bluuebunny/crossref_metadata_2025 huggingface dataset:
P086 Service evaluation of ultrasound use in patients with juvenile idiopathic arthritis in a UK tertiary paediatric rheumatology centre, as the first step towards developing an evidence-based guideline
Authors: Stead Lucy A , Malde Nishi , McCann Liza , Barnes Nik , Landes Caren , Gargh Kapil
Published: April 2023

Background/Aims

Some studies have shown that ultrasound can be more sensitive than clinical examination in detection of synovitis and improves diagnostic accuracy when clinical examination is in doubt. This study aimed to review if ultrasound results correlate with the clinical impression in patients with juvenile idiopathic arthritis (JIA) and determine if imaging helps to change management and assist in the optimisation of radiology resources, by improving our knowledge of when ultrasound is suitable.

Methods

We designed a retrospective study to review cases of JIA aged 1-18 years who have had an ultrasound requested from clinic between September 2021 - April 2022. Patients were excluded from study if; diagnosis was uncertain, new patients with JIA and patients with arthritis as part of a systemic inflammatory disorder. Data was collected from the radiology database and electronic patient record (MEDITECH).

Results

A total of 40 patients matched eligibility criteria with ultrasound performed on average 4 weeks after request. 13 (32.5%) male and 27 (67.5%) female with an average age of 11.7 years (3 -18 years). Of these patients 16 (40%) failed to demonstrate any active clinical signs of arthritis or tenosynovitis in clinic. The most common reasons for scan in this cohort included parental concern (43.75%) and difficulty of examination (12.5%). Other reasons included: patient reporting pain or morning stiffness in the absence of clinical signs during the consult. In these patients 13 (81.25%) were normal and 3 (18.75%) demonstrated chronic changes. Ultrasound in these patients did not lead to any change in treatment. 22 (55%) of patients demonstrated clinical signs of arthritis in clinic. 7 (31.2%) of these demonstrated active arthritis or tenosynovitis and subsequently had treatment changes in the form of a steroid injection (n = 5) or change in systemic medication (n = 5). Of those that had clinical signs but no active arthritis on ultrasound, 8 (36.4%) scans were found to be non-diagnostic / demonstrated chronic synovial thickening and 7 scans were normal (32%). 2 (5%) patients were seen in virtual clinic and not examined; both had a normal scan. Small joints of the ankles (26%) and hands (23%) are the most common joints scanned.

Conclusion

The use of ultrasound demonstrates benefit when clinical findings are present, and the scan allows clinicians to differentiate between active synovitis, tenosynovitis and chronic damage. In patients whose clinical examination does not show signs of inflammation, there is less evidence in this study for the use of ultrasound, and we should trust our clinical acumen.

Disclosure

L.A. Stead: None. N. Malde: None. L. McCann: None. N. Barnes: None. C. Landes: None. K. Gargh: None.
P095 Fibromyalgia correlates with neurodivergent traits in a self-selected community population
Authors: Ryan Laura , Beer Harriet , Thomson Ella , Philcox Edward , Kelly Clive
Published: April 2023

Background/Aims

Chronic musculoskeletal pain is now a common feature among younger women. Many such women exhibit a range of additional physical and psychological features and fulfil criteria for fibromyalgia. Hypermobility, irritable bowel syndrome and migraine are frequent comorbid conditions. These are all in part mediated by dysfunction of the autonomic nervous system and commonly include fatigue, poor sleep and brain fog. Anxiety, social withdrawal and a range of autistic traits are frequently described by those with chronic musculoskeletal pain, and autistic people are over-represented among patients attending pain clinics. This study was designed to explore the correlation between the degree of pain and autistic traits described within a self-selected community-based population.

Methods

The study used a nonexperimental, correlational design with data collected from a volunteer sample of 448 adults (aged 18-60) who completed online self-report questionnaires assessing each of autistic traits (RAADS score), fibromyalgia symptoms (ACR criteria) and hypermobility (Beighton’s test). Correlation analysis and linear regressions were used to test the relationships between each disorder. Data was analysed using parametric and non-parametric techniques to assess prevalence, strength and significance of relationships, causes of variance within populations and mediations.

Results

Our self-selected community population had a mean age of 24 years and was 77% female. The prevalence of significant autistic traits, fibromyalgia and hypermobility were all much greater than expected at 65%, 40% and 44% respectively. Those identifying as non-binary or trans had the highest rates. Fibromyalgia was strongly associated with autistic traits, with dysautonomia a better predictor than chronic pain. Regression analyses revealed hypermobility partially mediated the relationship between autistic traits and fibromyalgia.

Conclusion

This is the first community study to provide evidence for a direct association between fibromyalgia and neurodivergent traits. Although self-selected, the findings in our predominantly young population confirm that these conditions are common and that those with autistic traits are at significantly increased risk of developing fibromyalgia, especially if they are hypermobile. Those who self-identify as non-binary or trans appear at particular risk of developing features of fibromyalgia.

