bluuebunny/crossref_metadata_2025_split huggingface dataset:
O03 Prevalence of fragility fractures and medication prescription for osteoporosis in patients with polymyalgia rheumatica: results from the PMR Cohort Study
Authors: Sokhal Balamrit Singh , Hider Samantha L , Paskins Zoe , Mallen Christian D , Muller Sara 
Published: April 2021

Abstract
Background/Aims
Polymyalgia rheumatica (PMR) is one of the commonest indications for long term glucocorticoid (GC) use, leading to an increased risk of osteoporosis and fragility fractures. Clinical guidelines recommend prescribing medication including vitamin D, calcium and anti-resorptives, such as bisphosphonates. The aim of this study was to examine the association of reported falls and prescriptions of medications for osteoporosis with future fragility fractures in a cohort of people with PMR.
Methods
652 people with an incident diagnosis of PMR responded to a baseline survey between June 2012 and June 2014. This included data on general health, sociodemographics, history of falls and medication. Data on fractures and prescriptions were collected at 12 and 24 months. Fragility fractures were defined as fractures of the hip, wrist or spine. Logistic regression models were used to assess the association between baseline characteristics and fractures at 12 and 24 months. Analysis was conducted unadjusted and adjusted for age, gender, reported medication use and falls history.
Results
112 (17.2%) baseline respondents reported a previous fragility fracture. 60 (83.3%) of the 72 respondents who reported a fragility fracture between baseline and month 12 also reported a fragility fracture at baseline. 49 (79.1%) of the 60 respondents who reported a fragility fracture at between the month 12 and 24 also reported a fragility fracture at baseline. Falls before baseline was the most significant predictor of fragility fracture at 12 (OR 2.35 95% CI 1.35-4.12) and 24 (OR 1.91 95% CI 1.05-3.49) months. Fewer than 50% of respondents were ever prescribed treatment for osteoporosis. Being prescribed treatment for osteoporosis was associated with a reduced incidence of fragility fractures at 24 months (adjusted OR 0.28 95% CI 0.10-0.80), but an increased incidence at 12 months (adjusted OR 2.10 95% CI (1.3-3.48). Calcium and vitamin D prescription, gender and age were not significantly associated with fracture outcome.
Conclusion
Despite guidelines, fewer than 50% of patients were prescribed medications for osteoporosis. This data highlights the risks of fractures in PMR patients who have experienced previous falls. Over a period of two years, medication for osteoporosis was significantly protective, hence more needs to be done to encourage adherence to guidelines. Further studies need to address reasons for non-adherence to guidelines and the effects of long-term treatment.
Disclosure
B. Sokhal: None. S.L. Hider: None. Z. Paskins: None. C.D. Mallen: None. S. Muller: None.
P047 An unusual case of dermatomyositis with co-existent anti-GAD and anti-NXP2 antibody positivity
Authors: Beharry Karen , Barminski Grzegorz , De Lord Denise 
Published: April 2021

Abstract
Background/Aims
Dermatomyositis (DM) is a rare disease. We present a case of DM with both anti-nuclear matrix protein 2 antibody (NXP2) as well as anti-glutamic acid decarboxylase antibody (GAD) positivity, the combination of which has yet not been documented in the current literature.
Methods
The case is described below.
