bluuebunny/crossref_metadata_2025_split huggingface dataset:
P189 Diabetes may confer protection from giant cell arteritis: results from a large inception cohort
Authors: Spray Luke , Reynolds Gary , Heaney Jonathon , Houghton Karolyn , Hargreaves Ben , Thompson Ben , Lorenzi Alice 
Published: April 2020

Abstract

Background
Giant cell arteritis (GCA) is the commonest large-vessel vasculitis. Until recently high dose corticosteroids had been the mainstay of treatment. Significant concern about steroid related co-morbidities have driven interest in developing new treatment strategies, and the potential to reduce costs associated with managing these complications was pivotal in securing funding for tocilizumab. Despite this little is known about the at-risk population, comprising both those diagnosed with GCA and those suspected of GCA, as both groups undergo the same steroid exposure. We therefore sought to determine if patients referred to our GCA fast track pathway (GCA-FTP) were more or less at risk than the general age matched population of developing corticosteroid related side effects.

Methods
Data from 356 consecutively referred patients to our GCA-FTP between January 1st 2017 and December 31st 2018 were reviewed. Co-morbidity data is routinely collected as part of our GCA-FTP rolling audit. We determined the frequency of pre-existing co-morbidities most often associated with steroid related side effects and compared these with published background prevalence estimates for a similar age group in the UK.

Results
In general rates of co-morbidities were lower than published estimates in over-70s, as we did not actively pursue their identification beyond what was readily available at referral (Table 1). Interestingly, however, whilst the prevalence of diabetes mellitus in our cohort (n = 356) was comparable to that in the general population (23.6%), it was significantly lower in those diagnosed with GCA (n = 83) at 11% (p = 0.0017). Despite this difference, background rates of cardiovascular and peripheral vascular disease were similar in each group.

Conclusion
In our cohort, diabetes mellitus seems to be a protective factor against the development of GCA. Similar results were reported in 2015 from a meta-analysis of inception cohorts involving 903 patients with GCA and 1064 controls. The interaction between diabetes and the onset of GCA merits further investigation.

Disclosures
L. Spray None. G. Reynolds None. J. Heaney None. K. Houghton None. B. Hargreaves None. B. Thompson None. A. Lorenzi None.
P206 Cardiovascular risk knowledge in patients of South Asian origin living with rheumatoid arthritis: data from India and the UK
Authors: Kumar Kanta , Arya Suvrat , Nightingale Peter , Sheeran Tom , Aggarwal Amita 
Published: April 2020

Abstract

Background
South Asians have a higher risk of cardiovascular disease (CVD). Rheumatoid arthritis (RA) increases the risk of premature atherosclerosis. Therefore, we compared the level of CVD risk knowledge among patients of South Asian origin with RA in India and in the UK.

Methods
In this cross-sectional survey, patients of South Asian origin with RA from India and the UK were recruited from secondary care settings. Data were collected via Heart Disease Fact Questionnaire-Rheumatoid Arthritis (HDFQ-RA), a validated self-completion questionnaire. The HDFQ-RA was translated into Hindi and piloted among patients from South Asian background before use. Additionally, clinical and demographic data was collected.

Results
Among 118 patients from each country, 84% were female and they had similar age, education level, employment status and co-morbidities. Patients from India had longer disease duration (5.5 years versus 4.1 years (p = 0.012) whereas those from the UK had higher disease activity score (4.0 + 0.8 versus 3.1 + 0.7, p &lt; 0.01). Regarding modifiable risk factors for CVD only 44.6% from India and 45.4% in the UK were aware of them (p=ns). However, awareness of the link between RA and increased risk of CVD was even more limited (38.1% in India and 40.7% in UK (p=ns).

Conclusion
Patients of South Asians origin with RA from both countries had limited knowledge about CVD risk. There is a need to educate them about CVD risk during consultation, as this will result in better outcomes.

Disclosures
K. Kumar None. S. Arya None. P. Nightingale None. T. Sheeran None. A. Aggarwal None.
P208 A multidisciplinary approach to reproductive healthcare in women with rheumatic disease
Authors: Murray Kieran , Moore Louise , O'Brien Celine , Clohessy Anne , Brophy Caroline , McAuliffe Fionnuala , Veale Douglas J 
Published: April 2020

Abstract

Background
Rheumatic disease (RD) patients when family planning must consider fertility, disease activity, and management from preconception to lactation. A clear understanding is necessary, especially for those receiving disease-modifying antirheumatic medications. Previous studies have highlighted unmet needs in the care of women with RDs with reproductive healthcare needs. This study describes, to our knowledge, the first published standardised reproductive care pathway for women with RDs and the outcomes of this approach.

