bluuebunny/crossref_metadata_2025_split huggingface dataset:
P129 Adolescent knee pain and risk of knee osteoarthritis 50 years later
Authors: Clynes Michael A , Laskou Faidra , Edwards Mark H , Cooper Cyrus , Taylor Angela , Stokes Maria , Dennison Elaine M 
Published: April 2020

Abstract

Background
Adolescent knee pain is a common complaint which may be due to patellar dislocation, meniscal tear, Osgood-Schlatter’s disease or patellofemoral maltracking. We studied the association of such pain with knee osteoarthritis (OA) 50 years later using a retrospective cohort design.

Methods
This study was based in the Hertfordshire Cohort Study, a cohort of men and women born in 1931 - 9. Participants completed a questionnaire detailing recall of adolescent knee pain, self-reported OA, demographics, lifestyle and The Western Ontario and McMaster Universities Arthritis Index (WOMAC). Clinical OA was defined based on the American College of Rheumatology (ACR) criteria and assessed at a clinical visit where knee radiographs were also taken and graded according to the methods of Kellgren and Lawrence.

Results
Completed data were available for 135 men and 139 women. The mean age was 78.8 (SD 2.6) years and the mean (SD) BMI was 26.3 (4.0). Two percent of men (n = 3) and 5% of women (n = 7) reported adolescent knee pain, of which 2 men and 3 women sought medical advice for their knee pain. 1 man and 2 women reported that their pain had been constant since teenage years while 2 men and 4 women reported that it was intermittent in nature. A report of adolescent knee pain was associated with an increased risk of clinical (odds ratio (OR) 5.45, p-value 0.015, 95% confidence interval (CI) 1.39 - 21.36); radiological (OR 2.33, p-value 0.228, 95% CI 0.60 - 9.24) and self-report (OR 2.71, p-value 0.134, 95% CI 0.74 - 10.0) of knee OA in later life. After adjustments for age, sex and BMI, adolescent knee pain was associated with an increased risk of clinical (OR 4.80, p-value 0.047, 95% CI 1.02 - 22.53); radiological (OR 1.85, p-value 0.404, 95% CI 0.44 - 7.78); self-report (OR 3.23, p-value 0.10, 95% CI 0.80 - 12.94) although relationships were only significant for clinical knee OA.

Conclusion
Recalled adolescent knee pain was associated with a clinical diagnosis of knee OA in later life. The lack of association with self-report of OA suggests that this is not simply a consequence of recall bias and exploration in other data sets is now indicated.

Disclosures
M.A. Clynes: None. F. Laskou: None. M.H. Edwards: None. C. Cooper: None. A. Taylor: None. M. Stokes: None. E.M. Dennison: None.
P164 Can non-invasive techniques be used to image calcinosis?
Authors: Moore Tonia L , Marjanovic Elizabeth , Manning Joanne B , Dinsdale Graham , Wilkinson Sarah , Dickinson Mark R , Herrick Ariane L , Murray Andrea K 
Published: April 2020

Abstract

Background
A significant proportion of patients with systemic sclerosis (SSc, 20-40%) will develop subcutaneous calcinotic deposits which are painful and can perforate the skin, causing ulceration. The underlying aetiology is unknown and there is currently no effective treatment. Diagnosis is often made with plain radiography, which is not ideal for long-term monitoring. Identifying non-invasive techniques which do not involve ionising radiation will improve our understanding of calcinosis and how to monitor this over time, facilitating the development of potential treatments. The aim of this study was to assess several non-invasive imaging techniques to measure oxygenation (multispectral imaging), perfusion (thermography [a pseudo measure of perfusion] and laser speckle imaging) and size and depth (high frequency ultrasound) of the calcinoses. The hypothesis of the study was that there would be relationships between oxygenation, perfusion and calcinosis size and depth.

Methods
Twenty-one patients with SSc (all female, median age 63 (IQR 55 to 70) years; disease duration since onset of first non-Raynaud’s feature 14 (9 to 23) years, Raynaud’s phenomenon duration 23 (12- 36) years; underwent imaging of calcinosis. Measurements of oxygenation, perfusion and vessel size and depth were performed at the site of calcinosis and adjacent skin.