Disclosure

L. Ryan: None. H. Beer: None. E. Thomson: None. E. Philcox: None. C. Kelly: None.
P139 Rituximab in a large UK centre during the COVID-19 pandemic: the effects of employing a reduced dosing regimen on clinical response in Rheumatoid Arthritis patients
Authors: McLorinan Joanna , Slade Maria , Leong Chi-han , Baker Josie , Bailey Lynda , Nam Jacqueline , Bissell Lesley-Anne , Emery Paul , Dass Shouvik , Saleem Benazir
Published: April 2023

Background/Aims

When the COVID-19 pandemic began, steps were taken to minimise risk to those vulnerable to severe outcomes. For immunosuppressed patients with rheumatoid arthritis (RA), consideration was given to reducing risk whilst mindful of compromising control of their underlying condition. At Leeds Teaching Hospitals NHS Trust, patients receiving rituximab (RTX) were considered for a reduced dose regimen. A retrospective study, using real-world data, was undertaken to assess the impact of lower doses of RTX on response to treatment.

Methods

The clinical records of all patients with RA who had received RTX between March 2020 and March 2021 were reviewed. Demographics and previous RTX exposure were recorded. The dose of RTX given during the specified period was noted. Response to treatment was recorded pragmatically by physicians as good, partial or none, based on patient reported VAS for disease activity and swollen and tender joint counts, given the limitations placed on face-to-face patient review due to the pandemic. The time to subsequent RTX treatment and the need for steroid treatment for flares was also studied.

Results

The number of patients treated with RTX was 282, of whom 89 patients received full dose (1g x 2 infusions), 192 patients received half dose (500mg x 2 infusions). The mean age was 61 years. 77% were female. 9% were RTX-naive, 80% had previously had full dose. Follow-up data were available for 185/192 of the group receiving 1g and 88/89 of the group receiving 2g. Clinical outcomes were as follows for the two groups (1g RTX vs 2g RTX): no response 10.3% vs 9.1%; partial response:34.9% vs 20% %; good response: 54.8% vs 70.9%. The mean length of response was 7.5 months in the patients receiving 1g of RTX compared to 8.6 months in the group receiving 2g of RTX. Similar number of patients required steroid for a flare after receiving Ig of RTX (23.9%) compare to those receiving 2g of RTX (25.8%).

Conclusion

A majority of patients receiving RTX for RA at either standard or reduced dose reported clinical response. Those receiving lower dose RTX were more likely to report a partial response whilst those receiving full dose were more likely to report a good response. Duration of response and need for steroid therapy for flare of RA between treatments did not significantly differ between groups. Further analysis of factors that may influence clinical response to lower dose RTX is ongoing, which could guide tailored therapy regimens should the need arise again.

Disclosure

J. McLorinan: None. M. Slade: None. C. Leong: None. J. Baker: None. L. Bailey: None. J. Nam: None. L. Bissell: None. P. Emery: None. S. Dass: None. B. Saleem: None.
P155 Function is impaired during patient-reported idiopathic inflammatory myopathy flares - results from a longitudinal smartphone-based study
Authors: Howard Georgia , Krogh Niels S , Dixon William , Chinoy Hector , Oldroyd Alexander
Published: April 2023

Background/Aims

Idiopathic inflammatory myopathy (IIM) is a chronic autoimmune inflammatory disease characterised by myositis, thus impacting function and activities of daily living. Patients frequently refer to an exacerbation of IIM symptoms as a “flare”, however IIM flares have not been defined. High-frequency data collected via ubiquitous digital technologies, such as daily patient-reported outcome measurements, provide the opportunity to identify novel findings. This study aims to investigate associations between patient-reported IIM flares and function, thus characterising a priority area for patients.

Methods

The Myositis Physical Activity Device Study recruited a UK-based adult IIM cohort who completed weekly function and flare questions (i.e. every 7 days) via a specially designed smartphone-based app throughout a 13 week period in 2019/20. Weekly function questions, selected as priorities by a patient focus group from the Health Assessment Questionnaire, addressed carrying, exercise, socialising, reaching, and bending (4-point ordinal answers). A weekly flare question (binary “yes”/“no”) was also asked. The distribution of answers for function questions in participant-reported flare and non-flare weeks was calculated. Fisher’s exact test was used to determine whether there is a statistically significant difference between ‘flare’ and ‘non-flare’ weeks within each domain.

Results

Data on 21 participants (65% female) were collected across thirteen study weeks. In total, 1330 function questions and 266 flare questions were answered. 83 flare weeks and 183 non-flare weeks were reported. A lower proportion of answers across each function domain were answered as “without any difficulty” in flare weeks, compared to non-flare weeks (Table 1); the proportional difference was greatest for carrying and exercising. A higher proportion of answers across each function domain were answered as “with some difficulty” or “with much difficulty” in flare weeks, compared to non-flare weeks; the proportional difference was greatest for reaching and bending. Statistically significant difference (p-value <0.05, calculated via Fisher’s exact test) of all domains was observed between flare and non-flare weeks.

Conclusion

Functional impairment is associated with patient-reported IIM flare. The impact of flares upon activities of daily living highlights the need for further characterisation of IIM flares and the potential of patient-reported flares as a “digital biomarker” via smartphone-based app reporting.

Disclosure

G. Howard: None. N.S. Krogh: None. W. Dixon: None. H. Chinoy: None. A. Oldroyd: None.
P166 Parotid benign lymphoepithelial cyst in connective tissue disease: a rare case series and literature review
Authors: Palaniappan Nachammai , Nallasivan Subramanian
Published: April 2023

Background/Aims

Benign lymphoepithelial lesions are swellings of salivary glands caused by a reactive lymphoid infiltrate with follicular hyperplasia, obliterating the acinar glands and causing proliferation and disruption of the ductal epithelium. These have been described in HIV, lymphoma and Sjögren's syndrome. We report a case series with mixed connective tissue disease/Sjögren's syndrome and reviewed the literature with similar presentations in order to highlight this unusual manifestation.

