bluuebunny/crossref_metadata_2025_split huggingface dataset:
P158 Severity of hand vascular involvement as assessed by MRI Digital Artery Volume Index (DAVIX©) predicts worsening of clinical parameters and patient reported outcomes in scleroderma
Authors: Danzo Fiammetta , Gjeloshi Klodian , Lettieri Giovanni , Abignano Giuseppina , Hinton Mark , Dean Anne-Maree , Cuomo Giovanna , Kubassova Olga , del Galdo Francesco 
Published: April 2020

Abstract

Background
Neointima proliferation is a key pathologic feature of systemic sclerosis (SSc), causing arterial vessel narrowing and being the recognised culprit pathological lesion in digital ulcers (DUs), pulmonary artery hypertension and renal crisis. Nevertheless, there are no validated imaging techniques to assess the severity of vascular involvement in SSc. We have previously shown digital artery volume index (DAVIX©) assessed with time of right MRI angiography, is a reliable measure of neointima proliferation in the hands. The purpose of our study was to identify the value of DAVIX© in predicting worsening of patient reported outcomes (PROs) and clinical parameters in SSc.

Methods
Cross-sectional data were available for 91 patients and complete 12 months follow-up data for 68 patients. Data collected included: modfied Rodnan skin score (mRSS), pulmonary function tests (PFTs), echocardiography, nailfold capillaroscopy, Health Assessment Questionnaire Disability Index (HAQ-DI), and Scleroderma Health Assessment Questionnaire (sHAQ). DAVIX© of the dominant hand was calculated as the % mean of the 4 fingers, employing MeVisLab software. Following analysis of distribution, Spearman or Pearson test were used to determine correlation coefficients, as appropriate (Prism 7).

Results
56/68 were female and median of disease duration was 4 years (IQR 1.91-9). As previously reported DAVIX© correlated with the presence of DUs (p = 0.0093). Considering all patients, DAVIX© correlated with mRSS (r=-0.258, p = 0.017), DLCO% (r = 0.338, p = 0.008) and the pattern of capillaroscopy (r=-0.388, p = 0.001). In patients with DUs, DAVIX© showed a stronger correlation with DLCO% (r = 0.786, p = 0.048). Most importantly, DAVIX© predicted the worsening of HAQ-DI (r=-0.295, p = 0.029), sHAQ (r =-0.333, p = 0.029) and VAS pain (r=-0.269, p = 0.038) independently of the presence of DUs.

Conclusion
The quantitative assessment of neointima proliferation in the hand by DAVIX© is a useful imaging biomarker of vascular disease activity. The value of DAVIX© in predicting the worsening of PROs and clinical parameters in overall patients, may offer insights on the role of vascular disease activity in the global progression of SSc. The validation of our data in an independent cohort and the sensitivity to change over time of DAVIX© may aid to the implementation of hand MRI as imaging outcome measure of vascular severity in SSc.

Disclosures
F. Danzo None. K. Gjeloshi None. G. Lettieri None. G. Abignano None. M. Hinton None. A. Dean None. G. Cuomo None. O. Kubassova None. F. del Galdo None.
P172 Anti-domain I positivity in SLE at diagnosis is predictive of atherosclerotic plaque development
Authors: McDonnell Thomas C. R , Farinha Filipa , Pericleous Charis , Griffin Maura , Nicolaides Andrew , Croca Sara , Giles Ian , Rahman Anisur 
Published: April 2020

Abstract

Background
Cardiovascular disease is a significant burden on SLE patients, and no satisfactory markers exist to predict atherosclerotic development in patients. This study utilised an orthogonal approach to develop a marker of cardiovascular progression with predictive value in SLE patients.

Methods
The earliest available sample from a cohort of 92 SLE patients was tested for anti-Domain I (aDI), anti Beta-2-Glycoprotein-I, and anti-Cardiolipin antibodies. Persistent positivity was not assessed. These patients then had vascular ultrasound scans (carotid and femoral arteries) (mean 10 years later) to assess subclinical atherosclerotic plaque. A range of demographic, clinical and serological markers were recorded at the time of the scan. Predictors of plaque presence were investigated using binary logistic regression.