Results
There was no difference in oxygenation at the site of calcinosis vs adjacent median 0.15 (IQR 0.07 to 0.22) vs. 0.16 (0.00 to 0.21) arbitrary units respectively; non-significant. There was a trend for skin temperature (perfusion) to be lower at the site of the calcinosis compared to the adjacent area (calcinosis, 31.4 (28.4 to 35.6) vs adjacent 32.8 (28.4 to 35.7) oC; p = 0.052. Perfusion as measured by speckle imaging was significantly reduced 107.3 [60.3 to 213.4] vs 312.1 [107.8 to 432.2] arbitrary perfusion units; p &lt; 0.01. The mean depth of the calcinoses was 1.5 (1.11 to 2.07) cm and mean lesion area was 3.06 (2.33 to 4.62) cm2. No relationships were identified between perfusion, oxygenation or calcinosis depth and area.

Conclusion
Perfusion is reduced at the calcinotic sites, as measured by laser speckle imaging and also (although not significantly) as measured indirectly by thermography. That perfusion was decreased in the area of the calcinosis versus the adjacent skin may be due to the pressure on the skin leading to ischaemia, or it may be that calcinosis develops in areas which are under-perfused. This study has demonstrated the feasibility of imaging calcinosis properties. The ability to measure the depth and subcutaneous area with high frequency ultrasound may provide a useful outcome measure of treatment efficacy.

Disclosures
T.L. Moore None. E. Marjanovic None. J.B. Manning None. G. Dinsdale None. S. Wilkinson None. M.R. Dickinson None. A.L. Herrick None. A.K. Murray None.
P171 Factors determining sleep quality in SLE
Authors: Magro Rosalie , Camilleri Liberato , Borg Andrew A 
Published: April 2020

Abstract

Background
Poor sleep quality is common in systemic lupus erythematosus (SLE) and could contribute to fatigue, which is regarded as one of the most disabling symptoms in SLE. The Pittsburgh sleep quality index (PSQI) is a validated self-administered questionnaire that measures sleep quality over the previous month. The aim of this study was to analyse the relationship of sleep quality, measured by PSQI, with several variables including depression, anxiety, pain, disease activity, fatigue and functional disability in patients with SLE. A further aim was to establish the prevalence of poor sleep quality in SLE.

Methods
A cohort cross-sectional study was carried out including 92 SLE patients who fulfilled the SLICC classification criteria for SLE and who provided informed consent for participation. The patients were interviewed, and they were asked to fill in questionnaires including PSQI, Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS) for pain and modified Health Assessment Questionnaire (mHAQ). Blood and urine tests enabled the calculation of SLE disease activity index-2K (SLEDAI-2K). The study was approved by the University Research Ethics Committee.

Results
92.4% of the cohort studied were females, and the mean age was 46.9 years (range 19-79 years). 55.4% were noted to have poor quality sleep (PSQI &gt;5), and the median PSQI was 6 (range 0-18). Sleep quality measured by PSQI, had a significant correlation with SLEDAI-2K (R = 0.254, p = 0.014), VAS pain (R = 0.515, p &lt; 0.001), HADS-D (R = 0.605, p &lt; 0.001), HADS-A (R = 0.375, p &lt; 0.001), estimated glomerular filtration rate (eGFR) (R=-0.211, p = 0.044), FSS (R = 0.551, p &lt; 0.001) and mHAQ (R = 0.559, p &lt; 0.001). ANCOVA analysis showed that PSQI was significantly dependant on VAS pain (p &lt; 0.001), HADS-D (p &lt; 0.001) and eGFR (p = 0.003).

Conclusion
Poor sleep quality is highly prevalent in SLE patients. This study has shown that the strongest predictive factors for poor sleep quality are pain, depression and impaired renal function. Since poor sleep quality is significantly related to fatigue and functional disability, its identification and management is important for patients’ wellbeing.

Disclosures
R. Magro None. L. Camilleri None. A.A. Borg None.
P187 Not a headache clinic: giant cell arteritis fast track pathways (GCA-FTP) need not be overwhelming
Authors: Spray Luke , Reynolds Gary , Houghton Karolyn , Hargreaves Ben , Heaney Jonathon , Thompson Ben , Lorenzi Alice 
Published: April 2020

Abstract

Background
False positive and negative GCA diagnoses lead to significant morbidity. GCA Fast Track Pathways (GCA-FTP) are advocated in the NHS. Concern that these become ‘headache clinics’, lack of access to temporal artery ultrasound (TAUS) and biopsy (TAB) are cited as barriers to provision. We present prospectively collected data from referrals to our GCA-FTP demonstrating that this has not occurred in our service.

