bluuebunny/crossref_metadata_2025_split huggingface dataset:
P002 Real-world experiences of biologic tapering
Authors: Rutter-locher Zoe , Man Yik Long , Marsh Lydia , Mercer Scott , Menon Bina , Cope Andrew 
Published: April 2021

Abstract
Background/Aims
Biologic therapy and treat to target have significantly improved patient outcomes and we now have a proportion of patients on biologic therapy who remain in clinical remission. NICE guidance suggests “cautiously reducing drug doses or stopping drugs in those who have maintained the treatment target”. Despite this guidance, little is known about current clinical practice of biologic tapering in UK rheumatology centres. We aimed to illustrate current practice and success rates in biologic tapering in a real-world setting in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS).
Methods
We identified patients who were potentially suitable for biologic tapering 1 week prior to their follow up appointment using the following criteria - any anti-TNFα biologic ≥ 1 year, RA patients (DAS28 CRP&lt;3.2, CRP normal), PSA patients (no swollen joints, CRP normal, no extra-articular manifestations), AS patients (BASDAI&lt;4, CRP normal). We then analysed how many patients were successfully tapered at one year. Tapering schedule was decided by the supervising rheumatologist.
Results
From December 2018 to February 2019, 66 patients were identified as being suitable for biologic tapering. 3 patients did not attend and were excluded from further analysis. Tapered group: 20 (32%) patients were tapered. Based on the retrospective review of clinic letters, the “tapering schedule” was inconsistent and the information provided to patients if they flared was also inconsistent - 9 (45%) patients were advised to return to their normal dose and only 1 (5%) patient was advised to contact the helpline. After 12 months of follow up, 11 (55%) patients remained on the tapered dose, 7 (35%) patients returned to their prior dose and 2 (10%) patients were lost to follow up. Non-tapered group: 43 (68%) patients were not tapered. The reasons for not tapering were divided into 6 broad categories: active disease (n = 15, 35%), patient choice (n = 5, 12%), DMARD was tapered instead (n = 5, 12%), discuss at next visit (n = 3, 7%), reason not mentioned (n = 12, 28%), other (n = 3, 7%)
Conclusion
This Quality Improvement Project has highlighted the inconsistencies in biologic tapering in a UK real-world setting. In response to this inconsistency, we have developed a departmental guideline which provides stringent criteria to identify patients at lowest risk of flaring and standardises a tapering schedule and clinical pathway. We also created a patient information leaflet that could be distributed. Only half of the patients remained on the tapered dose after 1 year, suggesting a significant proportion of patients flare following dose reduction. However, our findings may be limited by small sample size. National guidance and a thorough audit based on this guidance is welcomed.
Disclosure
Z. Rutter-locher: None. Y. Long Man: None. L. Marsh: None. S. Mercer: None. B. Menon: None. A. Cope: None.
P005 Rheumatology virtual clinics during COVID-19: are our patients satisfied?
Authors: Altamimi Fajer A , Martin Una 
Published: April 2021

Abstract
Background/Aims
Telemedicine can be broadly defined as the use of telecommunication technologies to provide medical information and services. It can be audio, visual, or text. Its use has increased dramatically during the COVID-19 pandemic to ensure patient and healthcare worker safety. Any healthcare professional can engage with it. It carries benefits like reduced stress and expense of traveling, maintenance of social distancing, and reduced risk of infection. There are some potential drawbacks such as lack of physical examination, liability and technological issues.
Methods
A questionnaire was sent to 200 patients, selected from different virtual clinics (new and review, doctor and ANP led) run between March and May 2020 in the rheumatology department of University Hospital Waterford. We formulated 14 questions to cover the following aspects: demography, the purpose of the consult, punctuality, feedback, medico-legal concerns, and free text for comments. A self-addressed return envelope was included.
Results
83 responses were received. 2 were excluded. The ratio of females to male respondents was 59: 41, with the majority over 60 years old. The main appointment type was review 67 (83%). 80% of patients were called either before or at the time of their scheduled appointment. The vast majority (98.8%) of our patients had confidence in our data protection and trusted our system to maintain their confidentiality. 95% stated that they felt comfortable, were given enough time to explain their health problem and felt free from stress. The respondents who preferred attending the clinic in person (17 in total) compared to the virtual were mostly follow up patients- 12 vs. 5 new.
Conclusion
Patient satisfaction among those surveyed was high, despite having to introduce the service abruptly during the COVID-19 pandemic. There are many improvements we can adopt to improve our service and even maintain after the pandemic as a way of communicating with our stable patients. As we are covering a large geographical catchment, we can continue to implement the virtual clinic for some appointments. We should prioritize our efforts on identifying the right patient and the type of service we can offer, further training of staff, and increasing awareness of the patients as to how to get the most out of a virtual appointment.
Disclosure
F.A. Altamimi: None. U. Martin: None. C. Sheehy: None.
P069 Results of an online survey exploring the effects of shielding during the COVID-19 pandemic on patients with spondyloarthritis (SpA)
Authors: Naja Meena , Amarnani Raj , Castelino Madhura 
Published: April 2021

