bluuebunny/crossref_metadata_2025_split huggingface dataset:
P69 Occupational and leisure activities as a risk factor for hip and knee revision surgery
Authors: Lasala Elena Zaballa , Harris Clare , Walker-Bone Karen 
Published: April 2020

Abstract

Background
Lower limb arthroplasty is a highly successful orthopaedic procedure, but the prosthesis may fail over time, necessitating revision surgery. Recognised risk factors for revision include obesity and metal on metal devices, but it is less clear whether heavy physical activity, at work or during leisure time, can impact the survival of the replaced joint. We undertook a systematic review to explore this question.

Methods
Original studies published 1985-2017 reporting risk factors for hip or knee revision arthroplasty (excluding revision for infection) in people aged over 18 years and with ≥1 year follow-up post-arthroplasty were identified from Medline, Embase, and Scopus. The search yielded 10,361 results, amongst which 12 addressed the research question.

Results
Out of the 12 studies, 9 were concerned with failure of primary hip arthroplasty and only 3 with failure of primary knee arthroplasty. We found extraordinary variation in the methods used to quantify exposure to both occupational and leisure-time physical activity. As a result, the data were poorly comparable, and some studies reported that post-operative physical exposures were beneficial for joint survival whilst others reported that they were deleterious. Many studies only assessed the relevant exposures before the operation, which may limit the relevance to post-arthroplasty physical activities. Overall, we found some (variable quality) evidence suggesting that agriculture/farming and industry/engineering/construction work and, in women, health services work may increase the risk of revision. Likewise, there was conflicting and moderate quality evidence that exposure to high-intensity leisure-time activities may increase the risk of failure.

Conclusion
As increasing numbers of arthroplasties are performed at younger ages, and people are encouraged to work to older ages, more evidence is urgently needed about returning to some types of work and any future risk of joint failure. This is particularly important for advising people doing manual and emergency services/military type work. Leisure-time physical activity is good for health and high-quality evidence is needed here to inform if specific types of sport should be avoided, particularly for knee patients.

Disclosures
E. Zaballa Lasala None. C. Harris None. K. Walker-Bone None.
P78 Introduction of video consultation into the general rheumatology clinic
Authors: Griffith Sian M , Brewer Eleanor 
Published: April 2020

Abstract

Background
An expansion in consultant work force and increasing demand for outpatient services has led to a shortage of clinic space to run clinics, overcrowding in waiting rooms, and lack of space in patient car parks. We therefore decided to trial a video consulting technology that is used in remote areas by NHS Scotland, in an urban rheumatology clinic.

Methods
All follow up patients due to attend a weekly rheumatology clinic were contacted by letter 2-4 weeks before their appointment, and invited to opt for video consultation. Patients were asked not to use the service if they were likely to need a physical examination or procedure such as joint injection. The participating consultant then provided her usual clinic at the usual time using a mixture of face to face and video consultations. The service was evaluated by looking at the number of patients opting for this service, age and diagnosis of participating patients, and feedback from patients and consultant.

Results
Between 1 September and I October 2019, 77 patients were invited to attend, of which 12 patients requested video consultation. 2 patients did not attend their video consultation meaning 10 patients (13%) participated in the initial pilot. The average age of participants was 53 (range 36 to 68): 6 female, 4 male. The patients had the following diagnoses: rheumatoid arthritis (5), psoriatic arthritis (3), ankylosing spondylitis (1), and fibromyalgia (1). 7 patients gave feedback (4 male: 3 female). 7/7 rated process of booking and joining video consultation good or very good, 7/7 satisfied with picture quality, 4/7 satisfied with sound quality, 7/7 able to communicate everything they wanted to the doctor during the consultation. 6/7 rated the experience as the same as a face to face consultation, 1/7 better. 7/7 happy to have further consultations using video technology. In terms of time saved travelling to outpatients less than one hour (2), 1-2 hours (4), 2-3 hours (1).The feedback from the consultant was that clinic time was saved by using video consultations, and that all patients who had selected the technology has done so appropriately.