Methods
We developed the care pathway with multidisciplinary input from rheumatologists, rheumatology nurse specialists, obstetricians, midwives, maternal medicine specialists, and pharmacists. We identified patients’ emotional and healthcare needs, ensured access to expert advice, maintenance of good disease control, and positive reproductive outcomes. We prospectively followed the patients and report the results of the service.

Results
Ninety-eight women with median age (range) of 35 years (19-48) were assessed. The majority had an inflammatory arthritis. Seventy-six babies were born to 62 mothers. There were 12 miscarriages and one perinatal death. Breastfeeding rates at 6 weeks were low (28%).

Conclusion
We describe the first published evidence-based integrated multidisciplinary reproductive care pathway for women with RDs and the results of this approach. Seventy percent of women successful in trying to conceive delivered a healthy baby, and 90% of patients were ‘very satisfied’ with the service.

Disclosures
K. Murray: None. L. Moore: None. C. O'Brien: None. A. Clohessy: None. C. Brophy: None. F. McAuliffe: None. D. Veale: None.
P223 Influence of ambient air pollution on RA disease activity scores
Authors: Alsaber Ahmad R , Pan Jiazhu , Al-Herz Adeeba , Alkandary Dhary S , Al-Hurban Adeeba , Setiya Parul , Group KRRD RA Study 
Published: April 2020

Abstract

Background
This study aims to estimate the influence of air pollution ambients using the Air Quality Index (AQI) to Rheumatoid Arthritis (RA) disease activity. Disease Activity Score with 28 examined joints (DAS-28) and Clinical Disease Activity Index (CDAI) considered as disease activity indices for RA patients in the state of Kuwait.

Methods
Data for patients with RA disease were collected from Kuwait Registry for Rheumatic Diseases (KRRD) from 2013 to 2017. Moreover, data on air pollution obtained from The Kuwait Environmental Public Authority (K-EPA) during the same period. Statistical analysis was conducted using STATA to highlight the significant association between study variables. Descriptive statistics, correlation analysis and linear regression model techniques were employed to estimate the significant associations between RA disease activity represented by DAS-28 and CDAI; with air pollution components (PM10, NO2, SO2, O3, and CO). Multiple Imputation by Chained Equations (MICE) algorithm was also employed to tackle the value of the missing data for air pollution data.

Results
Total of 9,875 patients visits included in the analysis that matching with air pollution information from K-EPA database according to date and patient living address governorate. The study found SO2 and NO2 were significantly associated with RA disease activity using DAS-28 index, also, for CDAI index as well. For the score of RA disease activity using DAS-28 index, the correlation results show a positive significant correlation with exposure of SO2 using AQI (rp = 0.07), also the same results with the with the exposure of NO2 using AQI (rp = 0.07). The final model is demonstrating the effect from air-pollutants gaseous with RA factors (Swollen, RF, anti-CCP, ESR, CRP) on RA disease activity. The AQI of NO2 and SO2 still showed positive associations with disease activity performance of RA. The linear regression model shows a positive effects of NO2 (beta = 0.003, 95% CI: 0.002-0.005) and (beta = 0.048, 95\% CI: 0.030-0.066) for DAS-28 and CDAI respectively, where for SO2, the results shows positive significant effect with (beta = 0.003, 95% CI: 0.0004-0.005) and (beta = 0.044, 95% CI: 0.018-0.070) for DAS-28 and CDAI respectively.

Conclusion
In conclusion, our study showed that air ambients were significantly correlated to RA disease activity scores and should be considered as a possible risk factor for RA activity.

Disclosures
A.R. Alsaber None. J. Pan None. A. Al-Herz None. D.S. Alkandary None. A. Al-Hurban None. P. Setiya None.
P231 B-cell depletion therapy with rituximab in RA: UCLH/UCL 20 years of experience
Authors: Norris-Grey Caitlin M , Moore Samantha , Cambridge Geraldine , Reedy Venkat , Leandro Maria 
Published: April 2020

Abstract

Background
B-cell depletion therapy based on rituximab in patients with seropositive rheumatoid arthritis (RA) was pioneered at UCLH/UCL in 1998. The positive results of the initial open-label UCLH/UCL trials led to the Phase IIa proof of concept trial confirming efficacy and safety for rituximab in the treatment of patients with RA. A Phase III trial followed and licensing in 2006. We report a service evaluation of the UCLH/UCL cohort of RA patients treated with rituximab over the last 20 years.