Abstract
Background/Aims
The COVID-19 pandemic has created many challenges for patients with chronic rheumatological diseases. SpA - which includes ankylosing spondylitis (AS), axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and enteropathic arthritis - often affects young people who are otherwise fit and able. Many SpA patients take immunosuppressive medications and therefore were advised to shield. In view of this, we conducted a survey to better understand how shielding has affected the physical activity and symptoms of SpA patients during the pandemic.
Methods
An online anonymised survey was created and advertised via social media from 4th June to 4th July 2020. Patients with SpA were invited to complete the survey which included 18 questions exploring the impact of the pandemic on their symptoms, physical activity levels and medication use.
Results
There were 136 survey respondents, of whom 74.3% were female, with an age range from under 25 to over 75 years. The underlying diagnoses were PsA (60.5%), AS (28.4%), axSpA (10.5%) and enteropathic arthritis (0.8%). The majority (66.7%) of respondents were shielding; 44.1% were on disease modifying anti-rheumatic drugs (csDMARDs) and 56.6% were on biologics (bDMARDs). Most (94.1%) had continued their DMARDs throughout the shielding period. Non-steroidal anti-inflammatory drug (NSAID) use was reported to be increased in 18.6% of respondents, and unchanged in 69.0%. Compared to before the pandemic, 54.8% reported worsening joint stiffness and 45.6% reported worsening joint pain.
Most respondents (67.6%) reported reduced levels of physical activity, the commonest reasons being: shielding (54.6%); increased fatigue (45.8%); concerns around social distancing (45.4%); poor sleep quality (38.6%); working from home (28.6%) and low mood (28.6%). Only 14.7% had attended a virtual exercise class.
Conclusion
Approximately 2 in 3 patients with SpA reported they were shielding during the first wave of the pandemic. Similar numbers of patients reported reduced physical activity levels and increased joint stiffness over this time. It is important to acknowledge that given the nature of the anonymised survey, we cannot be certain if the same patients who were shielding were the same as those who had reduced levels of physical activity or worsening symptoms. We have, however, shown that over half of the surveyed patients attributed their reduced physical activity levels to shielding. Taking into account that social restrictions (either self-imposed or government advised) are likely to be ongoing, we believe that a focus should be placed on supporting patients to maintain their activity levels, through initiatives such as specialist virtual exercise classes.
Disclosure
M. Naja: None. R. Amarnani: None. M. Castelino: None.
P076 Adherence to COVID-19 risk stratification during the peak of pandemic: a District General Hospital experience
Authors: Azam Salma , Thompson Eils , Costello Natalie , Ahmed Ashar , Nune Arvind , Ahmed Hamza 
Published: April 2021

