bluuebunny/crossref_metadata_2025_split huggingface dataset:
E019 Management of idiopathic inflammatory myositis - a Northamptonshire audit of British Society for Rheumatology guidelines
Authors: Chauhan Neal , Abushama Sara , Jeffery Rachel 
Published: April 2024

Abstract

Background/Aims
The idiopathic inflammatory myopathies (IIM) are a rare group of multi-system autoimmune conditions characterised by muscle inflammation. They have an incidence of up to 19 per 1,000,000 person years in adults and a UK prevalence of 10,000 people. Last census data estimated the Northamptonshire population at approximately 785,200.
The small cohort of patients reflects the limited evidence base for best practice. In March 2022, the first UK evidence guideline on IIM was published from the British Society for Rheumatology (BSR). In view of absence of prior guidance, there is expected variability in patient management within and between centres.
To evaluate local practice against these standards an audit was conducted in Northampton General Hospital (NGH).

Methods
Using local MYOACT registry data and consultant caseload knowledge, a cohort of adult patients with IIM diagnoses consulted within the last 5 years were identified.
Retrospective clinical letters were analysed for details of patient care and compared to the 26 recommendations as set out by the myositis guideline.

Results
A total of 12 patients were sampled as having attended the rheumatology department within the last five years at NGH. All 26 standards will be presented, but for the purposes of this abstract, key results for discussion include:
• 100% of corticosteroids were tapered as the patient responded to treatment. • In presence of muscle inflammation 91% were treated with DMARDs. • In presence of active skin disease, 100% received treatment with csDMARD, IVIG or rituximab. • 100% of patients were screened for interstitial lung disease. • In presence of active muscle disease, 56% of patients received an exercise program led and monitored by therapists. • In 45% of patients’ psychological well-being and health was formally considered.

Conclusion
Initial service evaluation against BSR IIM recommendations reflects typical strengths and weaknesses encountered in delivering rheumatology services. There was strong concordance in diagnostic and pharmacological domains. However greater variability was encountered when considering multidisciplinary psychosocial domains involving access to therapy services and psychological support.
Tools such as the 36 Item Short Form Survey, highlighted in BSR recommendations, may offer a validated method for physicians to formally consider and target psychosocial domains in management of idiopathic inflammatory myopathies.

Disclosure
N. Chauhan: None. S. Abushama: None. R. Jeffery: None.
E022 Audit on the baricitinib dose in elderly and patients with chronic kidney disease among a cohort of rheumatoid arthritis patients
Authors: Rosa Chamith , Joseph Joyal , Kasavkar Ganesh 
Published: April 2024

Abstract

Background/Aims
Baricitinib use among elderly patients and in patients with chronic kidney disease needs modification of the dose. Baricitinib dose should be reduced to 2mg daily in patients who are 75 years or older given the associated increased risks in this age group. Additionally, baricitinib should be avoided in patients with creatinine clearance of less than 30 ml/min and dose needs to be reduced in patients with a creatinine clearance between 30-60 ml/min because it is primarily renally excreted drug.

Methods
All the blueteq requests for baricitinib at University Hospitals Coventry and Warwickshire, from 05/07/2021 to 05/07/2023 were evaluated. There were 128 patients who have been on baricitinib during this period. Twenty patients out of this, were 75 years or above. The baricitinib dose in patients above the age of 75 and in patients with chronic kidney disease was assessed by using NICE guidance on the use of baricitinib in patients with rheumatoid arthritis and the BNF as the audit standards respectively.

Results
Of the 20 patients who were 75 years and above, 13 patients were still on baricitinib. Ten patients were on a dose of 2mg daily which is in keeping with NICE guidance while 3 patients were still receiving a dose of 4mg daily. Seven patients were started on baricitinib after 75 years and 4 of them were started on 4mg daily which is not keeping with NICE guidance.
Of the 128 patients, none of them had a creatinine clearance less than &lt;30 ml/min while there were 16 patients who had received baricitinib (at some point) with a creatinine clearance of 30-60 ml/min. Of them, 14 patients were at some point on 4mg daily dose of Baricitinib which is not in keeping with guidance. Of those 14 patients, 6 patients were still receiving a dose of 4mg daily.