Results
A total of 34 patients from the cohort of 92 had atherosclerotic plaque (37%). A total of 32 patients had aDI positivity, of which 20 (62.5%) also had Plaque, this is reflected by the significantly higher levels of aDI antibodies seen in Plaque patients (p &lt; 0.01). Anti-DI positivity was predictive of the development of plaque in the future (Odds Ratio (OR) 5.476, p &lt; 0.001). No association was seen for any other antibody tested. Multiple binary logistic regression showed aDI positivity had as much predictive value as triglyceride levels on the day of the scan (OR 3.5 vs 3.9, Table 1) for predicting plaque in patients. Age at scan was a third independent variable associated with atherogenic plaque.

Conclusion
Early aDI positivity may be a good marker of atherogenesis in SLE patients in the long term.

Disclosures
T.C.R. McDonnell: Other; I am an inventor on the patent for Domain I. F. Farinha: None. C. Pericleous: Other; This Author is an Inventor on the Patent for Domain I. M. Griffin: None. A. Nicolaides: None. S. Croca: None. I. Giles: Other; This Author is an Inventor on the Domain I Patent. A. Rahman: Other; This Author is an Inventor on the Domain I Patent..
P185 Patient perceptions of physical activity following a diagnosis of giant cell arteritis: a multinational qualitative study
Authors: Austin Keziah , Dures Emma , Almeida Celia , Cramp Fiona , Gilbert Kate , Guly Catherine , Hill Catherine , Mackie Sarah , O'Brien Anne , Watts Richard , Robson Joanna 
Published: April 2020

Abstract

Background
Giant cell arteritis (GCA) is the most common vasculitis in the UK, with an incidence of 220 cases per million in adults over 50 years of age. The physical symptoms as well as the side effects of glucocorticoids may impact patients’ ability to exercise. Maintaining physical activity (PA) has been shown to be beneficial to disease activity in other inflammatory conditions and is also a specific priority for GCA patients. The aim of this project was to explore patient perceptions of physical activity in GCA.

Methods
Multinational qualitative study, using interviews with 36 patients from the UK (25) and Australia (11), all of whom had a definitive diagnosis from imaging or biopsy. Interviews were recorded, transcribed, and analysed using inductive thematic analysis. This is secondary analysis of data collected to explore health-related quality of life in people with GCA.

Results
107 individual themes were reported by patients, which divided broadly into two overarching themes: barriers to (59) and facilitators of (48) physical activity. Four sub-themes were identified within each overarching theme. For barriers, these were: negative physical symptoms (including effects of disease flares, visual loss, fatigue, weakness, pain and stiffness), lack of physical capability (including poor stamina, confidence and mobility), negative perceptions around PA, and negative reinforcement (i.e. new physical symptoms following PA). Facilitators of physical activity were also grouped into four sub-themes: external facilitators (including motivation from healthcare professionals), access to appropriate facilities, personal strategies (including pacing and goal-setting) and personal facilitators (including internal motivation to improve symptoms, and positive reinforcement from noticing physical and psychological benefits of PA).

Conclusion
There are a variety of barriers to physical activity in GCA patients, including patients being fearful of exercise. In other inflammatory conditions, patients report improved symptoms following physical activity as well as wider benefits to general wellbeing and cardiovascular health. Education, motivational interviewing, and personalised strategies may be beneficial components of an intervention to support physical activity in patients with GCA.

Disclosures
K. Austin None. E. Dures Grants/research support; Has previously received an independent learning grant from Pfizer, however the work has been completed and the grant has been closed. C. Almeida None. F. Cramp None. K. Gilbert None. C. Guly None. C. Hill None. S. Mackie None. A. O'Brien None. R. Watts None. J. Robson None.
P194 Non-bacterial osteitis syndromes: characterising an adult population
Authors: Gill Tiara , Bubbear Judith , Keen Richard 
Published: April 2020

Abstract

Background
Inflammatory bone syndromes, such as SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) and CRMO (chronic recurrent multifical osteomyelitis) are rare and have not been extensively described in the existing literature. Although there have been proposed classification and diagnostic criteria, there is still limited consensus and uniformity of approach in identifying and treating these patients. This may be due to a lack of data and understanding about the nature and prognosis of these conditions. Attempts to characterise, especially in adult populations, has been limited thus far. As a tertiary metabolic bone service with an allied regional sarcoma service, we present further data on these conditions in an adult population.