Abstract
Background/Aims
During the peak of COVID-19 pandemic, there were growing concerns that rheumatology patients could have an increased risk of contracting coronavirus due to the immunosuppressive drugs that they were taking. British Society for Rheumatology (BSR) recommended in its risk stratification guide in March 2020 that vulnerable patients should be either shielded or isolated according to their level of risk. The purpose of this survey is to evaluate the compliance to the risk stratification advice among rheumatology patients in a single centre.
Methods
Risk stratification guidance was sent out to 401 patients recommending either to shield or to isolate. Patients were contacted over the telephone between 14 September and 18 October 2020 to ensure they had received a postal letter with risk stratification advice. If received, it was checked whether they had followed the guidance. Responses received from all participants were analysed.
Results
93% (373) of patients confirmed that they had received the guidance; however, 8 patients suggested they hadn’t received and we were unable to contact 16 patients, despite trying multiple times. Four patients died but they did not have confirmed coronavirus. 267 confirmed they were shielding and 83 were isolating, but 21 patients decided not to follow the guidance despite the recommendation and two patients stopped taking the drugs due to fear of contracting the coronavirus. Total 258 females and 143 males with the mean age 59. Most common diagnoses were rheumatoid arthritis (227), psoriatic arthritis (97) and axial spondyloarthritis (59). It was noted that out of 7 patients who had symptoms suggestive of COVID-19, only three patients were confirmed to have COVID-19 positive PCR test. Three most commonly used drugs were Benepali (128) followed by Amjevita (100), then Rituximab (56).
Conclusion
Although uptake of postal communication was high in this study, it was difficult to establish how rapidly the guidance was delivered. We realise the need to employ better ways of communicating with the patients. Innovative ways such as text messaging and social media have an important role in the delivery of a rapid mass communication during the pandemic. It was reassuring to note that only a very small number of patients had COVID-19 among the patients who followed the government advice to either shield or isolate. But, it would be interesting to see whether the incidence of COVID-19 cases rise since rheumatology patients are no longer shielding.
Disclosure
S. Azam: None. E. Thompson: None. N. Costello: None. A. Ahmed: None. A. Nune: None. H. Ahmed: None.
P087 Mortality trends from systemic lupus erythematosus in Cuba: 2001-2014
Authors: Negrín Halbert Hernández 
Published: April 2021

Abstract
Background/Aims
There is little research on the mortality of Cuban patients with systemic lupus erythematosus (SLE), with not enough impact to recognize SLE as a health problem in the country. Our aim was to identify time trends and geographic variability in the mortality of Cuban patients with SLE.
Methods
Mortality data of decedents over 15 years old were retrieved from the Cuban Ministry of Public Health mortality database, based on International Classification of Disease (ICD), Tenth Revision (ICD-10, code M32). We computed age-standardized mortality rate (ASMR) for each year and province as the estimated number of deaths per million inhabitants and its 95% confidence interval (95% CI) using World Health Organization reference population. The 2001-2014 time trends were analyzed using Jointpoint software.
Results
Between 2001 and 2014, 1,054 deaths from SLE were found, mostly women (89.0%), white (54.4%) with a median age of 43 years (interquartile range: 34-53). In 2014 the ASMR caused by SLE per million inhabitants was 14.4 (95% CI: 10.9 to 18.4) in women and 1.3 (95% CI: 0.5 to 3.2) in men. A growing time trend was identified in the ASMR by SLE throughout the period (average annual percentage change [AAPC]: 1.6; 95% CI: 0.6 to 2.6), highest in males (AAPC: 5.6; 95% CI: 1.7 to 9.7) than in females (AAPC: 1.2; 95% CI: 0.3 to 2.0). The highest mortality in women was concentrated in the provinces of Camagüey, Las Tunas and Granma, and in the case of men, in Havana and Ciego de Ávila.
Conclusion
The variation in the magnitude of the risk of dying from SLE over time and geographic areas indicates the possible influence of biological, environmental, socioeconomic and health systems factors. The growing trend in SLE mortality in Cuba demands its recognition as an important health problem and immediate actions that help mitigate it.
Disclosure
H. Hernández Negrín: None.
P089 The cost of repeat ANA testing in north west London pathology services
Authors: Colquhoun Matthew , Mouyis Maria 
Published: April 2021