Methods
Rheumatology leads our GCA-FTP providing initial investigation, TAUS for all patients and long-term management when GCA is diagnosed. Ophthalmology is the point of access for patients with visual symptoms and, if required, TAB.

Results
Referral numbers for calendar years 2014 through 2018 were 70, 97, 134, 180 & 175 respectively. TAB was requested for 29, 43, 49, 57 and 41 patients and GCA diagnosed in 29, 34, 33, 43 & 40 patients per year. In 2017-18, TAUS without biopsy supported a diagnosis of GCA in 58 and excluded it in 199. Across 2017 and 2018 we received 356 referrals: 43.5% from ophthalmology, 34.3% primary care and 11.0% medicine. 59.3% were on corticosteroids. Mean age was 71 years, 73.3% were female. GCA was diagnosed in 83 (23.3%). Mean duration of symptoms at first review was 38 ±4.4 days in GCA patients and 58 ±6.4 days in non-GCA patients. Characteristic GCA clinical features were significantly higher in the GCA group (Table 1). Non-GCA final diagnoses were ophthalmic (NIAON) (13.8%) and musculoskeletal related (12.2%). 7.0% of patients received a primary headache diagnosis. In 41.4% no cause was recorded, and patients were discharged to their GP with corticosteroids stopped.

Conclusion
A GCA-FTP can be a predictable service to manage. Clinical review by an experienced doctor distinguishes many non-GCA presentations from GCA when seen promptly. Most patients with GCA will be seen by rheumatology during their disease course. Distinguishing non-GCA diagnoses at later time points is significantly more challenging and means patients are exposed unnecessarily to high dose steroid, often for many months. TAUS and TAB are useful adjuncts to diagnosis and required for use of high tariff drugs. Lack of access need not however mean deferring setting up a GCA-FTP.

Disclosures
L. Spray None. G. Reynolds None. K. Houghton None. B. Hargreaves None. J. Heaney None. B. Thompson None. A. Lorenzi None.
P188 Tocilizumab for giant cell arteritis: real world experience in a single UK centre
Authors: Reynolds Gary , Griffiths Bridget , Houghton Karolyn , Thompson Ben , Lorenzi Alice R , Heaney Jonathan 
Published: April 2020

Abstract

Background
Tocilizumab was approved for the treatment of giant cell arteritis (GCA) by NICE in April 2018. This decision followed the GiACTA (Giant Cell Arteritis Actemra) study, a randomised control trial that demonstrated a beneficial effect of tocilizumab in reducing the frequency of disease flare and overall prednisolone requirements. However, as noted in the NICE appraisal, the extent to which the patient population in the GiACTA study reflects the population it is eventually used for in UK clinical practice is not clear. To address this, we analysed the records of all patients started on tocilizumab treatment for GCA in a single centre since its approval.

Methods
We performed a retrospective analysis of the clinical records of all patients started on tocilizumab for GCA at the Freeman Hospital in Newcastle. All patients are discussed in a regional connective tissue disease MDT prior to the initiation of therapy to ensure they fulfil NICE guidelines. At each subsequent visit adverse events related to both tocilizumab and corticosteroids and any flares of GCA or ischaemic events are recorded.

Results
In total 14 patients started tocilizumab since June 2018, with a cumulative exposure of 8 patient-years. The mean age was 74 years, slightly older than the average age in the GiACTA trial (69 years). In contrast to GiACTA where 48% of patients were newly diagnosed, all our patients had established disease. In our cohort 36% of patients had CT PET evidence of large vessel vasculitis, similar to the rate in GiACTA (40%) but higher than the national average of around 5%. Incidence of visual loss in our treated patients was higher at 29% than recorded in the general GCA population in the DC-VAS study (7.9%). In those treated for relapsing disease around half (56%) had recorded previous significant adverse events with steroids, including heart failure, hypertension and mood changes. Five patients had infections requiring antibiotics (cellulitis/ulcer in three, chest infection in one, urinary tract infections in two), with two serious infections requiring hospital admission (both urinary tract infections). No patients had further ischaemic events while on treatment. All patients were on a lower dose of prednisolone following treatment with an average of a 63% reduction in steroid dose.