Conclusion
In conclusion, it appears that we have not completely adhered to standard criteria laid down by NICE guidelines and in the BNF. This presentation aims to raise awareness among rheumatologists regarding these guidelines. Also, changing the format of the prescription to include the age and renal functions would prompt the prescriber to amend the dose accordingly.
The use of baricitinib may reduce in the future due to concerns of increased cardiovascular disease. However, there is a group of patients who are already on baricitinib and will want to continue, despite these concerns, given the significant improvements in disease control.

Disclosure
C. Rosa: None. J. Joseph: None. G. Kasavkar: None.
E045 Adherence to physiotherapy among patients with knee osteoarthritis in a rheumatology specialized care unit in Sri Lanka
Authors: Ubhayasiri Sasheela K , Abeysinghe Duminda 
Published: April 2024

Abstract

Background/Aims
Knee osteoarthritis is a degenerative joint disorder that has a significant impact on global health and healthcare resources. Non-pharmacological interventions play a vital role in the management of osteoarthritis, and their effectiveness relies on the patient’s active participation and adherence. But non-adherence to these interventions including physiotherapy has become a recognized problem across the globe. The extent of adherence to physiotherapy specifically in the Sri Lankan population with osteoarthritis has not been assessed to date.

Methods
This cross-sectional study was conducted at Rheumatology and Rehabilitation Hospital, Ragama, Sri Lanka recruiting 100 patients diagnosed with knee joint osteoarthritis according to the EULAR 2011 Recommendations. General Rehabilitation Adherence Scale (GRAS) was used to score the adherence level to center-based physiotherapy. Home-based physiotherapy adherence was measured using a 5-point scale. Demographic data also were assessed to determine the associations with adherence levels. Data were analysed by using the Statistical Package of Social Sciences (SPSS).

Results
The study population consisted of 93% females and 7% males. Center-based physiotherapy adherence according to the GRAS score revealed 53% had a high adherence rate while 8% found poorly adhered to. Of the highly compliant patients, the majority, 35.8% patients were within the 60-69 years age group and 35.8% were housewives. 37.7% were not having co-morbidities. 41.7% have reported a disease duration of 1-5 years. The majority complained that they had poor adherence due to other commitments (36%) followed by and lack of time (34%). The third common cause for the default was transport expenses (26%). 91% of patients had knowledge of home-based physiotherapy activities. Of them, 32% followed the exercise regime as advised and 13% continued it as far as possible. 17% were unable to engage in those at all. As reasons for noncompliance to home therapy, 35% of patients reported having a lack of time and 31% had poor motivation. None of the sociodemographic factors significantly correlated with center-based or home-based physiotherapy adherence.

Conclusion
The findings indicate that a significant proportion of patients demonstrated high adherence to center-based physiotherapy. Although a majority of patients had knowledge of home-based physiotherapy activities, only a portion followed the prescribed exercise regime. Addressing barriers such as time constraints, commitments, and transportation expenses is crucial. Future research should explore personalized approaches and innovative strategies to enhance engagement and overcome challenges to optimize physiotherapy adherence.

Disclosure
S.K. Ubhayasiri: None. D. Abeysinghe: None.
E060 A multinational survey investigating the unmet needs and patient perspectives concerning proton pump inhibitors in systemic sclerosis
Authors: Bandini Giulia , Alunno Alessia , Oliveira Pinheiro Filipe , Campochiaro Corrado , Galetti Ilaria , Cerinic Pietro Matucci , Ruaro Barbara , Aoufy Khadija El , Melis Maria Ramona , Pignone Alberto Moggi , Dagna Lorenzo , Cerinic Marco Matucci , McMahan Zsuzsanna H , Hughes Michael 
Published: April 2024

Abstract

Background/Aims
The gastrointestinal (GI) tract is largely (&gt;95%) affected in systemic sclerosis (SSc) and its involvement is associated with significant morbidity, mortality and huge impact on the quality of life. Upper GI tract dysfunction, often presenting with gastroesophageal reflux disease (GERD) is one of the principal complaints. Proton pump inhibitors (PPIs) are widely used to treat GERD in SSc. However, not all patients respond to this therapy, and many remain on long-term treatment. Significant concerns about PPI long-term safety have been raised. Our aim was to identify perspectives and unmet needs of SSc patients on PPIs.

