining the ‘appropriate’ level of skill. This project demonstrates a potential mechanism for validation against an expert sonographer.

Methods

Over a 6-month period, 12 scans of patients referred with suspected GCA were sequentially performed by first a trainee (FC) and then an expert sonographer (CM) on the same day. FC had theoretical knowledge and supervised practical experience but had not scanned independently prior to this project. CM has performed >1000 scans. 6 vascular territories considered to be the core GCA US data set (common, frontal and parietal branches of the superficial temporal artery, and the 1st, 2nd and 3rd part of the axillary artery) were marked as either ‘normal’ or ‘halo’. CM was blinded to FC’s results. Inter-observer reliability was calculated for all vascular territories using Cohen’s kappa.

Results

A total of 144 vascular territories were scanned in 12 patients. Table 1 details the inter-observer variation, with a near perfect level of agreement demonstrated, kappa=0.90 (95% CI 0.83 - 0.98).

Conclusion

This is the first study that demonstrates a mechanism for validation of ultrasonography skills which will allow GCA US to become a feasible reality in clinical practice. This project demonstrates that after acquiring supervised training, near perfect levels of agreement can be arrived between a trainee and expert.

Disclosure

F.L. Coath: None. C. Mukhtyar: None.
A Standardized Technique for Gummy Smile Treatment Using Repeated Botulinum Toxins: A 1-year Follow-up Study
Authors: Adel Noury
Published: April 2022

The present study was performed to evaluate the effect of repeated botulinum toxin injections and their long-term effects, using a customized injection point and dosage technique in the treatment of excessive gingival display. Twenty women who had gummy smile due to hypermobility of the upper lip or gingival display, ranging from 4 to 6 mm‚ were included in the study. All patients were injected with Botox injections at different injection points according to the type of smile. Pre- and postoperative measurements were taken by measuring digitally the gingival display at smiling, using Adobe Photoshop software via standardized digital photographs. Patients were followed up at 14 days, 4 months, 8 months, and 12 months. Postoperative measurements showed marked improvement at 14-day follow-up, with a significant reduction in the amount of gingival display. Relapse, however, occurred at 4 months and later. For excessive gingival display, Botox is an effective treatment that lasts for 2–3 months, with almost complete relapse at 4 months. We concluded from the results of our study that, despite repeated Botox injections at two follow-up intervals (4 and 8 months), the theory that repeated Botox injections may offer a permanent effect is still questionable.
Implementation of an At-home Blood Pressure Measurement Protocol in a Hypertension Management Clinical Trial During the COVID-19 Pandemic
Authors: Miller Hailey N. , Berger Miriam B. , Askew Sandy , Trefney Elizabeth , Tyson Crystal , Svetkey Laura , Bennett Gary G. , Steinberg Dori M.
Published: April 2022

Background

The Dietary Approaches to Stop Hypertension eating plan is an evidence-based treatment of hypertension; however, adherence to the Dietary Approaches to Stop Hypertension is low. To improve adherence to the Dietary Approaches to Stop Hypertension among adults with hypertension, we designed Nourish, a 2-arm, 12-month randomized controlled trial. The COVID-19 pandemic necessitated a change from in-person to remotely delivered visits, requiring substantial protocol modifications to measure blood pressure accurately and safely for secondary outcome data.

Purpose

The purpose of this article is to describe the implementation of an at-home blood pressure measurement protocol for the Nourish trial.

Conclusion

Our investigator team and study staff developed and implemented a robust and feasible blood pressure measurement protocol to be executed within an at-home format.

Clinical Implications

The described blood pressure measurement protocol provides a framework for use in future clinical trials and clinical settings in which a remote visit is preferred or required.
Comfort Level of Occupational and Physical Therapist Students in Addressing Sexual Issues With Patients
Authors: Dockter Mary , Parker Michael , Gebeke Lauren , Scheresky Kara , Tulintseff Alexandra , Truscinski Madison , Ver Burg Kyle , Abraham Karen , Reisch Rebecca
Published: April 2022

Introduction.

Addressing a patient's sexuality and sexual health is an important component of holistic health care, but there are several challenges affecting students' comfort levels. Studies have indicated that patients want to talk about sexual issues, but there is a lack of conversation initiation from the health care providers. Although there is research to indicate that occupational therapists (OTs) are more comfortable than physical therapists (PTs) in discussing sexual issues, both professions report a lack of content within their respective programs. The purpose of this study was to determine comfort levels of OT and PT students when discussing and addressing sexual issues, as well as demographic factors that might influence comfort level and perceived barriers.

Methods.

A survey was sent to OT and PT students from 3 different universities inquiring as to the respondent's demographics, academic and clinical training, comfort level with various patient scenarios, and perceived barriers to addressing sexual issues. Mann -Whitney U and Kruskal -Wallis statistical tests were used to analyze the differences in comfort levels between groups of students, and open ended questions were coded into themes based on similarity and frequency of responses.

Results.

A total of 128 students completed the survey. Third-year students, regardless of professional program, were more comfortable addressing sexual issues compared with first-year students. The most common barriers to addressing sexual issues with patients included lack of experience and lack of knowledge.

Discussion and Conclusion.

Overall, the comfort level was affected by age, academic year, personal demographics, and perceived confidence. Neither geographical location nor religious background had a significant influence on student comfort level.