Conclusion
The modest number of patients receiving tocilizumab for GCA suggests we are not treating everyone at first relapse. The higher rates of large vessel vasculitis, visual loss and previous steroid-induced complications suggest a preference for saving tocilizumab for a more severely affected subset of patients. In this preliminary data there were reassuringly no recorded ischaemic events following treatment and steroid doses were successfully reduced in all patients.

Disclosures
G. Reynolds None. B. Griffiths None. K. Houghton None. B. Thompson None. A.R. Lorenzi None. J. Heaney None.
P203 Oral glucocorticoid use is associated with hypertension in patients with RA
Authors: Costello Ruth E , Jani Meghna , Yimer Belay B , Dixon William G 
Published: April 2020

Abstract

Background
Oral glucocorticoids (GC) are frequently prescribed to patients with rheumatoid arthritis (RA), however GC use is associated with several potential side effects. Hypertension is cited as a possible side effect, but few studies have specifically investigated GC-associated hypertension in patients with RA with conflicting results. The aim of this study was to determine whether GCs were associated with an increased risk of incident hypertension in a cohort of patients with RA.

Methods
A retrospective cohort of patients with incident RA and no hypertension at RA diagnosis were identified from UK primary care electronic health records (Clinical Practice Research Datalink). GC prescriptions were used to determine time-varying GC use and dose, categorised as: no use, &gt;0-4.9 mg/day, 5-7.4 mg/day, 7.5-14.9 mg/day, ≥15mg/day. A 3-month risk attribution model was used where patients continued to remain at risk for 3 months after the end of prescriptions. Hypertension was identified if a patient had either: 1) 2 consecutive systolic blood pressure (BP) measurements &gt;140mmHg within a year, 2) 2 consecutive diastolic BP measurements &gt;90mmHg within a year or 3) antihypertensive prescriptions on at least two occasions and a Read code for hypertension. Unadjusted and adjusted Cox proportional hazards (PH) regression models were fitted to determine if there was an association between GC use and hypertension.

Results
There were 17,760 patients with incident RA and no hypertension. The cohort had a mean age of 56.3 ± 12.7 years and were predominantly female (68%). 7,421 (42%) were prescribed GCs during follow-up. There were 6,243 cases of incident hypertension. The Cox PH model indicated that recent GC use was associated with a 17% increased hazard of hypertension (hazard ratio: 1.17 (95% CI 1.10 to 1.24)). When categorised by dose, only doses above 7.5mg were significantly associated with hypertension (Table 1).

Conclusion
In this large cohort of patients with RA and without hypertension, recent GC use was associated with incident hypertension. Doses ≥7.5mg were associated with hypertension while the association with lower doses was inconclusive. Clinicians need to consider cardiovascular risk when prescribing GCs and ensure BP is regularly monitored.

Disclosures
R.E. Costello None. M. Jani None. B.B. Yimer None. W.G. Dixon None.
P232 Effectiveness of adalimumab biosimilar switching: real world data from a London rheumatology centre
Authors: Vigneswaran Shivanee , Galloway Megan , Hanlon Samuel , Tynan Aoife , Singh Animesh 
Published: April 2020

Abstract

Background
Biologic drugs have revolutionised the management of many rheumatological diseases with remission or low disease activity now the realistic targets for treatment. However, given the chronic nature of most rheumatological disease and the need for long term treatment, there has been a significant increase in the cost associated with disease treatment. The advent of biosimilars offers an attractive target in reducing drug costs for payers. Biosimilar medications are thought to be equally efficacious as originator drugs. Real world data in adalimumab biosimilar switching is limited. In this audit we aim to examine the real-world outcomes from switching from originator Humira to biosimilar Amgevita in a London teaching hospital.

Methods
A list of all adult rheumatology patients on Amgevita was obtained through pharmacy records. All patients had been switched from Humira to Amgevita from February 2019. Using clinic letters and an in-house biologics database, data was collected on the underlying disease and the date of switch. Outcomes reviewed were disease activity scores pre and post switch, documented side effects and flare of disease activity following switch including decision to revert to originator Humira or change treatment.