Methods
An online English survey, targeting SSc patients on PPIs was developed and distributed through social media and international patient associations. The survey was launched on 4th November 2022 and kept open for 4 weeks.

Results
301 respondents from 14 countries completed the survey (UK 19.3% and US 70.4%). Most respondents were between 30-70 years and the majority were female (95%).
The most frequently reported symptoms were acid reflux (97%), dysphagia (60%), and trouble swallowing or food got stuck in the chest (32%).
Multiple PPIs use (two: 30% and three: 21%; in series) was common and the majority (89%) reported improvement in GI symptoms with PPIs.
Even though only 19% experienced side effects on PPIs, most respondents (79%) were concerned (Table 1). Half (47%) experienced a flare of symptoms after initial improvement with PPIs and 58% received lifestyle information, while most (85%) searched online for information about PPIs.
A minority (12%) reported that a surgical approach was discussed, and 46% indicated that they would be willing to undergo surgery, despite having significant concerns.

Conclusion
Our survey highlights the importance of upper GI symptoms in SSc patients and the frequent use of PPIs. There is significant heterogeneity in use, and treatment is often not fully effective. Patients have concerns about side effects related to long-term PPI use. There is a clear unmet need regarding patients’ education about PPIs. A surgical approach is rarely discussed, although patients would potentially consider this approach. Further research is needed to optimize the therapeutic strategy concerning PPIs in SSc.

Disclosure
G. Bandini: None. A. Alunno: None. F. Oliveira Pinheiro: None. C. Campochiaro: None. I. Galetti: None. P. Matucci Cerinic: None. B. Ruaro: None. K. El Aoufy: None. M. Melis: None. A. Moggi Pignone: None. L. Dagna: None. M. Matucci Cerinic: None. Z. McMahan: None. M. Hughes: None.
Risk Factors for De Novo Overactive Bladder After Midurethral Sling
Authors: Serna-Gallegos Tasha , Dutta Sonia , Crowder Carly , Wadensweiler Paul , Whitcomb Emily L. , Guaderrama Noelani M. 
Published: April 2024

(Abstracted from Urogynecology 2024;30:59–64
The standard surgical treatment for stress urinary incontinence is midurethral sling (MUS) placement, due to its excellent efficacy, minimally invasive approach, and low overall rates of complication. However, development of de novo overactive bladder (OAB) symptoms is a known complication of anti-incontinence procedures and previously described as occurring in 5%–32% after fascial sling or Burch urethropexy.
Diagnosis, management and therapeutic options for eosinophilic esophagitis
Authors: Caminati Marco , Senna Gianenrico , Maule Matteo , Di Sabatino Antonio , Rossi Carlo Maria 
Published: April 2024

Purpose of review
Eosinophilic esophagitis is a chronic and commonly evolving condition leading to relevant and potentially irreversible burden in terms of tissue damage and related functional impairment, thus significantly impacting on quality of life. The aim of the present review is to summarize the recent advances in terms of diagnostic work-up and pharmacological and nonpharmacological management of the disease, under the broader perspective of type 2 inflammation.

Recent findings
Two major novelties have prompted an innovative approach to EoE. In terms of diagnosis, it has been proposed to dissect the disease heterogeneity in three endotypes, independent from tissue eosinophil number: EoEe1, characterized by normal appearing oesophagus; EoEe2, associated with type 2 inflammation and steroid-refractoriness; EoEe3, whose features include adult onset, a more fibro-stenotic aspect and loss of epithelial gene expression. Concerning treatment, two recently licensed drugs for EoE, oro-dispersible budesonide and dupilumab represent the first treatment options specifically developed for EoE and addressing EoE-related peculiar pathobiological features.