Conclusion
Inviting all rheumatology follow-up patients to use video technology for consultation resulted in 13% fewer patients attending the outpatient clinic, reducing congestion in the patient car park and clinic waiting room. Patients opted appropriately for such consultations, as none needed to return on another occasion for further consultation. The video consultations took less time than face to face consultations, saving time in the clinic. The overall patient and doctor satisfaction with the technology was good, and patients saved significant time on travel to the clinic.

Disclosures
S.M. Griffith None. E. Brewer None.
P79 The changing face of rheumatology referrals 2011-2018
Authors: Ford Mark , Panchal Sonia , John Holly 
Published: April 2020

Abstract

Background
‘Getting it right first time' includes seeing the right patient, at the right time, in the right place, by the right person. This includes seeing suspected inflammatory arthritis patients within 3 weeks of referral. An understanding of the case mix of new referrals is therefore required. Such an audit would allow capacity planning for early arthritis, follow up, and therapy appointments. We have audited the case mix of our new patient referrals 3 times over 7 years.

Methods
All new patient referrals, to a single hospital trust, seen in a 3-6-month period in 2011, 2015 and 2018 were audited. Data was collected on primary rheumatological diagnosis (by rheumatologist), outcome (discharge/follow-up), if it was a re-referral for the same problem within 12 months, and onwards referrals (AHPs, injection clinic, ultrasound). In 2018, additional data captured included GP reason for referral. Data was entered onto an electronic proforma and analysed with descriptive statistics.

Results
Data was collected on 547 patients in 2011, 335 patients in 2015 and 305 patients in 2018. The primary diagnosis made by the rheumatologist in 2011, 2015 and 2018 respectively was: inflammatory arthritis (18%, 15%, 13%); gout (9%, 4%, 2%); osteoarthritis (19%, 19%, 17%); fibromyalgia (6%, 15%, 19%); spondyloarthropathy (4%, 4%, 3%); PMR (6%, 3%, 4%); soft tissue (9%, 6%, 3%). In 2018, comparison between GP reason for referral, and diagnosis by rheumatologist was, respectively, 33% and 13% for inflammatory arthritis; 2% and 17% for OA; 23% and 19% for fibromyalgia. Discharge at first appointment was 33% (2011), 38% (2015) and 39% (2018). Re-referral rates were 4.1% (2015) and 3% (2018). Onward referrals in 2011, 2015 and 2018 were, respectively 26.5%, 28.1% and 41% for physiotherapy; 23.4%, 20.9% and 10% for joint injection clinics; 10.1%, 17.3% and 21% for ultrasound.

Conclusion
Detailed case mix audit can help with service planning and delivery; suspected inflammatory arthritis (&lt; 3 weeks) requires a third of the new patient capacity. Over the 7 years, the proportion of patients diagnosed with an inflammatory arthritis has remained stable, as has the two-thirds of new patients who are followed up; capacity in early arthritis and follow-up clinics is required to match this demand. Demand for ultrasound has significantly increased, and units may need to consider local ways to meet his demand. Local therapy teams will find this audit helpful to ensure capacity can match demand. Over the 7 years there has been a tripling of the proportion of patients diagnosed with fibromyalgia, such that it now represents a fifth of all new patient referrals. Seeing these patients 'in the right place, by the right person' could include developing community clinics and the role of a GP with a specialist interest.

Disclosures
M. Ford None. S. Panchal None. H. John None.
P86 Evaluation of a 10-week progressive resistance training programme for people with inflammatory arthritis
Authors: Skeates Jade , Pearson Jennifer , Derham Sandi , Palmer Shea 
Published: April 2020

Abstract

Background
Inflammatory arthritis [IA] has adverse effects on strength, function, fatigue and well-being. Guidelines recommend people with IA should exercise to improve strength and cardiovascular fitness. In 2015, our Rheumatology Physiotherapy Team introduced an evidence-based Progressive Resistance Training Programme [PRTP] for people with IA. This research aimed to evaluate its effectiveness within a United Kingdom National Health Service [NHS] setting.