Methods

Index patient: A 25-year-old lady presented with a history of arthralgia, fatigue and Raynaud's 3 years ago and was diagnosed by rheumatologist to have MCTD with ANA showing U1RNP, Ro positive and histones antibody positive. She was managed with mycophenolate and improved. A year ago she developed parotitis which improved with antibiotics. She recently came to the outpatient department with painful swelling in the parotid region. Blood counts remain normal, ESR 36 mm/hr , CRP 6 mg/dl, ACE level, HIV screening normal. MRI parotid showed bilateral multiple lymphoepitheial cysts in the parotid glands. Opinion was obtained from oncology and the ENT surgeon. No evidence of malignancy was found. In view of this, consensus opinion among rheumatologists was to stop mycophenolate and give 2gm rituximab. We also reviewed 10 cases of benign lymphoepithelial cyst arising in the parotid region in acquired immunodeficiency syndrome negative patients. Cases were from 8 published articles plus the three cases of benign lymphoepithelial cyst in a mixed connective tissue disease/Sjögren's syndrome in AIDS negative patients reported in Table 1. Most of the patients had been treated surgically, however, immune therapy is sufficient.

Results:

Conclusion

Benign lymphoepitheial cysts have been described in patients with sarcoidosis, HIV, cancer and CTD. Our patients had features of MCTD with Sjögren's syndrome and manifested with benign lymphoepithelial cysts in the parotids, which is very unusual. Parotid swelling in connective tissue disease requires evaluation and multidisciplinary input. Benign lymphoepithelial cysts will not require any surgery; once malignancy is excluded, they will require modification of immune therapy.

Disclosure

N. Palaniappan: None. S. Nallasivan: None.
P183 Disease activity, comorbidities and functional status predict treatment response to biologic and targeted synthetic disease-modifying anti-rheumatic drugs in psoriatic arthritis
Authors: Addae-Kyereme Christine , Lembke Stephanie , Macfarlane Gary J , Jones Gareth T
Published: April 2023

Background/Aims

Much discussion surrounds the optimal therapeutic treatment plan for biologic and targeted synthetic disease modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) when treating psoriatic arthritis (PsA). The current study aims to identify predictors of treatment response among PsA patients initiating bDMARD/tsDMARD treatment, focusing on disease activity, functional status (Health Assessment Questionnaire, HAQ), and comorbidities.

Methods

The systematic review of clinical trials and observational studies used Medline, Embase and Cochrane databases. Eligible studies included full text papers with quantitative estimates of effect (or data to allow these to be computed). Papers also required a validated assessment of treatment response i.e., Minimal Disease Activity (MDA), or some other marker of treatment response such as treatment continuation. Case reports and conference abstracts were excluded.

Results

From 2824 articles identified, 27 were included. Across these, >15 different outcomes were used, and measured at > 10 different timepoints. There was consistent evidence to suggest that higher baseline disease activity was associated with a reduction in the likelihood of treatment response, see Table 1. Some studies reported up to 20% reduction in odds of LDA at 6 months associated with each 1 unit increase in DAPSA. Others demonstrated that patients with a high DAS28 (>3.2) experienced over a 90% reduction in the odds of MDA at 12 weeks. Eleven studies (from 15) demonstrated a significant association between baseline function and odds of treatment response. Each 1 unit increase in HAQ-DI decreased the odds of a good EULAR response at 3 months by up to 66%. The presence of comorbidities was also consistently associated with a decrease in treatment response. Studies showed that the presence of comorbidities at baseline lessened the odds of MDA at 6 months by up to 80%. Others reported that comorbidities were associated with a reduction in the odds of 5 year treatment persistence by up to 40%.

Conclusion

This review shows clear evidence of reduced bDMARD/tsDMARD response in PsA among patients with disease activity, poor function, and comorbidities. Clinicians should be aware of the reduced chances of treatment success and should consider early review of therapy, to consider whether treatment escalation or switching is required.

Disclosure

C. Addae-Kyereme: None. S. Lembke: None. G.J. Macfarlane: None. G.T. Jones: None.
P195 Use of the Giant Cell Arteritis Score (GCAPS) in a district general hospital
Authors: Waller Rosemary , Carty Sara , Schmitt Tobias
Published: April 2023

Background/Aims

The Giant Cell Arteritis Score (GCAPS) was developed by the specialist team in Southend, Essex, UK in 2018. It is a clinically focused tool to aid diagnosis of GCA by providing a pre-test probability, with a threshold of greater than 9 denoting higher risk of GCA requiring further diagnostic testing. So far, it has been validated externally in patients in 2 centres. In all cases, scoring was completed by a rheumatology consultant. We are keen to validate it in our setting, a district general hospital without rapid access to vascular ultrasound, to determine whether it was a valid and reliable tool for assessing which patients required temporal artery biopsy and which patients could rapidly taper steroids following a negative result. We also aimed to see whether scoring could be completed by clinicians other than rheumatology consultants.