Results
A 48 year old Caucasian male with no co-morbidities presented with a one-month history of sore throat and lethargy, followed 2 weeks later by muscular pain in his upper arms. On examination, there was erythema to the sun-exposed areas of the face and arms, hoarse voice and Gottron’s papules. He had proximal muscle weakness of 4/5 in his shoulder and hips. His creatinine kinase(CK) was elevated at 2914U/L. He was started on methylprednisolone 1 gram od for 3 days with improvement of his CK to 642U/L. His muscle biopsy showed mild chronic neurogenic changes and upregulation of C5b-9 but no evidence of inflammatory myopathy which was attributed to the steroid use prior to the biopsy. His myositis antibody screen was positive for Anti-Nuclear Matrix Protein antibody 2(NXP2). After 4 days he developed rapid onset dysphagia and a sudden drop in his spirometry readings with a fall in his FEV1from 94% to 85% and a fall in his FVC from 88% to 79%. He became acutely unwell, drowsy with difficulty completing sentences and global weakness. His CK had risen to 1567U/L despite the high dose intravenous methylprednisolone. He was diagnosed with Diabetic ketoacidosis(DKA) with a blood glucose of 32mmol/L , pH of 7.0, and transferred to ITU. Intravenous immunoglobulin (IVIG) was administered with subsequent improvement in all muscle groups. He was then commenced on a subcutaneous insulin regime and pulsed intravenous cyclophosphamide (Eurolupus) as his EMG showed a sensorimotor polyneuropathy as well as an inflammatory myopathy. His serology was negative for infectious aetiology. Malignancy screen including PET scan, oesophagogastroduodenoscopy and colonoscopy were normal however, he was found to be positive for anti-GAD antibody.
Conclusion
GAD antibodies are known to be associated with many disorders including diabetes and stiff person syndrome and can recognise different epitopes in various diseases. This is the first documented case of GAD occurring in a DM patient, in the presence of NXP2 antibodies. IVIG is used to treat both stiff man syndrome and refractory DM. It is possible that the combination of GAD and NXP2 contributed to the pathogenesis and severity of the clinical presentation in this case.
Disclosure
K. Beharry: None. G. Barminski: None. D. De Lord: None.
P094 Incidence of clinically diagnosed Paget’s disease of bone: evidence of a continuing decline
Authors: Cook Michael J , Pye Stephen R , Dixon William G , O'Neill Terence W 
Published: April 2021

Abstract
Background/Aims
Evidence from the UK suggest that the incidence of Paget's disease of bone declined during the latter half of the last century with a decline also in the incidence of clinically apparent disease. We aimed to characterise the recent incidence of clinically diagnosed Paget’s disease of bone in the UK by age and sex among those aged &gt;18 years and, to determine whether the incidence has changed from 1999-2015.
Methods
Incident cases of Paget’s disease during 1999-2015 were identified from the first recorded diagnostic code for Paget’s disease in the UK Clinical Practice Research Datalink (CPRD) database. Crude incidence was calculated for each year from 1999 to 2015 and, to account for changes in the distribution of age and sex over time within the CPRD, direct age- and sex-standardised incidence rates were calculated for each year. This was done by multiplying the crude incidence in each age-sex stratum by the age-sex stratum weight of the 1999 population of those at risk of developing Paget’s disease. We looked also at the incidence of disease by quintile of index of multiple deprivation and geographic region. Using Poisson regression, we looked at the influence of deprivation and geography on occurrence of the disease after adjustment for age and sex.
Results
In total 3,592 incident cases of Paget’s disease were identified between 1999 and 2015. Overall the incidence increased with age and at all ages was greater in men than women. In men, and women, respectively, incidence increased from 0.074 and 0.037 per 10,000 per year at the age of 45-49 years to 6.3 and 3.7 per 10,000 per year at age of 85 years and older. When stratified by year, the age- and sex-standardised incidence fell from 0.75/10,000 person years in 1999 to 0.20/10,000 person years in 2015. Crude incidence (1999-2015) was slightly higher in those living in the most deprived areas (0.53/10,000 person years) compared to those in least deprived areas (0.43/10,000 person years). After adjustment for age and sex, compared to those in the highest quintile of index of multiple deprivation, those in the lowest quintile of index of multiple deprivation had over a 30% increased risk of disease. There was evidence also of geographic variation in the occurrence of disease with the highest incidence in the North West of England.
Conclusion
The incidence of clinically diagnosed Paget’s disease has continued to decrease since 1999. The reason for the decline remains unknown, though the rapidity of change points to an alteration in one or more environmental determinants.
Disclosure
M.J. Cook: None. S.R. Pye: None. W.G. Dixon: None. T.W. O'Neill: None.