Methods
A pre- to post-treatment evaluation was conducted. People with IA attending Rheumatology Physiotherapy were offered the supervised PRTP (1-hour x 10 weeks), performing 7 resistance exercises each session (70-80% 1RM, 3 x 8-12 reps). Pre- and post-treatment outcomes included Health Assessment Questionnaire [HAQ], EQ5D-5L, Self-Efficacy (SARAH Trial), 30 second Sit-to-Stand [STS], FACIT-F (fatigue scale) and Grip Strength. Changes in outcomes were analysed using Paired Samples t-tests and standardised mean difference (SMD) were calculated.

Results
201 patients commenced the programme between May 2015 and April 2019, with 121 participants completing it. Diagnoses included Rheumatoid Arthritis (n = 149), Psoriatic Arthritis (n = 42), Juvenile Idiopathic Arthritis (n = 5), Enteropathic IA (n = 2), Oligoarthritis (n = 1), Reactive Arthritis (n = 1) and Undifferentiated IA (n = 1). Age = mean 56.8 ± SD 14.8 years; number of sessions attended = 7.7 ± 3.4. There were no differences between participants not completing (n = 54; 72% women; age 55.0 ± 14.6 years; HAQ 0.99 ± 0.70) versus those completing the PRTP (n = 147; 78% women; age 57.5 ± 14.8 years; HAQ 0.86 ± 0.65). A pragmatic decision was made to analyse all available data for each outcome.

Conclusion
All outcome measures demonstrated statistically significant improvements. Notably, minimal clinically important differences were achieved in STS and FACIT-F. STS correlates to lower limb power, balance and endurance, and is a predictor of falls. Fatigue significantly impacts function in people with IA, often limiting confidence and willingness to participate in exercise activities. Effective evidence based PRTPs for people with IAs can be delivered in an NHS service. Improvements in function, wellbeing, self-efficacy, strength and fatigue are achievable, however, exploration of the clinical relevance of these observed changes is recommended. Further research exploring patients’ perspectives of the PRTP and adherence to long-term exercise is needed.

Disclosures
J. Skeates: None. J. Pearson: None. S. Derham: None. S. Palmer: None.
P108 Awareness of musculoskeletal disorders and its health impact among civil servants in Malaysia: a cross-sectional survey
Authors: Ariff Hairul Hadi , Shahril Nor Shuhaila , Eow Liu Hing , Musa Wan Rosmaiza Wan , Rajalingam Shamala , Jeffrizal Malek Faris Riza Feisal , Ramlan Azwarina Hanim , Selvadurai Shantene , Ang Diana Lee Min , Suahilai Dayang Masyrinartie , Isa Liza Mohd 
Published: April 2020

Abstract

Background
Work-related musculoskeletal disorders have been perceived as one of the reasons of declining work productivity in relation to absenteeism, sick leave or early retirement. We have determined the prevalence of musculoskeletal symptoms among current working civil servants and have assessed the health impact of musculoskeletal disorders towards them or other people surrounding them.

Methods
Participants were given a self-administered questionnaire consisting of demographic data, experience of musculoskeletal disorders, perceptions, knowledge and attitudes towards musculoskeletal disorders. Out of 174 participants, 147 returned completed forms (response rate: 84.5%). Data were analysed using SPSS Statistics v22.

Results
The average age of the respondents with standard deviation was 39.9 ± 9.82 years and a majority were female (78.2%). Mean body mass index between the participants were 26.36 ± 5.26, normal to obese range. Most of the participants described their type of job as active in nature (51.7%) with a majority working 5-8 hours per day. Mean duration for years of working in service were 16.20 ± 9.53. Half of them had musculoskeletal pain within the last 3 months prior to the study date, with highest frequency over the knee joint (29.9%) followed by lower back (21.8%) and shoulder area (21.1%). From the multivariate logistic regression analyses, only 2 factors in the knowledge section showed statistical associations regarding questions asking whether the participants knew what arthritis was (p = 0.005), and if they experienced arthritis themselves (p = 0.002). We found that there were no significant associations between the race, education level, marital status, type of work, duration of work or body mass index (BMI) with the prevalence of musculoskeletal pain within the participants.