Methods
A retrospective review of electronic records from all patients with RA treated with rituximab followed up in a dedicated clinic at UCLH/UCL (1998-2019) were included. Data on gender, age at first treatment, previous DMARDs, concomitant therapy at the time of the first rituximab cycle, total number of rituximab cycles and length of follow-up while on rituximab were collected. For patients currently on rituximab, further information was collected at last follow-up, including concomitant therapy, swollen and tender joint count, global VAS, CRP and ESR. DAS28ESR was calculated.

Results
296 patients had received rituximab therapy since November 1998, with 105 remaining on rituximab at final data collection (14/10/2019). Median follow-up was 77.5 months. Clinical data is shown in Table 1. Information for previous DMARDs was only available for 196 patients in the whole cohort, and for 70 patients currently on rituximab. The most common concomitant DMARD at first cycle was methotrexate with a similar percentage receiving methotrexate at last follow-up. The median number of previous DMARDs were 4 and 3 respectively. Within both cohorts approximately 31% of patients received rituximab as their first biologic.

Conclusion
This retrospective service evaluation of 296 patients with RA who had undergone rituximab therapy since 1998 showed that more than one third remained on rituximab at last follow-up. Of these, 70.2% of patients were in clinical remission or with low disease activity. Most patients (94%) remaining on rituximab were receiving only 1 or no concomitant therapies. Multiple cycles of treatment with rituximab have thus proved to be an effective therapeutic strategy for patients with RA resulting in long-term and highly favourable control of their disease.

Disclosures
C.M. Norris-Grey None. S. Moore None. G. Cambridge None. V. Reedy None. M. Leandro Consultancies; Genentech: consultancy fees for attending meeting on obinutuzumab trial in lupus nephritis.
P239 Third generation APCA improve prediction of clinical arthritis in at-risk individuals with positive second generation ACPA
Authors: Matteo Andrea Di , Mankia Kulveer , Duquenne Laurence , Mahler Michael , Corscadden Diane , Mbara Katie , Garcia-Montoya Leticia , Nam Jacqueline , Emery Paul 
Published: April 2020

Abstract

Background
Anti-citrullinated peptide antibodies (ACPA) are important biomarkers in rheumatoid arthritis (RA) and can predict arthritis development in at-risk individuals. ACPA are conventionally detected using the second-generation or third generation IgG anti-CCP antibody (Ab) assays. Although the value of anti-CCP2 Ab for predicting progression to RA in at-risk individuals is well understood, very little knowledge exists for anti-CCP3.The objectives of this study were: i) To evaluate the prevalence of serum anti-CCP3 Ab in serum anti-CCP2 Ab positive at-risk individuals (CCP2+ at-risk); ii)) To study the incremental value of anti-CCP3 Ab in CCP2+ at-risk subjects for predicting progression to clinical inflammatory arthritis (IA).

Methods
Anti-CCP3 Ab were tested on stored serum samples obtained from 347 CCP2 + (BioRad, USA) at-risk individuals from the Leeds CCP study. Anti-CCP2 and anti-CCP3 tests positivity threshold was &gt;2.99 IU/ml and &gt;20 units, respectively. Moreover, anti-CCP2 and anti-CCP3 titres were categorised according to manufacturer’s cut-off: low (LT) and high (HT) for anti-CCP2, negative/weak/moderate/strong for anti-CCP3. Progression to IA was defined as the development of clinical synovitis in at least one joint. Only subjects with at least one follow-up visit were included in the progression analysis (n = 317).

Results
Anti-CCP3 Ab were negative in 138/347 (39.7%) CCP2+ individuals, and weakly, moderately, and strongly positive in 15/347 (4.3%), 5/347 (1.4%) and 189/347 (54.4%) individuals, respectively. LT and HT anti-CCP2 Ab were found in 103/347 (29.7%) and in 244/347 (70.3%) individuals, respectively. Eighty-eight/317 subjects (28%) developed IA. The rate of progression of LT and HT anti-CCP2, when anti-CCP3 was negative, decreased from 6.5% to 2.7%, and from 36.6% to 9.4%, respectively. Progression in anti-CCP2 HT increased from 36.6% to 45.6% when anti-CCP3 was positive (Table 1).