P097 Raised inflammatory markers with unclear cause; what do they tell us? An audit of patients presenting to rheumatology service at RNHRD, Bath
Authors: Jamal Muhammad Safwan , Peck Rachel , Sengupta Raj 
Published: April 2021

Abstract
Background/Aims
Unexplained persistently raised inflammatory response in patients’ leads to concern for clinicians. Different studies have demonstrated increased risk of mortality in patients with persistently raised inflammatory response. Rheumatology input is often sought in these cases when cause of inflammatory response is unclear. We conducted this project in our department to see the progress of new patients with raised inflammatory markers presenting to the rheumatology service.
Methods
Patients referred to the rheumatology outpatients with raised inflammatory markers (Plasma viscosity &gt;1.85 or CRP&gt;100) from April to November 2018 were included. Patient demographic information was gathered through patient’s records and imaging information was gathered through PACS system. Information about investigative modalities was included. Treatment recommendations were also included. Patients were followed up for 6 months and any change in their diagnosis was also incorporated into the data.
Results
169 patients satisfied the inclusion criteria. Median age was 58 years. Majority were females (72%). Mean referral to seen time was 3.43 weeks. Mean elevation in CRP and PV was 10 and 1.93 respectively. A diagnosis of mechanical/non rheumatological cause was made in 36% patients of those 11% were Fibromyalgia. Inflammatory arthritis diagnosis made in 34% patients. Autoimmune testing and radiological tests were performed in 97% and 90% patients respectively. 67% patients had malignancy or infection work up. Diagnosis was changed in 25% patients on follow up with investigation. With PV &gt; 2.0 (44 patients), only 20% had non inflammatory conditions. There were 6 deaths in this cohort of patients (13% mortality). 3 new cases of malignancy were diagnosed. P097 Table 1:Investigative modalitiesInflammatory disorders N=number of scansNon-inflammatory conditionsCT100MRI1812PET CT71NM scan14
Conclusion
Patients with persistently elevated inflammatory markers had a higher mortality rate than the other group over 6 months. Three quarters of patients with raised inflammatory markers remain under follow up of Rheumatology team for surveillance. Patients were reviewed in Rheumatology clinics in reasonable time. Appropriate investigative modalities were considered while investigating for inflammatory disorders. Further large scale studies are required to find an association between raised inflammatory response with mortality in rheumatology patients.
Disclosure
M. Jamal: None. R. Peck: None. R. Sengupta: None.
P098 Higher self-reported depression, anxiety and MSK scores in patients with non-inflammatory compared to inflammatory rheumatic diseases irrespective of age and gender
Authors: Henty Julian R , Ciurtin Coziana , Stefanova Eveta , Ellis Benjamin , Kocsis Agnes 
Published: April 2021

Abstract
Background/Aims
It is recognised that chronic musculo-skeletal (MSK) conditions have a significant impact on patients’ quality of life and level of functioning, as well as mood. In order to explore holistic therapeutic approaches and multidisciplinary support for this patient group, the differential impact of a diagnosis of an inflammatory versus non-inflammatory rheumatic condition on anxiety, depression and MSK general health was assessed.
The objectives of this pilot study were to determine the level of anxiety and depression in patients with inflammatory versus non-inflammatory rheumatic conditions and explore some of their determinants.
Methods
A questionnaire comprising the GAD-7 (anxiety), PHQ-9 (depression) and MSKHQ instruments was disseminated to 165 randomly selected patients attending outpatient clinics. Preliminary results from this questionnaire were analysed using descriptive statistics, Mann-Whitney tests and a multiple linear regression. Patients were stratified according to diagnosis classified as categorical variable, inflammatory and non-inflammatory rheumatic conditions.