Methods

We retrospectively applied the GCAPS score to all patients referred as possible GCA to our service between November 2021 - April 2022 by reviewing clinical notes. A medical student (TS) with no prior experience was trained to use the score, with scoring independently repeated by a rheumatology consultant (RW).

Results

34 patient records were reviewed. 14 (41%) were male, mean age 70.5 (range 49 - 89). 6 had biopsy confirmed GCA, 7 had a clinical diagnosis of GCA and 21 had a low probability of GCA. All 13 patients with biopsy confirmed or clinical GCA were scored > 9 by both assessors. There was GCAPS agreement in 7/34 patients (21%). Of 27 patients with differing scores, TS gave a higher score in 17 (50%). In 4 patients, there was a difference in probability threshold. In all cases, the patient was scored more highly by TS. None of the patients had a final diagnosis of GCA. 5 patients had known GCA and a relapse was being questioned. 2/5 had a flare - one clinical and one biopsy proven. The GCAPS was >9 in both patients. There were no missing data.

Conclusion

We have demonstrated that it is possible to train someone without prior experience to use GCAPS. There were differences in probability threshold in 4 patients, with the less experienced assessor tending to overscore. The GCAPS is applicable in our non-specialised centre and is feasible to use as evidenced by the lack of missing data. No patients with a GCAPS under 9 had a final diagnosis of GCA. This good negative predictive value is in keeping with previously published data. In a small patient number, the GCAPS threshold remained valid in distinguishing relapse. We feel GCAPS has two roles. It can be used to triage who needs review in rheumatology clinic. It can also be used in rheumatology clinic to determine who requires temporal artery biopsy.

Disclosure

R. Waller: None. S. Carty: None. T. Schmitt: None.
E010 Checkpoint inhibitor-induced rheumatological adverse events: real-world experience from Northeast England
Authors: Gault Abigail , Williams Kristian , Stewart Christopher , Anderson Amy E , Plummer Ruth , Pratt Arthur G
Published: April 2023

Background/Aims

Immune checkpoint inhibitors (CPIs), in the form of either single agent anti-PD1 or combination therapy with anti-PD1/anti-CTLA4 monoclonal antibodies, are widely used in clinical practice. Whilst CPI-induced rheumatological immune-related adverse events (RirAEs) are relatively infrequent compared to other toxicities (8-12%), increasing CPI use in oncology settings means a growing number of patients are affected. As part of an audit of inter-specialty referrals, we evaluated patients developing new musculoskeletal symptoms on CPI treatment and the breadth of specialist-confirmed RirAEs.

Methods

Two sources of data were reviewed. First, consecutive consultant-confirmed RirAE cases in our rheumatological service between 2017 and 2022 (referred to as the ‘RirAE cohort’) were evaluated. Second, an observational cohort of 50 consecutive oncology patients treated with CPIs from 2019-2022 in whom symptom questionnaires had been completed (“Oncology cohort”) was reviewed. Local audit registration/safeguarding approvals were obtained. Medical records were reviewed by two medical professionals, and anonymised data analysed in a spreadsheet.

Results

24 patients were identified in the RirAE cohort, of whom most presented with arthritis (Table 1). Amongst 50 patients in the Oncology cohort, 20 (40%) reported new-onset/worsening musculoskeletal symptoms on a questionnaire (“MSK-symptomatic Oncology Cohort”). Three of these were referred, diagnosed and counted amongst the RirAE cohort. Of the remaining 17, 6 were identified as having developed musculoskeletal pain by consulting oncologists; the remaining 11 were not objectively identified as having experienced potential musculoskeletal toxicity (Table 1).

Conclusion

Confirmed RirAEs comprised predominately seronegative, oligoarticular presentations with notable PMR overlap. In the oncology setting, the self-reported joint symptoms of 20/50 (40%) patients were identified by a physician and 3/9 of these (33%) were referred for a specialist opinion. RirAEs may be more common than appreciated amongst CPI recipients, and the extent of low-grade inflammatory arthritis unreported or “hidden” amongst other irAEs is not clear. Early evaluation of new-onset musculoskeletal symptoms in CPI recipients, and close cross-specialty collaboration, could reduce morbidity for patients who already face significant health challenges.

Disclosure

A. Gault: None. K. Williams: None. C. Stewart: None. A.E. Anderson: None. R. Plummer: None. A.G. Pratt: None.
E014 Severe myocarditis with cardiogenic shock in adult-onset Still’s disease after mRNA COVID-19 vaccination: a case of atypical presentation
Authors: Kan Andy Ka Chun , Yeung Winnie Wan Yin , Lau Chak Sing , Li Philip H
Published: April 2023

Background/Aims

Adult-onset Still’s disease is a systemic inflammatory disease of unknown aetiology. Post-COVID-19 vaccine adult-onset Still’s disease has been reported and was associated with only mild myocarditis. Here we report the first case of adult-onset Still’s disease after mRNA COVID-19 vaccination presenting with severe myocarditis with acute heart failure and cardiogenic shock.

Methods

We described the case history of the patient.