Results
There was a total of 289 adult patients on Humira who switched to Amgevita. Of these patients, 28 in total discontinued treatment - 13 with rheumatoid arthritis, 10 with psoriatic arthritis and 5 with ankylosing spondylitis. 22 had to be switched back to Humira, with a further 4 patients approved to switchback and awaiting to restart. Two additional patients were switched to alternative biologic therapy due to inefficacy. A further 3 patients refused to switch onto Amgevita. Sixteen patients had documented flares, with one requiring admission and ten requiring local or systemic corticosteroid therapy to control activity. Seven patients had documented side effects which included chest pain, headache, rash and site reactions and one patient developed shingles post switch.

Conclusion
A total of 9.6% of patients switched to Amgevita had disease flare or side effects resulting in a switchback to Humira or alternative biologic therapy. For a biosimilar to be approved, efficacy and safety profiles needs to be comparable to the originator biological therapy and usually looks at two treatment naïve groups, rather than direct switch. Thereby, data on switches in therapy is limited. One systematic review looking at 11,053 patients with inflammatory arthritis treated with Etanercept and switched to Benepali, found 768 reverting to original therapy giving a lower total of 6.9%. We find that although no previous data of Amgevita, our figure of 9.6% appears high in the context of previously controlled inflammatory disease with Humira.

Disclosures
S. Vigneswaran None. M. Galloway None. S. Hanlon None. A. Tynan None. A. Singh None.
P245 Relationship between symptoms and imaging in axSpA
Authors: Taylor Jodie , Gullick Nicola 
Published: April 2020

Abstract

Background
Axial spondyloarthritis (axSpA) is an inflammatory condition affecting the axial skeleton, which includes the sacroiliac joints (SIJ) and the spine. Common symptoms include back pain which often radiates to the hip/buttocks and morning stiffness that is relieved by exercise. Treatment includes physiotherapy, non-steroidal anti-inflammatories (NSAIDs) or in severe cases with biologic agents. In the UK, patients can access biologics if they are unresponsive to NSAIDs and BASDAI is &gt; 4.

Methods
Patients under care of a rheumatologist with a diagnosis of axSpA, with an MRI of the axial skeleton, CRP or ESR and BASDAI within 3 months of imaging were included in the study. MRIs (T1 and STIR) of the spine and sacroiliac joints were scored using the ASspiMRI-a (Berlin modified) and SPARCC SIJ methods. Data from a total of between 35-53 patients was used for the project, depending on available data for the scoring method. Due to incomplete data sets for spinal MRIs, the scoring was sub-grouped as follows: - BerlinC2: C2/3 to L5/S1 VU (maximum score 69) - BerlinT1: T1/2 to L5/S1 VU (maximum score 51) - BerlinT10: T10/11 to L5/S1 VU (maximum score 24) Kendall’s tau-b correlation coefficient was used for statistical analysis. The p value of significance was also corrected using the Bonferroni adjustment to 0.00192 due to multiple statistical analysis.

Results
The median and interquartile ranges for each of the scoring methods were relatively low in relation to the maximum possible score. These were 5(11) for SPARCC, 5(5.5) for BerlinC2, 4.5(8) for BerlinT1 and 3(3) for BerlinT10. The ranges for the collected scores were also low compared to the maximum possible score for each method. These were 0-45 for SPARCC (maximum 72), 0-23 for BerlinC2 (maximum 69), 0-18 for BerlinT1 (maximum 51) and 0-8 for BerlinT10 (maximum 23). A total of 26 correlations were evaluated from 10 variables. These variables were the SPARCC, BerlinC2, BerlinT1, BerlinT10, BerlinC2 + SPARCC, BerlinT1 + SPARCC, BerlinT10 + SPARCC, CRP, ESR. and BASDAI. None of the correlations were significant.

Conclusion
There was no significant correlation between BASDAI and inflammation as assessed by imaging in axial spondyloarthropathy. The subjectivity of the items of the BASDAI may contribute to this finding and as such, should be a point for further research to assess the suitability of the BASDAI in evaluating disease activity and response to treatment in axial spondyloarthropathy.

Disclosures
J. Taylor None. N. Gullick None.