Results
Differences between patients’ age and gender, as well anxiety, depression and MSK outcomes between the inflammatory and non-inflammatory groups are presented in the table below:
Linear regression showed that the strongest determinant of anxiety and depression was the category of diagnosis, i.e. inflammatory or non-inflammatory (p = 0.002, R2 = 0.060; p = 0.001, R2 = 0.072, respectively). Anxiety, depression or MSKHQ outcomes were not affected by gender or age, and MSKHQ was not predicted by diagnosis category either, when we accounted for gender and age. P098 Table 1:InflammatoryNon-inflammatoryp-valuen11946% Female65.871.70.467Age mean (range)54.1 (24-85)53.1 (26-81)0.689Anxietymedian (IQR)5 (1-11)9.5 (5-15.3)0.001n (%) clinically significant anxiety44 (37.0)25 (54.4)0.042Depressionmedian (IQR)8 (4-13)13 (7-19.3)0.002n (%) clinically significant depression54 (45.4)30 (65.2)0.022MSKHQ median (IQR)26 (16-35)33 (22-42.5)0.004
Conclusion
The preliminary analysis of our study showed that patient-reported anxiety, depression and MSK outcomes were significantly higher in patients with non-inflammatory compared to those with inflammatory rheumatic conditions, and that the diagnosis category was the strongest determinant for anxiety and depression.
Disclosure
J.R. Henty: None. C. Ciurtin: None. E. Stefanova: None. B. Ellis: None. A. Kocsis: None.
P100 Acute crystal arthritis: a leading cause of hospital admission, yet poorly recognised and mistreated
Authors: Abdalla A 
Published: April 2021

Abstract
Background/Aims
Crystal arthritis is the commonest inflammatory arthritis in adults. A common mimic is septic arthritis. Without appropriate synovial fluid analysis, a mis-diagnosis of sepsis can be made with resultant unnecessary hospitalization, inappropriate intravenous antibiotic therapy and excess cost. Such cases are frequently described as ‘culture-negative’ septic arthritis. We aimed to examine and analyse the cases of acute arthritis requiring acute hospital admission in a tertiary referral centre in Dublin.
Methods
A retrospective review of database between Jan - Dec 2019 at the Mater Misericordiae University Hospital, Dublin, was carried out. All cases of acute arthritis requiring acute hospital admission were identified. Cases treated at the Emergency Department, Acute Medical Unit or Outpatients which did not require hospital admission were excluded.
Results
30 patients were identified during this period, 16 (53%) had an ultimate diagnosis of crystal arthritis, 8 (27%) had confirmed septic arthritis and 6 (20%) had other arthritides (e.g. haemoarthrosis). The median age for crystal arthritis was significantly higher (85.5 y) compared to septic arthritis (47 y). Apart from age, the clinical profile and biomarkers for crystal and septic arthritis were comparable. The majority of crystal arthritis cases were due to pseudogout (69 %), ultimately diagnosed by rheumatology. Septic arthritis led to more days in hospital than crystal arthritis (median 14 vs 5.5 days). All 30 patients received IV antimicrobial therapy for presumed septic arthritis.
Conclusion
This retrospective study showed crystal arthritis, especially pseudogout, was the commonest cause of hospital admission (53%) with acute arthritis particularly among elderly patients. Accurate diagnosis by synovial fluid analysis with appropriate equipment is extremely useful in the assessment of these cases. More awareness and training among orthopedic, emergency and acute clinicians is needed in order to avoid unnecessary admissions and interventions.
Disclosure
A. Abdalla: None.
P141 How effective are high-cost drugs for rheumatoid arthritis beyond the third choice in routine care?
Authors: Walker David , Robinson Sandra , Barry Jane , Punter Phillip , Kearns Sinead , Goff Iain 
Published: April 2021

Abstract
Background/Aims
It became apparent at a session at the BSR Annual Conference 2019 that some CCGs restrict the prescription of high cost drugs (HCDs) beyond three drugs for people with rheumatoid arthritis (RA). We were interested to explore the efficacy of HCDs beyond the third choice in our own service.
Methods
All patients in our service who are being considered for HCDs, are discussed at a multi-disciplinary team meeting comprising of seven consultants and eight nurses. The HCD decision is recorded in the minutes of the meeting which were scrutinised to identify patients who had received four or more HCDs. We began at March 2017, the launch of JAK inhibitors, in the expectation that few people would have had four HCDs before that time. The medical records were reviewed for the order of HCDs given and for evidence of efficacy and toxicity. The response to each drug choice was graded as: responder; partial responder and failure (primary non-responder or toxicity).