Methods
Retrospective analysis of notes of patients, with a diagnosis of SAPHO and CRMO, that were registered on a departmental database was performed. Data on demographics, symptom onset and character, serum and radiological tests and treatment were analysed.

Results
77 adults were identified with a diagnosis of SAPHO and CRMO, with a 60:40 % split respectively. Female preponderance was noted with 74% of this cohort represented. SAPHO patients tended to present slightly later with a mean age of symptom onset of 37 years as compared to 24 years in the CRMO group. Diagnostic delay was evident with mean time to diagnosis averaging 34 months. Pain and bony swelling were the most common symptoms (99% and 39% respectively), with the clavicle, sternum and spine being the most common sites involved. Osteitis was a universal feature in both groups, whereas skin and inflammatory joint involvement was more of a feature of SAPHO patients (59% vs 39%). There is limited consensus on appropriate diagnostic tests. This was reflected in this cohort with variable testing of inflammatory markers, serological testing of HLA B27 and extent and modality of imaging. Non-steroidal anti-inflammatories (NSAIDS), intravenous bisphosphonates, steroids and anti-microbials were all employed as treatment options, although efficacy was difficult to establish in this retrospective analysis, a significant source of referrals were from the local Sarcoma Unit; this may have introduced a degree of bias in our results.

Conclusion
As rare conditions, promoting awareness, having an index of suspicion and early referral to specialist centres would help address current issues faced by this patient population. Several national and international disease registries are in development and will undoubtly help to standardise data collection in order to guide further work in this area. Future studies examining treatment efficacy in current as well as emerging biological therapies, such as anti-tumour necrosis factor, anti- interleukin 1 and 17 agents, would be of significant value.

Disclosures
T. Gill None. J. Bubbear None. R. Keen None.
P196 Predictors of fracture in patients with primary hyperparathyroidism
Authors: Mariannis Demetris , Bukhari Marwan 
Published: April 2020

Abstract

Background
Primary hyperparathyroidism (PHPT) is a recognised risk factor for fractures as the persistently elevated parathyroid hormone levels are associated with lower bone mineral density (BMD). In early osteoporosis (&lt;65 years), there is mainly trabecular bone loss while with increasing age, the largest loss of absolute bone mass occurs in cortical sites. Our aim was to compare cortical versus trabecular bone sites to determine which sites better predict fracture in PHPT patients referred for dual-energy X-ray absorptiometry (DEXA) scan in an observational cohort.

Methods
508 patients with PHPT referred for DEXA scan at Royal Lancaster Infirmary (UK) between 2006-2016 were included in a retrospective data analysis. Data collected included femoral and lumbar BMD, age, gender, height, weight, BMI, rheumatoid arthritis, smoking, alcohol, family history of fractures, secondary osteoporosis and long-term steroid use and was used to look at predictors of fractures using BMD at different sites. Simple statistics using independent t-tests and chi-squared tests were initially used and subsequently, logistic models were fitted unadjusted and adjusted confounding variables.

Results
97 males (19%) and 411 females (81%) were included, with 111 patients sustaining at least one fracture (21.9%). Mean age was 65 years (SD 0.55). Advanced age, female gender and a reduced BMD were all statistically significant factors associated with an increased risk of fractures. Smoking and long-term steroid use were also shown to increase risk of fracture however these were non-statistically significant. Adjusting for age and gender, a reduced L4 BMD was the strongest statistically significant predictor of fracture (OR 0.139, 95% CI: 0.112-0.782). Multivariate analysis revealed that a reduced L3 BMD was the strongest statistically significant predictor of fracture (OR 0.170, 95% CI: 0.071-0.72).

Conclusion
Overall, our study suggests that a reduced BMD at trabecular sites is a stronger predictor of fracture compared to cortical sites [Table 1]. Older age and female gender significantly increased the risk of fracture in PHPT patients. To the best of our knowledge, this is the first study looking at specific bone sites as independent predictors of fracture in PHPT patients. This analysis should be repeated using a larger cohort to validate our results.