Summary
In the era of precision medicine, managing EoE according to a phenotype-driven approach might be helpful in defining the best treatment options in the different disease forms or stages. In addition, exploring the coexistence or the previous occurrence of other type 2 conditions may suggest the opportunity to specifically target type 2 inflammation through biologic therapy. The complex EoE pathobiology combining inflammatory and functional features, both at organ and systemic level, requires a multidimensional approach relying on the strict integration of gastroenterologists and allergist-immunologists.
Global and Regional Heterogeneity of Lung Aeration in Neonates with Different Respiratory Disorders: A Physiologic Observational Study
Authors: Loi Barbara , Sartorius Victor , Vivalda Laura , Fardi Avand , Regiroli Giulia , Dellacà Raffaele , Ahsani-Nasab Sara , Vedovelli Luca , De Luca Daniele 
Published: April 2024

Background
Aeration heterogeneity affects lung stress and influences outcomes in adults with acute respiratory distress syndrome (ARDS). The authors hypothesize that aeration heterogeneity may differ between neonatal respiratory disorders and is associated with oxygenation, so its evaluation may be relevant in managing respiratory support.

Methods
This was an observational prospective study. Neonates with respiratory distress syndrome, transient tachypnea of the neonate, evolving bronchopulmonary dysplasia, and neonatal ARDS were enrolled. Quantitative lung ultrasound and transcutaneous blood gas measurements were simultaneously performed. Global aeration heterogeneity (with its intra- and interpatient components) and regional aeration heterogeneity were primary outcomes; oxygenation metrics were the secondary outcomes.

Results
A total of 230 (50 respiratory distress syndrome, transient tachypnea of the neonate or evolving bronchopulmonary dysplasia, and 80 neonatal ARDS) patients were studied. Intrapatient aeration heterogeneity was higher in transient tachypnea of the neonate (mean ± SD, 61 ± 33%) and evolving bronchopulmonary dysplasia (mean ± SD, 57 ± 20%; P < 0.001), with distinctive aeration distributions. Interpatient aeration heterogeneity was high for all disorders (Gini–Simpson index, between 0.6 and 0.72) except respiratory distress syndrome (Gini–Simpson index, 0.5), whose heterogeneity was significantly lower than all others (P < 0.001). Neonatal ARDS and evolving bronchopulmonary dysplasia had the most diffuse injury and worst gas exchange metrics. Regional aeration heterogeneity was mostly localized in the upper anterior and posterior zones. Aeration heterogeneity and total lung aeration had an exponential relationship (P < 0.001; adj-R
2 = 0.62). Aeration heterogeneity is associated with greater total lung aeration (i.e., higher heterogeneity means a relatively higher proportion of normally aerated lung zones, thus greater aeration; P < 0.001; adj-R
2 = 0.83) and better oxygenation metrics upon multivariable analyses.

Conclusions
Global aeration heterogeneity and regional aeration heterogeneity differ among neonatal respiratory disorders. Transient tachypnea of the neonate and evolving bronchopulmonary dysplasia have the highest intrapatient aeration heterogeneity. Transient tachypnea of the neonate, evolving bronchopulmonary dysplasia, and neonatal ARDS have the highest interpatient aeration heterogeneity, but the latter two have the most diffuse injury and worst gas exchange. Higher aeration heterogeneity is associated with better total lung aeration and oxygenation.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
50 years of spondyloarthritis: a look back and a look ahead
Authors: Helliwell Philip S. 
Published: April 2024

Purpose of review
It is now 50 years since the concept of spondyloarthritis was introduced by Moll, Wright and co-authors from Leeds, UK. This review will review the original concept and mark significant milestones over the last 50 years while looking ahead to developments in the future.

Recent findings
While the diseases included under this rubric in the original description may have changed the core conditions remain and are still characterized by axial inflammation as a common feature. Imaging, animal models, genetics and immunology have contributed to our knowledge of the pathogenesis and classification of these diseases and have led to the development of more effective treatments.

Summary
Future developments, facilitated by large research consortia, will help build on our current knowledge and will help clarify disease heterogeneity and provide insights into new therapeutic pathways.
Racial and Socioeconomic Disparities in Laminoplasty Versus Laminectomy With Fusion in Patients With Cervical Spondylosis
Authors: Hou Brian Q. , Croft Andrew J. , Vaughan Wilson E. , Davidson Claudia , Pennings Jacquelyn S. , Bowers Mitchell F. , Vickery Justin W. , Abtahi Amir M. , Gardocki Raymond J. , Lugo-Pico Julian G. , Zuckerman Scott L. , Stephens Byron F. 
Published: April 2024

Study Design.
A retrospective cohort study using prospectively collected data.