Results

A 72-year-old Chinese woman developed gradual onset of fever, shortness of breath, sore throat, generalised arthralgia, malaise and poor appetite 15 days after receiving the first dose of BNT162b2 mRNA COVID-19 vaccine. Physical examination revealed fever, bilateral ankle oedema and elevated jugular venous pressure. Significant investigation results are shown in Table 1. Extensive viral panel tests (including enterovirus, influenza and cytomegalovirus) were all negative. Echocardiography showed severely reduced left ventricular ejection fraction of 20%. The acute heart failure was complicated by cardiogenic shock requiring intensive care unit admission. Myocarditis was later diagnosed. Although the heart condition subsequently improved, there were persistent fever and arthralgia, as well as the development of generalised maculopapular skin rash. In view of that, series of investigations were performed, which revealed persistent neutrophilic leucocytosis, hyper-ferritinaemia and liver function derangement, while autoimmune panel was grossly unremarkable and septic/viral workup was negative (Table 1). Contrast PET-CT scan showed no features of malignancy. Adult-onset Still’s disease was diagnosed, and the patient was treated with oral prednisolone 40mg daily. The patient’s condition responded to the treatment; the fever subsided and the leucocyte count and inflammatory markers were normalised, and she was subsequently discharged. Three months after discharge, the patient was clinically well with prednisolone tapered down to 5mg daily. Reassessment echocardiogram showed full recovery with LVEF 60%.

Conclusion

Severe myocarditis with acute heart failure and cardiogenic shock is a possible initial presentation of adult-onset Still’s disease after mRNA COVID-19 vaccination. After exclusion of more common aetiologies, it is important to consider adult-onset Still’s disease as one of the differential diagnoses in the presence of compatible features following COVID-19 vaccination, such that appropriate and timely workup and treatment can be offered.

Disclosure

A. Kan: None. W. Yeung: None. C. Lau: None. P.H. Li: None.
E040 Disease flare-ups after SARS-CoV-2 vaccination among patients with rheumatic and musculoskeletal diseases in a Rheumatology Specialized Care Center: Sri Lanka
Authors: Ubhayasiri Sasheela K , Abeysinghe Duminda
Published: April 2023

Background/Aims

In the recent past, there has been growing research interest in COVID-19 vaccines and their impact on the disease dynamics of rheumatic and musculoskeletal diseases (RMDs). The intersection of COVID-19 and autoimmunity has led to the theoretical possibility of flare-ups of autoimmune diseases with COVID vaccines. This study was conducted to evaluate the occurrence and the nature of flare-ups following the COVID vaccination on patients with RMDs.

Methods

This cross-sectional analytical study was conducted at Ragama Rheumatology and Rehabilitation Hospital, Sri Lanka involving 248 clinic patients using a structured questionnaire.

Results

The mean age of the study population was 52.69 and 75.4% were females. 12 patients (4.7%) reported flare symptoms following 1st dose of vaccination. Of them, 67% were females and 41.7% were within the 40-45 years age group. 75% of patients have experienced the onset of the flare symptoms following 1 week of the vaccination and 41.7% of symptoms have lasted more than 8 weeks. 66.7% who had this flare have received Sinopharm, while 25% received Covishield. In this flare 58.3% got polyarthritis,16.7% monoarthritis, 8.3% oligoarthritis and 16.7% generalized rash. By contrast, 42 (16.9%) patients who received the 2nd dose of the vaccine had flare symptoms. 90.5% of this population were females and 38.1% were within the 50-59 years age group. 42% got flare following 1st week of the vaccination and 57% of symptoms have lasted more than 8 weeks. 5 patients who had flare symptoms following the first dose reported having flare after the 2nd dose too. None of the flare symptoms following 1st or 2nd dose of the vaccinations needed hospitalization. Interestingly gender (p = 0.012), use of methotrexate (p = 0.043), and the presence of flare to the first dose (p = 0.02) were found to be significantly correlated with the occurrence of flare symptoms following 2nd dose of vaccination.

Conclusion

This study reveals a considerable incidence of non-severe RMD flare-ups following COVID vaccination, mainly with the 2nd dose. Further studying on the effects of repeated and periodic COVID vaccination among patients with RMDs is timely to reassure and to improve vaccine acceptance in this group of patients.

Disclosure

S.K. Ubhayasiri: None. D. Abeysinghe: None.
E049 The Initial Impacts of the UK-Wide Rheumatology Physiotherapy Capabilities Framework
Authors: Gregory William J , Chambers Hannah , McCrum Carol
Published: April 2023

Background/Aims

The Rheumatology Physiotherapy Capabilities Framework, first published September 2021, was developed to describe the physiotherapy-specific skills and knowledge unique to the speciality and to act as a profession standard. Dissemination strategies for the framework included profiling through professional organisations, specialist interest groups and online via Twitter and ResearchGate. This project aims to describe the initial dissemination of the Framework and to provide an evaluation of the areas of impact within rheumatology networks.

Methods

An appraisal was undertaken in October 2022 on how widely the Rheumatology Physiotherapy Capabilities Framework has been used and embedded in UK clinical practice and service delivery. Evaluation strategies included data on downloads since publication and a brief online survey of a convenience sample of experienced, specialist rheumatology physiotherapists. The open-ended survey question asked for “implementation feedback on your use of the framework” and allowed undirected free-text comments. Responses were analysed using qualitative content and thematic analysis.

Results

The framework has been downloaded from the British Society for Rheumatology website 154 times and the launch news story on the BSR website has been viewed 4145 times; the Framework has been accessed 354 times from ResearchGate; analysis of impact on the Twitter shows 33 tweets, 238 likes and 95 “re-tweets”.