Disclosures
D. Mariannis None. M. Bukhari None.
P202 Monitoring of immunoglobulin levels in RA patients on anti CD20, rituximab
Authors: Rice Ceara , Ghandi-Das Dhivya , Negi Anurag 
Published: April 2020

Abstract

Background
Rituximab is an anti-CD-20 used in resistant RA. It functions by reducing the efficacy of B cells which participate in this pro-inflammatory process. The BSR recommend immunoglobulin monitoring when using rituximab to aid rapid detection of hypogammaglobinaemia and address its potential complications which have been suggested by a recent large study in 2018 in the UK. Our objectives included: Are we measuring immunoglobulin (Ig) levels prior to rituximab infusions in all RA patients? Are we measuring Ig levels ‘4-6 months post infusions’ as per BSR guidelines? Is the cumulative dose of rituximab associated with hypogammaglobinaemia?

Methods
We collected data from departmental records for all the RA patients who were initiated on rituximab between 30/1/15 and 30/1/19. We recorded their basic demographics, pre-infusion immunoglobulin levels and subsequent levels with repeated infusions. All data was anonymised, but some patients had to be excluded from the final analysis due to missing immunoglobulin levels.

Results
42 patients were identified via the methodology. 88% of the 42 had Ig’s checked before starting rituximab. Only 38% of 37 patients included in this subsequent analysis had Ig’s checked within the recommended 6 months after their initial rituximab infusion. We also observed a notable average percentage drop in IgG levels after receiving approximately 6g of rituximab therapy, with 2 new patients developing new hypogammaglobinamia after 8g-10g of rituximab. After 10g of rituximab we noted an average percentage drop in rituximab of 26.8%. However, no statistical correlation between hypogammaglobinaemia and infection rates was found.

Conclusion
Although no correlation between hypogammaglobinaemia and infection rates were found, this study used small numbers from a single centre only. To improve UHW’s monitoring of Ig’s we introduced a performer which aims to help recording of pre and post IgG levels and recording of infections experienced between infusions. We hope this will increase identification of newly developed hypogammaglobinaemia and increase awareness of infection rates, ultimately leading to an improvement in patient care.

Disclosures
C. Rice None. D. Ghandi-Das None. A. Negi None.
P228 Risk of sinusitis in patients with rheumatoid arthritis: association with different treatment strategies
Authors: Halai Kapil , Bechman Katie , Norton Sam , Cope Andrew P , Hyrich Kimme L , Galloway James B 
Published: April 2020

Abstract

Background
There is an established increase risk of infection in rheumatoid arthritis (RA). Most published data examine serious events, which affect 3-5% of patients annually. Approximately half of the patients experience non-serious infection, which does not require parental antibiotics or hospitalisation. Sinusitis events affecting patients on biologics (particularly TNF inhibition) have been observed but not well described, with a prevalence of 2-17%. Sinusitis is associated with treatment discontinuation and surgical interventions. We aim to describe the rates of sinusitis with different RA treatment strategies and provide estimates of risk difference.

Methods
The population was adults with RA, enrolled in the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis registry (BSRBR-RA) during the first 3 years of study on biologic treatment. The predictor was treatment strategy at the time of event (csDMARD only, TNF inhibitors, IL-6 inhibitors and anti-CD20). The primary outcome was sinusitis according to MeddraPT codes reported by patients (via patient diary) or clinician (on an adverse event form). A multi-failure Cox survival model was used to compare risk across treatment groups. A multivariate model adjusted for confounders (age, gender, entry year in BSRBR-RA, disease duration, baseline disease activity by DAS-28, HAQ, comorbidities, smoking status and steroid use.

Results
23,584 patients were included, contributing to a total of 64,035 patient-years of follow up. There were 797 infective events in 580 patients. This corresponded to a rate of 0.95 per year (95% CI 0.87 to 0.1.02). The sinusitis rate was numerically highest with anti-CD20 (Rituximab) and lowest with csDMARDs (Table 1). In the adjusted Cox proportional hazard model, all 3 biologics strategies had a significantly higher rate of sinusitis compared to csDMARD cohort; (TNFi 2.76 (95%CI 1.85 to 4.12); IL-6R 2.51 (1.00 to 6.29); anti-CD20 3.14 (1.46 to 6.72).

Conclusion
Sinusitis is more common in patients prescribed biologics compared to the csDMARD. The highest rate was seen with rituximab. This would fit biologically, as the primary immunodeficiency phenotype of recurrent sinusitis aligns with antibody defects e.g. common variable immunodeficiency. However, it is interesting to observe that sinusitis is more common across the treatment classes.