Objective.
The aim of this study was to investigate preoperative differences in racial and socioeconomic factors in patients undergoing laminoplasty (LP) versus laminectomy and fusion (LF) for degenerative cervical myelopathy (DCM).

Summary of Background Data.
DCM is prevalent in the United States, requiring surgical intervention to prevent neurological degeneration. While LF is utilized more frequently, LP is an emerging alternative. Previous studies have demonstrated similar neurological outcomes for both procedures. However, treatment selection is primarily at the discretion of the surgeon and may be influenced by social determinants of health that impact surgical outcomes.

Materials and Methods.
The Quality Outcome Database (QOD), a national spine registry, was queried for adult patients who underwent either LP or LF for the management of DCM. Covariates associated with socioeconomic status, pain and disability, and demographic and medical history were collected. Multivariate logistic regression was performed to assess patient factors associated with undergoing LP versus LF.

Results.
Of 1673 DCM patients, 157 (9.4%) underwent LP and 1516 (90.6%) underwent LF. A significantly greater proportion of LP patients had private insurance (P<0.001), a greater than high school level education (P<0.001), were employed (P<0.001), and underwent primary surgery (P<0.001). LP patients reported significantly lower baseline neck/arm pain and Neck Disability Index (P<0.001). In the multivariate regression model, lower baseline neck pain [odds ratio (OR)=0.915, P=0.001], identifying as non-Caucasian (OR=2.082, P<0.032), being employed (OR=1.592, P=0.023), and having a greater than high school level education (OR=1.845, P<0.001) were associated with undergoing LP rather than LF.

Conclusions.
In DCM patients undergoing surgery, factors associated with patients undergoing LP versus LF included lower baseline neck pain, non-Caucasian race, higher education, and employment. While symptomatology may influence the decision to choose LP over LF, there may also be socioeconomic factors at play. The trend of more educated and employed patients undergoing LP warrants further investigation.
Distal Upper Extremity Arterial Calcification as a Predictor for Subclinical Coronary Artery Disease by Coronary Artery Calcium Scoring
Authors: Iskandarova Aygul , Rao Shiavax J. , Yohe Gabriel J. , Shah Ankit B. , Giladi Aviram M. 
Published: April 2024

Summary:
Several studies have linked calcification of the thoracic and lower extremity arterial trunks to an increased risk of developing coronary artery disease (CAD). Calcifications of the radial and/or ulnar artery are regularly identified in hand/wrist x-rays; however, the clinical relevance of these findings as related to identifying subclinical CAD is not well understood. Associations between CAD and upper extremity calcifications have been reported, but the timeline is unclear. The purpose of this study was to evaluate the association between upper extremity arterial calcifications on hand radiographs with CAD by coronary artery calcification (CAC) scoring in patients with no known history of CAD. This is a pilot single-center, prospective, matched cohort study. We included patients with no known history of CAD, related symptoms, or major risk factors. We recruited five patients with calcifications (cal+) and five patients matched by age, race, sex, and medical history but without calcifications (cal−). CAC scores were determined from computed tomography scanning, and lipid profile was evaluated. In the cal+ group, the mean CAC total score was 244.1; in the control (cal−) group, it was 85.2. The mean total cholesterol levels were 220.8 mg per dL and 167 mg per dL in the cal+ and cal− groups, respectively. Two cal+ patients with CAC scores of 937 and 669 died shortly after being enrolled in our study. Preliminary findings suggest that calcifications in the radial or ulnar artery in otherwise asymptomatic patients with no history of CAD may be an independent sign of CAD.
Modulation of Cellular Stemness for Enhanced Fat Grafting
Authors: Izadpanah Amin , Chaffin Abigail E. , Jansen David A. , Alt Eckhard U. , Izadpanah Reza 
Published: April 2024

Summary:
Low volumetric retention limits the utility of fat grafting. Although inclusion of stem cells and platelet-rich plasma have been proposed to enhance graft retention, accumulating evidence has failed to show a clear benefit. Here, we propose a strategy to pharmacologically enhance stemness of stem and progenitor cell populations in fat grafts to promote increased volume retention and tissue health. We also propose how to integrate stemness-promoting and differentiation-promoting therapies such as platelet-rich plasma, and viability promoting therapies within the common fat grafting workflow to achieve optimal fat grafting results.