Thematic analysis identified four key areas of use of the framework:(i) Increasing awareness of the physiotherapy role in a Rheumatology service(ii) Personal and team professional development(iii) Recruitment, job matching, re-banding and promotion(iv) Referral pathways and service improvement. Quotes from the survey responses are collated according to these identified themes in Table 1.

Conclusion

In its first year of publication, this brief survey indicates that the Rheumatology Physiotherapy Capabilities Framework has already started to accomplish many of the aims of its development. The ability for individuals and services to compare their capabilities to an agreed national standard is supporting staff and services in valuable ways. Service improvement projects have been an additional benefit of the framework. It has already become fairly well embedded in UK rheumatology practice; however, further dissemination, awareness-raising strategies and utilisation support are required to fully accomplish its aims.

Disclosure

W.J. Gregory: Honoraria; W.G. has received honoraria for speaker and advisory board from Abbvie, Novartis and Pfizer. H. Chambers: None. C. McCrum: Honoraria; C.McC. has received speaker honoraria from Novartis. Grants/research support; C.McC. has received a funding grant from Janssen.
E053 Effectiveness of colchicine among patients with COVID-19 infection: a randomised, open labelled, clinical trial
Authors: Jalal Aryan M , Aref Sheelan , Albustany Dashty
Published: April 2023

Background/Aims

In November 2019, there were abundant cases of COVID-19 for which the first case was reported in Wuhan, China. Cytokine storm syndrome is the severe immune reaction that may cause a severe tissue response in COVID-19 patients. Colchicine has an important role in inhibiting activation of NLRP3 inflammasome that predispose to decrease cytokine production. This study aimed to evaluate whether colchicine is effective in treatment of COVID-19 patients or not.

Methods

A randomized, open labelled, clinical trial of colchicine for the treatment of COVID-19, allocated between 8th May to 18th June 2021. Patients with mild, moderate, or severe COVID-19 infection; confirmed by real time PCR (RT-PCR) and/or lung involvement confirmed by computed tomography scan compatible with COVID-19. The colchicine tablet dosage was 0.5mg twice daily for 14 days added to the standard treatment versus control group who received standard treatment without colchicine, with the trial registration ID: NCT04867226. The study was conducted in Erbil City, Iraq with the endpoints being clinical, laboratory parameters duration of hospitalization and side effects.

Results

80 patients participated in the study. Fewer patients in the colchicine group had musculoskeletal symptoms (17.5%, p: 0.001) in comparison to the patients, who received control treatment. The serum ferritin level in most of patients who treated with colchicine returned to normal in contrast to the control group, whose serum ferritin level was still high (p: 0.041). Similarly, the average of CRP and D-dimer after treatment among the colchicine group participants was significantly lower than the control group, the P-values were 0.011 and 0.043, respectively. The colchicine group patients stayed for a shorter duration at the hospital (18.4 days) compared to the control group (24.24 days). P-value was 0.009. In addition to that the response and cure rate were higher in the colchicine group (56%) in the comparison to control group (43.1%) Table 1: Laboratory Parameters with musculoskeletal symptoms and duration of hospitalization of both Treatment Regimens..

Conclusion

The colchicine drug can be effective in treating patients with COVID-19 infection by improving musculoskeletal symptoms and inhibiting inflammatory biomarkers; it is also effective in reducing duration of hospitalization.

Disclosure

A.M. jalal: None. S. Aref: None. D. Albustany: None.
E058 The effects of a pain management programme for patients with an inflammatory arthritis
Authors: Corcoran Kelley , Hung Isabelle , Stovell Rachel , Manson Jessica , Moore Samantha , Soni Anushka , Williams Amanda
Published: April 2023

Background/Aims

This study examines the benefits of Pain Management Programmes (PMPs) for patients with inflammatory arthritis who still report pain and fatigue despite optimal medical management. PMPs are widely recommended (e.g. NICE 2021) for people living with persistent pain, using cognitive behavioural therapy and acceptance and commitment therapy. Programmes aim to enable participants to develop self-management ways of living with their pain, so that pain interferes less in their lives and people feel more confident, and positive about the future. We developed a PMP for patients with an inflammatory rheumatological condition with the additional aim of helping participants to identify when they could self-manage their pain and when they needed healthcare to treat their condition and manage acute pain crises.

Methods

Patients were offered the programme in an information session, followed by assessment with a psychologist and physiotherapist where treatments options were discussed, among them the PMP. Selection criteria were: any type of inflammatory rheumatological condition and persistent pain diagnosed at least 18 months earlier and relatively stable in terms of current treatment; over the age of 18; and able to speak English. The programme ran for eight weekly, 5-hour sessions, with reviews at one and 9 months afterwards. Groups of between 3-11 patients were run in person by a multidisciplinary team of specialists from both outpatient pain management and rheumatology services. Between April 2016 and September 2020, 45 patients (8 men, 37 women) attended 6 programmes and 33 completed outcome measures on pain, disability and distress on the first and last day and at reviews.

Results

Post-treatment results showed significant improvement in confidence in managing pain, less interference of pain with everyday life, less fear, greater acceptance and a more positive outlook. Mood, pain intensity and relief from the pain did not change. Improvements gained post-treatment were sustained at one month and nine-months. The effect size of the improvements was medium or large.