Disclosures
K. Halai None. K. Bechman None. S. Norton None. A.P. Cope None. K.L. Hyrich Honoraria; AbbVie paid to the institution and grant income from Pfizer and Bristol-Myers Squibb for activities outside of this work. J.B. Galloway Honoraria; or speaking or attending conferences from AbbVie, Bristol-Myers Squibb, Celgene, Janssen, Pfizer and Union Chimique Belge.
P274 Association of self-reported symptoms and behaviour in axSpA: initial analyses from the Project Nightingale study
Authors: Barnett Rosie , Ng Stanley , Jones Simon L , Young Matthew , Sengupta Raj 
Published: April 2020

Abstract

Background
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the spine and sacroiliac joints, characterised by fluctuating periods of flare and remission. Management is based on patient-reported symptoms and outcome measures collected at follow-up appointments which may be subject to recall bias. Smartphone technologies for monitoring disease symptoms provide an opportunity to gain a more complete understanding of disease burden and symptom patterns and may facilitate optimisation and personalisation of axSpA management.

Methods
Patients with axSpA attending the Royal National Hospital for Rheumatic Diseases in Bath were invited to participate in the study. Through the uMotif symptom tracking app, patients were sent daily reminders to log pain, fatigue, sleep, recommended exercise, mood and stress using 5-point Likert scales (higher scores indicating better outcomes eg. No pain=5), in addition to optional variables such as screen time, caffeine intake and menstrual cycle. For each patient, at each time-point, Spearman rank correlation coefficients were used to evaluate inter-variable correlations. Lagged variables were used to assess correlations with variables from the previous day (variable-1).

Results
Between 05/04/18 and 08/03/19, 174 patients consented for research and logged a mean of 99.73 (SD = 99.97) days of data (range=1 - 323 days). Significant correlations were identified between uMotif variables (Table 1), including pain and fatigue; mood and stress; hot flushes and fatigue/pain; confidence in self-management and mood/pain; smoking and pain/fatigue; exercise and sleep; exercise and mood - supporting existing evidence regarding exercise implementation in axSpA.

Conclusion
These findings demonstrate relationships between a variety of patient-reported symptoms, including variables that to our knowledge, have not yet been explored in axSpA. In future research, it will be important to determine whether there is a chronological pattern within an individual or combination of variables that could predict a flare. Greater understanding of axSpA disease patterns and identification of the optimal timing of intervention to ameliorate these symptoms may ultimately reduce flare frequency, duration and intensity, and greatly improve quality of life for patients with axSpA.

Disclosures
R. Barnett None. S. Ng None. S.L. Jones None. M. Young None. R. Sengupta None.
Semantic Search in Psychosis: Modeling Local Exploitation and Global Exploration
Authors: Lundin Nancy B , Todd Peter M , Jones Michael N , Avery Johnathan E , O’Donnell Brian F , Hetrick William P 
Published: April 2020

Abstract
Impairments in category verbal fluency task (VFT) performance have been widely documented in psychosis. These deficits may be due to disturbed “cognitive foraging” in semantic space, in terms of altered salience of cues that influence individuals to search locally within a subcategory of semantically related responses (“clustering”) or globally between subcategories (“switching”). To test this, we conducted a study in which individuals with schizophrenia (n = 21), schizotypal personality traits (n = 25), and healthy controls (n = 40) performed VFT with “animals” as the category. Distributional semantic model Word2Vec computed cosine-based similarities between words according to their statistical usage in a large text corpus. We then applied a validated foraging-based search model to these similarity values to obtain salience indices of frequency-based global search cues and similarity-based local cues. Analyses examined whether diagnosis predicted VFT performance, search strategies, cue salience, and the time taken to switch between vs search within clusters. Compared to control and schizotypal groups, individuals with schizophrenia produced fewer words, switched less, and exhibited higher global cue salience, indicating a selection of more common words when switching to new clusters. Global cue salience negatively associated with vocabulary ability in controls and processing speed in schizophrenia. Lastly, individuals with schizophrenia took a similar amount of time to switch to new clusters compared to control and schizotypal groups but took longer to transition between words within clusters. Findings of altered local exploitation and global exploration through semantic memory provide preliminary evidence of aberrant cognitive foraging in schizophrenia.