Conclusion
The majority of respondents had knee pain followed by lower back pain and shoulder pain. Although there is strong correlation between knowledge of arthritis among participants, majority of them cannot specify the type of arthritis correctly. As such, continuous health education and promotion of the programme is vital.

Disclosures
H. Ariff None. N. Shahril None. L. Eow None. W. Wan Musa None. S. Rajalingam None. M. Jeffrizal None. A. Ramlan None. S. Selvadurai None. D. Ang None. D. Suahilai None. L. Mohd Isa None.
P109 Influenza vaccine uptake
Authors: Noureldin Basil , Erb Nicola 
Published: April 2020

Abstract

Background
Patients on immunosuppressive csDMARDs and bDMARDs for inflammatory and autoimmune conditions are more susceptible to infection. Viral infection in these patients is associated with an increased likelihood of severe outcomes such as bacterial pneumonia, hospitalisation and death. The influenza vaccine is a simple and effective measure to protect patients from seasonal flu. Traditionally uptake has been patchy in rheumatology patients for unclear reasons.

Methods
Aim: To assess the uptake of the influenza vaccine amongst at risk patients in a secondary care rheumatology department and investigate the factors that may affect uptake.
Methodology: This is a cross sectional retrospective study with a sample size of 200. Patients were invited to complete a paper survey when they attended their outpatient rheumatology clinic in May/June 2019 about the previous winter 2018/19 influenza season. Chi square tests were used to determine whether age, educational level and ethnicity had an impact on vaccine uptake.

Results
5% of the population were aged between 18 - 30, 21% between 31 - 50, 48% between 51 - 70, 25% between 71-90 and 1% were above 90. 56% attained secondary school level education, 13% completed college/A levels,18% had completed university,12% completed vocational education and only 1% attained primary school level alone. Most of the patients were Caucasian (93%) with only a small percentage of different ethnic groups represented in the sample. 62% of the patients were on DMARD treatment. Of those who were on DMARD treatment, 78% were vaccinated against influenza in the last season. 55% of those not on DMARD treatments were vaccinated. Chi square tests showed a significant relationship between age and vaccine uptake with older patients more likely to have the vaccine(p &lt; 0.001). The tests also showed that higher education levels were associated with higher vaccine uptake(p &lt; 0.02). Those on DMARDs were also significantly more likely to be vaccinated than those not on DMARDs (p &lt; 0.001). The sample sizes in the different ethnic groups weren’t big enough to assess the effect of ethnicity on uptake. The top three reasons given by patients for not having the vaccine were that they didn’t feel it was necessary, worrying that they’d get sick afterwards and not finding the time to have it done.

Conclusion
Age, education level and being on DMARD treatment had an impact on influenza vaccine uptake. Further patient education on the importance and benefits of the influenza vaccine needs to be provided to patients to improve vaccination rates in at risk individuals. Influenza vaccine should be discussed with all patients at routine follow up visits, appropriate educational provided and general practitioners alerted to the need to place immunosuppressed rheumatology patients on call up schemes for influenza vaccination

Disclosures
B. Noureldin None. N. Erb None.
P117 Rituximab for IgG4-related disease: the Newcastle experience
Authors: Rayner Fiona , Griffiths Bridget , Nayar Manu , Oppong Kofi , Vila Josephine 
Published: April 2020

Abstract

Background
IgG4-related disease (IgG4-RD) is a multisystem immune mediated fibro-inflammatory condition characterised by the three histopathologic features of IgG4-RD lymphoplasmacytic infiltration, storiform fibrosis and obliterative phlebitis. The condition can be indolent with few symptoms or present with organ or life-threatening disease. First-line treatment with high dose corticosteroids is often effective, however when tapering steroids, the disease can relapse, and second line agents such as methotrexate (MTX), azathioprine (AZA) or mycophenolate (MMF) are not always effective or tolerated. In 2016, following evidence from observational studies, NHS England approved the use of rituximab (RTX) in refractory IgG4-RD according to strict criteria. In our unit we have used rituximab, with or without cyclophosphamide induction, in eight patients with IgG4-RD. Our aim was to assess effectiveness of rituximab treatment and adherence to NHS England guidelines.