Results
From a database of 2,673 patients with RA, 542 patients were taking HCDs, thirty-two of those had received four or more of these drugs. Eleven of the thirty-two patients had tried four HCDs, seven had received five HCDs, ten patients had six, one patient had seven HCDs, two had tried eight and one patient had received nine HCDs. The response rates for each choice of drug are shown in table 1. Many patients responded to their fourth, fifth and sixth choice of HCD. If there was a restriction of three HCDs in our service, thirty-three prescriptions for drugs that patients have responded to, would not have been made.
Conclusion
Many patients responded to their fourth or subsequent HCD. Thus, there is no clinical justification in restricting the use of HCDs below at least six choices. Additionally, this data suggests that only small numbers of patients are prescribed more than four HCDs. Therefore lifting this limitation would have little cost implication. P141 Table 1:HCD Response RateHCD Choice*123456&gt;6Responder12 (38%)10 (31%)10 (31%)12 (44%)14 (58%)6 (60%)1 (14%)Partial Responder5 (16%)1 (3%)7 (22%)5 (19%)4 (17%)1 (10%)1 (14%)Failure15 (47%)21 (66%)15 (47%)10 (37%)6 (25%)3 (30%)5 (71%)n =3232322724107*Switches to biosimilars were not regarded as a change.
Disclosure
D. Walker: Honoraria; Gilead Sciences Ltd, Ely Lilly Pharmaceuticals, Pfizer Pharmaceutical. Grants/research support; Gilead Sciences Ltd. S. Robinson: None. J. Barry: Corporate appointments; Gilead Sciences Ltd. P. Punter: Corporate appointments; Gilead Sciences Ltd. S. Kearns: Corporate appointments; Gilead Sciences Ltd. I. Goff: None.
P183 Osteitis condensans ilii or axial spondyloarthritis: a diagnostic challenge!
Authors: Saeed Sadaf , Jamal Muhammad Safwan , Ostry Dave , Robinson Graham , Sengupta Rajiv 
Published: April 2021

Abstract
Background/Aims
Osteitis condensans ilii (OCI) is a rare cause of chronic non-inflammatory axial lower back pain. It has become an important differential diagnosis of axial spondyloarthritis. Bone marrow oedema can be present in 48% of patients. Although 'aunt minnie' appearance on MRI is pathognomonic, specialised imaging like SPECT/PET CT can be considered in difficult cases to confirm the diagnosis. We reviewed case notes of patients with incidental diagnosis of OCI on imaging and followed their clinical progression to see if the diagnosis was modified later.
Methods
Retrospective radiological database analysis was performed to find imaging reported as OCI or osteitis from 2015-2020. Electronic patient records were analyzed and data was compiled through Microsoft Excel.
Results
Data from 24 patients was reviewed. Most patients were females (91.7%), with a median age of 43 years (range 19-79 years). CT and MRI were the chief modalities of imaging (46% and 38% respectively) while 20% had plain x-rays of the pelvis. The main indications for imaging were pelvic or hip girdle pain (58.3%), cancer surveillance (25%), abdominal pain (6%), and infection (6%). 20% had an underlying rheumatological diagnosis of which 8% had spondyloarthritis. 12.5% of patients had seronegative features of spondyloarthritis and 8.3% were HLA B27 positive. Approximately 40% of patients were seen by the Rheumatology team for further assessment after imaging and 12.5% of patients were diagnosed with axial spondyloarthritis and remained under follow-up.
Conclusion
OCI can mimic sacroiliitis on imaging. Although only a minority of patients with OCI reported on initial imaging were subsequently diagnosed with axial spondyloarthritis, thorough clinical assessment and multidisciplinary discussion can reduce the chance of a missed axial spondyloarthritis diagnosis. Further large-scale studies are required to find the exact incidence of spondyloarthritis in patients with imaging features of OCI.
Disclosure
S. Saeed: None. M. Jamal: None. D. Ostry: None. G. Robinson: None. R. Sengupta: None.