Conclusion

This study shows that attending a PMP can improve quality of life for people with inflammatory arthritis even without reducing pain intensity. Across the programme, patients grew in confidence to engage in life alongside their pain; with significant changes sustained at nine months. However, follow-up outcomes were not returned by two thirds of those who completed the programme, in part due to the pandemic, making it hard to generalise to the wider population of patients.

Disclosure

K. Corcoran: None. I. Hung: None. R. Stovell: None. J. Manson: None. S. Moore: None. A. Soni: None. A. Williams: None.
E062 Calcium pyrophosphate dihydrate crystal in operated rheumatoid arthritis of the knee
Authors: Nishikawa Masataka
Published: April 2023

Background/Aims

Calcium pyrophosphate dihydrate (CPPD) crystals are also one of the common types of crystals causing crystal-induced inflammatory arthritis. Several studies have elucidated important aspects of the molecular and cellular mechanisms of CPPD crystal formation. CPPD crystal deposition disease is a common arthritic disorder in mainly elderly patients. CPPD crystals are found in multiple joints (e.g. knee, wrist joints) in association with severe cartilage degeneration in osteoarthritis. However, there are few reports concerning about CPPD crystals in patients with rheumatoid arthritis (RA). In this study, I investigated the relationship between CPPD crystal and operated RA of the knee.

Methods

Seventy-seven total knee arthroplasties were performed for RA knees from January 2016 to September 2021. I defined the lower extremity alignment (LEA) base on the femorotibial angle (FTA) as valgus (FTA<170°), neutral (170°≤FTA<180°), and varus (FTA≥180°). I also defined the osteophyte formation degree (OFD) in the knee (grade 0-3). At the operation, joint fluids were collected from 70 knees (average age 71.6; male 8; female 72 body mass index (BMI) 24.4kg/m2,; C-reactive protein (CRP) 1.20mg/dL; erythrocyte sedimentation rate (ESR) 49.5mm/h; matrix metalloprotease (MMP)-3 289.5ng/dL; OFD (0/1/2/3) 0/38/25/7; FTA 177.9°; LEA: varus 35; neutral 22; valgus 13). We evaluated the relationship between CPPD crystals and age, gender, FTA, BMI, CRP, ESR, MMP-3, OFD and LEA. When I analyzed the risk factors using the logistic regression method, LEA were defined as valgus (FTA<175°) and varus (FTA≥176°).

Results

CPPD crystals were detected from 19 RA knees (27.1%). There were no significant differences between CPPD(+) and (-) groups about age, gender, FTA, BMI, CRP, ESR and MMP-3. The more severe osteophyte formation showed higher CPPD(+) rate tendency; however, there was no significance. CPPD(+) rates were 34.2% in varus knees, 23.1% in valgus knees and 18.2% in neutral knees, respectively. We reported that age, valgus knee, severe osteophyte and low BMI were the risk factors of CPPD(+) in operated osteoarthritis (OA) knees, previously. In this study, there was no difference between CPPD(+) and (-) groups about these factors. Especially, CPPD(+) rate in RA valgus knees was one third of that of OA valgus knees.

Conclusion

It may be suggested that CPPD production mechanism in RA knees is different from that in OA knees.

Disclosure

M. Nishikawa: None.
E070 How well is the mental health of rheumatoid arthritis patients assessed in the routine rheumatology clinic?
Authors: Cooney Hannah , Ellis Jessica , Mulhearn Ben , Allard Andrew
Published: April 2023

Background/Aims

All patients with rheumatoid arthritis (RA) should have an annual review appointment (NG100). This should involve monitoring for the development of co-morbidities including depression and offer psychological interventions where appropriate. The current literature suggests that the prevalence of depression in RA patients is as high as 38.8% and is associated with poorer disease outcomes. We undertook a retrospective record review of our RA cohort to assess adherence to the NICE RA guidance, including mental health monitoring specifically.

Methods

340 patients were selected using convenience sampling from the total population of 3400. The letters 12 months prior to an identified appointment in January 2019 were reviewed looking at: age, gender, DAS28 score, other long-term conditions, whether mental health was discussed that year, and who initiated the conversation. Data was collected, reviewed, and analysed by HC, JE and AA.

Results

The mean age was 65.9 (SD = 12.3), the female to male ratio was 2.3:1 (70% female), the median DAS28 score was 2.94 (IQR=2.01), and the median VAS score was 40.0 (IQR=63.5). 73.2% (n = 249/340) had at least one other documented co-morbidity, 12.1% (n = 41/340) had a documented chronic pain syndrome, 3.5% (n = 12/340) had a documented mental health diagnosis. 7.9% (n = 27/340) of patients discussed mental health at their appointment; this increased to 58.3% (n = 7/12) of the patients with a known mental health diagnosis. Mental health discussions were initiated by the clinician 18.5% (n = 5/27) of the time, and by the patient 81.5% (n = 22/27) of the time. Of the 5 patients who were asked directly about their mental health: 100% (n = 5/5) were female, the mean age was 63.8, the median DAS28 and VAS scores were lower than the overall cohort at 2.56 (IQR=0.93) and 28.5 (IQR=15.3) respectively. Of the 22 patients who initiated a discussion about their mental health: 72.7% (n = 16/22) were female, the mean age was 62.3, the median DAS28 and VAS scores were higher than the overall cohort at 3.55 (IQR=2.45) and 60.0 (IQR=51.3) respectively. Of the 27 patients who had a mental health discussion: 76.0% (n = 19/27) had another documented co-morbidity, 22.2% (n = 6/27) had a documented chronic pain syndrome, and 25.9% (n = 7/27) had a mental health diagnosis.