Abstract
Background/Aims
The anti-nuclear antibody (ANA) test is commonly used to screen for autoimmune connective tissue (CTD) disease. It is a test that should be used judiciously and should only be requested if a patient presents with symptoms suggestive of a CTD and should not be used as a screening test for vague musculoskeletal symptoms. Recent studies have demonstrated that it is often repetitively requested in those patients both with a known positive and known negative ANA with little value in altering a diagnosis. With this information in mind, we sought to examine the frequency and associated cost of repeat ANA testing in hospital trusts served by North West London Pathology Services (NWL).
Methods
The trusts included in the study were Imperial College Healthcare NHS Trust, Chelsea and Westminster Hospital Foundation Trust and Hillingdon Hospitals NHS Foundation Trust. Data was obtained regarding how many patients had repeat ANA testing in total between these trusts between 2017-2019. The data was obtained via a freedom of information request.
Results
In total, there were 6,799 instances of repeated ANA testing in the same patient across three trusts over three years. This included one patient who had 16 ANA tests in a single year in 2017. The cost of an ANA test is £12.27. The total cost of repeat ANA testing in the three years across three trusts was £83,423.73 (£27,807.66 per year on average). Data is provided in tabular form and gives a breakdown of the number of repeat ANA tests per year and how many times the test was repeated in the same patient.
Conclusion
The requesting of unnecessary tests can add to a hospital pathology workload and is associated with significant cost. It has been previously demonstrated in the literature that repeat ANA testing is of little value and rarely alters the diagnosis of a rheumatic disease. There is a large burden of repeated ANA testing in North West London Pathology Services and this is associated with significant expense. More judicious use of ANA testing can result in significant cost saving. This is the first study to specifically examine the cost of repeat ANA testing in the NHS.
Disclosure
M. Colquhoun: Other; MC has received support to attend conferences from Pfizer. M. Mouyis: None.
P124 Are chronic pain syndromes associated with a unique cytokine profile? A systematic review and meta-analysis
Authors: O'Mahony Luke Furtado , Srivastava Arnav , Mehta Puja , Ciurtin Coziana 
Published: April 2021

Abstract
Background/Aims
The aetiology of primary chronic pain syndromes (CPS) is highly disputed. One theory suggests that pain is due to a pro-inflammatory cytokine milieu leading to nociceptive activation. We performed a systematic review and meta-analysis aiming to assess differences in cytokines levels in CPS patients versus healthy controls (HC).
Methods
Human studies published in English from PubMed, MEDLINE/Scopus and Cochrane databases were searched from inception up to January 2020. We included full text cross-sectional or longitudinal studies with cytokine measurements in CPS patients and HC. We excluded studies with underlying organic pathology. Quality assessment was completed using a modified version of the Newcastle-Ottawa Scale. Random-effects meta-analysis models were used to report pooled effects and 95% CIs. Study registered with PROSPERO (CRD42020193774).
Results
Initial search yielded 324 papers, 36 studies (3229 participants) eligible for systematic review and 26 studies (2048 participants) suitable for metaanalysis. There were reproducible findings supporting trends of cytokine levels comparing CPS patients with HC. Eotaxin (chemokine) however was consistently raised in CPS. Meta-analysis showed significantly increased tumour necrosis factor (TNF) (SMD=0.39, p = 0.0009, %95I=0.16-0.63, p &lt; 0.001; I2=70%, Q2 p &lt; 0.001), interleukin (IL)-6 (SMD=0.15, 8 (SMD=0.26, p = 0.01, 95%CI =0.05-0.47; I2=61%, Q2 p = 0.005) and IL-10 (SMD=0.61; %95 = 0.34-0.89, p &lt; 0.001; I2 = 10%, Q2 p = 0.34) in CPS compared to HC.
Conclusion
We found significant differences in peripheral blood cytokine profiles of CPS patients compared to HC. However, the distinctive profile associated with CPS includes both pro-inflammatory (TNF-α, IL-6, IL-8), and anti-inflammatory cytokines (IL-10) in pooled analysis, as well as chemokine (eotaxin) signatures.
Disclosure
L. Furtado O'Mahony: None. A. Srivastava: None. P. Mehta: None. C. Ciurtin: None.
P137 Epidemiological study of influenza vaccination and RA
Authors: Juber Nirmin , Wannasri Arnat , Do Tam Minh , Chen Hsin-Jen , Chuang Yi-Fang , Liu Jason J 
Published: April 2021