Conclusion
Our results support an important role for anti-CCP3 Ab in improving prediction of IA in CCP2+ at-risk individuals.

Disclosures
A. Di Matteo None. K. Mankia None. L. Duquenne None. M. Mahler Other; Inova Diagnostic. D. Corscadden None. K. Mbara None. L. Garcia-Montoya None. J. Nam None. P. Emery Honoraria; AbbVie, BMS, Bristol-Myers Squibb, Gilead, Lilly, MSD, Novartis, Pfizer, Roche, Samsung, Samsung Bioepis Co., Ltd.
P265 Burden of psoriatic nail disease and response to biologic therapy in a PsA cohort
Authors: Nair Preeti , Anthony Anna , Lovell Christopher , Korendowych Eleanor , Cavill Charlotte , McHugh Neil , Tillett William 
Published: April 2020

Abstract

Background
Psoriatic nail disease is one of the six disease manifestations of psoriatic arthritis (PsA) in addition to peripheral arthritis, psoriasis, enthesitis, dactylitis and axial disease. Nail pitting is associated with an increased risk of developing PsA and onycholysis is associated with radiographic damage at the distal interphalangeal joints. Quantitative assessment of psoriatic nail disease is rarely performed in clinical practice therefore little is known about the burden of nail disease and effect of treatment in observational cohorts. We set out to quantify the burden of nail disease and response to b/tsDMARD treatment in a secondary care cohort.

Methods
Data were taken from the Bath PsA cohort. Patients fulfil CASPAR criteria and have clinical and patient reported outcomes at routine clinic follow-up visits. Patients commencing a b/tsDMARD with at least one follow up visit were included for analysis. Nail involvement was assessed using the Bath Nail score; pitting (0-10), onycholysis (0-10), hyperkeratosis (0-10) and severe deformity (0-10).

Results
157 of 485 (32%) of the cohort commencing b/tsDMARDS had nail disease at baseline and were included in the analysis. At baseline nail pitting (65%) and onycholysis (57%) were the most frequent nail manifestations followed by hyperkeratosis (14%) and severe nail deformity (7%) (Table 1). At the first follow-up visit (mean duration 20 weeks), 39% of patients achieved clear nails. At the final follow-up visit (mean duration 59 weeks) 56% had clear nails and 44% of patients had residual nail disease with a median (IQR) nail score of 0 (0.0-2.0). Earliest improvements were seen in nail bed manifestations (onycholysis/ hyperkeratosis) whilst improvement in nail matrix features (pitting) occurred later (Table 1) (p &lt; 0.001).

Conclusion
Psoriatic nail disease affects one third of those commencing b/tsDMARDs in this cohort. Earliest treatment responses are seen in features of psoriatic nail dystrophy that affect the nail distally. At 20 weeks 39% of those with nail disease at baseline achieve clear nails. At one year, 44% of patients have ongoing nail manifestations, but few patients have persistently high nail scores.

Disclosures
P. Nair None. A. Anthony None. C. Lovell None. E. Korendowych None. C. Cavill None. N. McHugh None. W. Tillett None.
P266 IL-4/13 inhibitor dupilumab associated with new onset peripheral axial spondyloarthritis in patients with atopic dermatitis
Authors: Hughes Catherine D , Menon Bina , Willsmore Zena , Woolf Richard , Smith Catherine , Pink Andrew , Kirkham Bruce W 
Published: April 2020

Abstract

Background
Dupilumab is a recombinant human monoclonal antibody that inhibits signalling of interleukin-4 and interleukin-13. It has NICE approval for use in patients with moderate to severe atopic eczema who have failed at least one standard therapy. The main reported side effects in clinical trials were allergic conjunctivitis (1-5%), injection site reactions (8-19%) and herpes viral infections (3-7%).

Methods
Here we report symptoms and signs of a new peripheral axial spondyloarthritis/ psoriatic arthritis type presentation in 8 patients within 16 weeks of commencing dupilumab. This has not been described previously in the clinical trials patient population.