Conclusion

Mental health problems may be under-recognised amongst our patients; this may reflect lack of documentation or limited routine screening. The majority of conversations about mental health appear to be initiated by patients. Patients with lower disease activity appear to be more likely to have mental health discussions. The study is limited by small numbers, and further research in this area would be beneficial.

Disclosure

H. Cooney: None. J. Ellis: None. B. Mulhearn: None. A. Allard: None.
E072 Real-world single-centre experience of JAK inhibitor use in RA
Authors: Anjum Aqeel Maqsood , Ghanem Khaled , Smale Shaun , Srinivasan Usha , Duffill Suzanne , Jenkins Charlotte
Published: April 2023

Background/Aims

The use of Janus Kinase Inhibitors (JAKi) has been gradually increasing overtime in the management of rheumatoid arthritis (RA) and other inflammatory arthritis and these appeal to patients. being oral agents. Nevertheless, rheumatologists have become cautious about their use since recent trials have shown safety concerns about VTEs, MACE and malignancies.

Methods

We decided to study use of JAKi at our centre in Princess of Wales Hospital Bridgend. The aim was to assess whether appropriate patients were selected (considering cautions about MACE, VTEs and malignancies). We also wanted to see whether all patients had required pre-treatment safety testing and post-treatment monitoring performed.

Results

These were 70 patients; 59 were females and 11 were males. All of them were diagnosed as RA. Average age was 61.1 years (20—85), average duration of disease 129.9 months (16—340) and average duration of treatment was 58.1 weeks. The most common JAKi being used was baricitinib (84%) followed by tofacitinib (12%) and upadacitinib (4%). 50% patient were on concomitant csDMARDs among whom two-thirds were on methotrexate. Looking at previous biologic use, 9 patients were biologic naïve, 22 had one biologic, 15 had two biologics used in the past. All patients were appropriately selected (severe RA and no significant risk factors for MACE, VTEs and malignancies). All patients had pre-treatment Hepatitis B, Hepatitis C, latent TB, FBC and LFTs checked. All patients had FBC and LFTs monitored post treatment. No patient developed VTE, MACE or cancer on treatment. 84.2% patients had lipids tested before starting JAKi. 22.8% patients had abnormal lipids before Rx initiation and 62.5% of these were on lipid lowering Rx. All patients had lipids tested post treatment, but the timing was quite variable and only 62.5% of patients had lipids tested on the recommended time. There were 2 deaths recorded in this cohort. One of those was an 80-year-old RA patient on baricitinib 2 mg OD, who died due to chest infection on the background of ILD. He was not on steroids or csDMARDs. The second patient was 63 years' old (on baricitinib 4mg OD), and died due to respiratory sepsis, and was also on azathioprine. She had RA with advanced ILD. The reasons for discontinuing JAKi were inefficacy (46%), side effects (39%) and both inefficacy and side effects (15%). 41.4 % of patient experienced side effects due to JAKi. These included infection 28%, deranged lipids 17%, cytopenia 14%, deranged LFTs 14%, GI side effects 10%, skin rash 7% and varicella zoster 3%.

Conclusion

There has been steady increase in the use of tsDMARDs for RA and other rheumatic conditions. Due to short half-life, these drugs became a popular choice during COVID-19 pandemic but on the other hand safety monitoring became extremely challenging during this time.

Disclosure

A. Anjum: None. K. Ghanem: None. S. Smale: None. U. Srinivasan: None. S. Duffill: None. C. Jenkins: None.
E078 Inflammation modifies the effect of rheumatoid arthritis in overall mortality among females
Authors: Banerjee Sri
Published: April 2023

Background/Aims

Rheumatoid arthritis (RA) is a common autoimmune condition which is difficult to control. This condition causes three times as likely of death than the general population. However, the precise levels of inflammatory biomarkers is unknown. In this study, we tried to understand the relationship rheumatoid arthritis and overall mortality and C-reactive protein modifies this effect on females.

Methods

The study was conducted on participants aged 20 years or older living in the United States. We assessed RA status by using the arthritis question in the NHANES survey for the years 1999 to 2010 with mortality follow-up. C-reactive protein was determined by latex nephelometry. Prospective analysis was performed using complex samples Cox regression with adjustment for known confounders to determine the relationship of RA and mortality, as experienced by the inflammatory biomarker of C-reactive protein.

Results

Prevalence of RA in this population was 1.2% among males and 3.8% among females. The mean follow-up was 10.1 years. For all-cause mortality, the overall unadjusted hazard ratio (HR) of RA to no RA was 2.98 (95% confidence interval [CI], 2.11-4.22, p < 0.001). Adjusted HR was elevated, 2.62 (CI 0.62-11.11, p > 0.05), among patients with elevated C-reactive protein with RA but closer to 1.0 (1.28 CI 0.94-1.74, p > 0.05) among patients without elevated C-reactive Protein, after controlling for medical and demographic risk factors. Similar patterns did not apply for males.

Conclusion

There was a clear connection between RA and increased mortality. Additionally, among females the connection of inflammatory biomarkers is more pronounced while this not affected in females. Inflammatory biomarkers such as C-reactive protein must be closely monitored.

Disclosure

S. Banerjee: None.