Methods
Using our connective tissue disease database, patients with IgG4-RD were identified and their electronic notes were reviewed. Outcome after rituximab treatment was assessed by the evaluation of clinical and radiological responses.

Results
Between August 2017 and September 2019, 15 patients with IgG4-RD were seen in the rheumatology service. 8 patients went on to receive rituximab therapy, 4 with IV cyclophosphamide (CYP). 5/8 patients had head and neck disease and 3/8 had abdominal disease (pancreas, retroperitoneal, renal). By comparison, those patients that did not receive rituximab had a preponderance of abdominal disease (4/7 had abdominal disease, 2/7 head and neck, 1/7 breast). 8/8 patients receiving rituximab were discussed in a designated MDT and met NHS diagnostic guidelines. MDT treatment decisions were made based on ‘refractory’ or ‘organ critical’ disease criteria. In all patients, with available post treatment imaging, radiological response was demonstrated. In one case, imaging showed improvement in some areas and progression in other areas and response was described as ‘partial’.

Conclusion
In the patients treated to date in our unit, rituximab has been shown to be an effective treatment for IgG4-RD. Cyclophosphamide induction has been used in a subset of patients. Patients with head and neck disease were more likely to require escalation to rituximab therapy, compared with those with abdominal disease.

Disclosures
F. Rayner None. B. Griffiths None. M. Nayar None. K. Oppong None. J. Vila None.
P119 Characteristics and treatment of fibrosclerosing orbital inflammatory disease
Authors: Thanopoulou Vasiliki , Weller Alexander , Nigar Ezra , Marais Joseph , Lee Vickie , Marjanovic Branka , Ahmed Abdul , Balasundaram Indran , Hamdulay Shahir 
Published: April 2020

Abstract

Background
Orbital inflammatory disease (OID) encompasses a group of disorders which affect the orbit and neighbouring areas. Several multi-system inflammatory diseases including small vessel vascuilitides, Sarcoidosis and IgG4 disease can manifest as an OID. Treatment generally includes steroid therapy in combination with conventional immunosuppressant’s, cyclophosphamide or rituximab. Herewith we describe a series of non-vasculitic, fibroinflammatory OID.

Methods
We retrospectively reviewed records of 5 patients referred to rheumatology with inflammatory OID after malignancy, infection and Graves’ ophthalmopathy were excluded. General demographics, histology, MRI and treatment responses were reviewed.

Results
Patients were generally female (4:1) and of a young age (range 33-54). Proptosis and diplopia were the key symptoms with occasional sino-nasal symptoms. Inflammatory markers on presentation were marginally raised (CRP mean 11, ESR mean 37). All patients were negative for autoantibodies and had normal serum IgG4 levels. MRI showed fibrotic mass lesions in all cases with bone erosion/ destruction in 2 cases. Biopsy showed fibrosclerosis mixed with chronic inflammatory cells. 3 cases stained positive for IgG4 cells but only one of them achieved diagnostic levels (case 3). All patients were initially treated with high dose steroids (prednisolone 1mg/kg or IV methylprednisolone (MP)) with either methotrexate or cyclophosphamide (1g EUVAS protocol). Highly resistant cases were treated with rituximab (total 2g). There was a good clinical response to treatment in all cases but in 4 patients residual fibrosis persisted on follow-up MRI (Table 1).

Conclusion
We describe a series of fibrosclerosing OID with histology like IgG4 disease, but with normal serum IgG4 levels and negative tissue immunofluorescence (IF) in some cases. Most cases will respond well to steroids and second-line therapy, but residual fibrosis may persist with mild clinical sequelae. Early recognition and intensive therapy may minimise fibrotic complications.

Disclosures
V. Thanopoulou None. A. Weller None. E. Nigar None. J. Marais None. V. Lee None. B. Marjanovic None. A. Ahmed None. I. Balasundaram None. S. Hamdulay None.