Results
These patients had a long history of atopy with severe eczema and raised baseline IgE levels of &gt; 12000. A positive response to dupilumab was seen in all patients as evidenced by marked improvements in the Eczema Area and Severity Index (EASI). Musculoskeletal symptom onset began between 2 and 16 weeks after commencement of drug. Patients typically complained of inflammatory type pain in the small joints and entheseal sites. 2/8 patients had inflammatory sounding spinal pain. Early morning stiffness was common. All patients had normal acute phase reactants and one patient had a positive rheumatoid factor. 6/8 patients had radiologically evident enthesitis as seen on MRI or ultrasound (power doppler ultrasound signal-PDUS). 3/8 patients had such severe symptoms that they had to discontinue dupilumab. All patients were commenced on non-steroidal anti inflammatories. One patient was commenced on a low dose JAK inhibitor and exhibited improvement in musculoskeletal symptoms.

Conclusion
IL-4 has been shown to suppress delayed type hypersensitivity reactions (DTHRs) in both human and mice studies. It has been demonstrated previously that IL-4 can prevent bone erosion and disease progression in animal models of inflammatory arthritis. Guenova et al (2015) showed that IL-4 can selectively suppress IL-23 transcription and secretion with reduced Th17 function. They suggest that administration of IL-4 may be of therapeutic benefit in Th17 mediated inflammatory conditions. Conversely, dupilumab through the inhibition of IL-4 and IL-13 and possible resultant increased IL-17 and IL-23 levels, has perhaps unmasked a tendency towards development of a peripheral axial SpA phenotype in these patients.

Disclosures
C.D. Hughes None. B. Menon None. Z. Willsmore None. R. Woolf None. C. Smith Grants/research support; CS is a PI/CoPI on a number of commercially supported studie (Abbvie, Janssen, Leo, Sanofi). A. Pink None. B.W. Kirkham Consultancies; BK has worked as a consultant for Eli Lilly, Gilead, Janssen and Novartis. Grants/research support; BK has received research support from Eli Lilly and Novartis.
P269 Longitudinal patterns of pain distribution in axSpA patients: a retrospective cohort study
Authors: Nishtala Revathi , Barnett Rosie , Chyou Teyuan , Soni Anushka , Sengupta Raj 
Published: April 2020

Abstract

Background
Chronic pain is an important and debilitating symptom experienced by patients with axial Spondyloarthritis (axSpA). The patterns of pain and their associations in this patient group is poorly understood. The overall aim of the study is to investigate patterns of pain distribution in patients with axSpA using Margolis Pain Diagrams, and any associations with clinical and demographic measures.

Methods
We analysed data collected from individuals attending the axSpA outpatient clinic at the Royal National Hospital for Rheumatic Diseases in Bath. All participants were asked to record their pain on a pre-printed Margolis Pain diagram at each clinical visit. The number and distribution of painful areas were assessed and then categorised into regional or widespread pain, using pre-defined anatomical criteria. Descriptive analyses and any associations between pain distribution and demographic and clinical variables were assessed. Changes in pain distribution over time, using data from up to four clinic visits, were further investigated using a Sankey diagram.

Results
Of the 187 participants who had a baseline pain assessment, their mean age at diagnosis was 31.6 (11.9) years and 31.6% were female. 89.3% of patients reported pain at baseline, and of these 21.4%, 29.4 % and 38.5% reported pain in 1-2, 3-4, and 5-6 regions respectively. The most common sites of pain are in the Trunk (68.4%), followed by Head and Cervical (65.8%) and Left lower limb regions (58.8%). Univariate analyses did not reveal any significant associations between the presence of widespread pain and age at diagnosis, sex, smoking or HLA-B27 status. Disease activity, measured using Bath Ankylosing Spondylitis Disease Activity Index, was significantly higher in participants with widespread pain compared to those with regional pain OR 1.60 (1.30-1.96), and a trend towards higher sleep disturbance, was demonstrated OR 1.05 (1.00-1.10). Longitudinal analyses demonstrated considerable flux over time in the number and distribution of pain reported.

Conclusion
The Margolis Pain diagram is a practical instrument for assessing pain in axSpA patients. Several pain patterns were noted in patients with axSpA, and future research should focus on the potential impact on quality of life measures, response to treatment, and radiological findings.

Disclosures
R. Nishtala None. R. Barnett None. T. Chyou None. A. Soni None. R. Sengupta None.