Abstract
Background/Aims
Rheumatoid arthritis (RA) has been known as an autoimmune and inflammatory disease. Previous studies found individuals with RA had a two-fold increased risk of infections compared to general population. For infectious disease as influenza, vaccination may confer protection. However, whether or not influenza vaccination is safe to be given to genetically predisposed individuals with RA still on debate since there is an evidence that influenza vaccine as inflammatory stimulus could induce RA.
Methods
This study aims to provide an up-to-date epidemiological evidence between influenza vaccination and RA among American adults from 18 years old.
Methods
With case-control study design using 2014 Full year consolidated data in Medical Expenditure Panel Survey (MEPS), the association between influenza vaccination and RA among adult 18 years old and above were assessed using logistic regression analysis adjusted for potential covariates (age, sex, comorbidity, body mass index (BMI), education, smoking status, and insurance status) to estimate odds ratio (OR).
Results
In the crude model, individuals who reported receiving influenza vaccine were 2.02 (95% CI: 0.97-4.22) times more likely to develop RA, although the association were not significant. In the full adjusted model, the magnitude of association was decreased to 0.25 (95% CI: 0.06-1.05), but the significance was still not reached.
Conclusion
Analysing a comprehensive and large-scale population-based survey dataset (MEPS 2014) with adjustment for potential confounders suggested that receiving influenza vaccine did not increase the risk of RA and we have no evidence to suggest that influenza vaccination is not safe to be given to genetically predisposed individuals with RA. Further studies with more complete confounders, such as physical activity level and nutrition intake are strongly recommended.
Disclosure
N. Juber: None. A. Wannasri: None. T. Do: None.
P138 Developing a digital remote assessment for monitoring rheumatoid arthritis disease activity
Authors: Donadoni Francesca , Gionfrida Letizia , Clarke Benjamin , Galloway James 
Published: April 2021

Abstract
Background/Aims
In an era of increasingly stretched health care resources, accompanied by pressures to deliver more care for people with long term conditions remotely, we need innovative solutions to measure disease activity. In the case of monitoring rheumatoid arthritis (RA), a robust method of capturing reliable Disease Activity Score (DAS-28) information remotely could reduce patient visits to hospitals and free up clinic space. Information would ideally be captured from a home setting by a patient. However, self-reporting of DAS-28 has limited reliability especially at moderate or high levels of disease activity. A mechanism for remotely ascertaining DAS-28 which is both accurate and precise would improve remote management for people living with RA.
Methods
We undertook a study to assess patient attitudes regarding a novel remote RA monitoring platform, which uses images and video captured movements to estimate DAS-28. The study involved a semi-structured 30-minutes video interview. Participants were adults with RA living in the UK. The interviews focused on these key areas: i) an overview of their history with the condition, ii) familiarity with DAS-28, iii) relationship with the clinical team, iv) relationship with technology and telemedicine, v) feedback on the RA monitoring platform.
Results
Eleven subjects participated in the study. They reported a median disease duration of 11 years (range: 4 to 35), and all had experienced flares, with 10/11 familiar with the DAS-28 prior to the study interview. Since the start of the COVID-19 pandemic, most patients only had contact with clinicians or healthcare facilities over the phone, with only one patient having visited a hospital for a reason not directly related to RA, and one patient having no contact at all. Overall, patients expressed enthusiasm towards the RA monitoring platform and were confident that they would be able to use it at home. Access over the Internet was not perceived as a barrier, and the advantages of tracking disease progression regularly, sharing data with the consultant and saving time travelling to appointments far outweighed the disadvantages. Participants generally reported that they would most benefit from a blended interaction with the clinical team, combining face-to-face appointments with use of the platform at home rather than seeing the platform as a complete alternative to face-to-face assessment.
Conclusion
This study provides the first insight into the perception and acceptance of the RA monitoring platform in a small sample of RA patients. Results are positive, and support further evaluation of the platform. Evidence to understand how technology can improve the quality of telemedicine for people with RA is urgently needed as the pandemic continues.
Disclosure
F. Donadoni: None. L. Gionfrida: None. B. Clarke: None. J. Galloway: None.