bluuebunny/crossref_metadata_2025_split huggingface dataset:
P017 Planned infliximab use during pregnancy for pakistani patients with immune-mediated inflammatory disease - case series of 12 patients
Authors: Tayyab Zaid , Haroon Mohammad 
Published: April 2024

Abstract

Background/Aims
Immune-mediated inflammatory diseases (IMIDs) affect mostly young females during their reproductive age. Therefore, a better understanding is needed about the possible disease effects in pregnancy, as well as the risks of fetal exposure to the medications used. Studies have shown that anti-TNF are considered safe and do not increase the risk of adverse events during pregnancy. Nevertheless, the data is quite limited, hence fall in FDA pregnancy category B. We wish to report a series of 12 pregnant women with IMIDs who were intentionally being treated with infliximab for the treatment of active intractable IMIDs.

Methods
The study included pregnant patients with IMIDs who were treated using anti-TNF between January 2021 to July 2023 at Fatima Memorial Hospital and Doctors Hospital & Medical Centre, Lahore. All patients receiving infliximab were reviewed by a dedicated medical team, who maintained a detailed medical record of each visit. The patients were prospectively followed up and the neonatal outcome was also recorded.

Results
12 pregnant women with IMIDs received Infliximab during this study. All these patients required &gt;7.5mg of deltacortil to control their arthritis and hence decision was made to add bDMARDs. 10 patients successfully completed their pregnancies uneventfully and two additional patients are in the later stages of pregnancy. Seven patients had complete remission of their underlying IMIDs and the rest had overall good improvement but continued to have low grade active disease. All our patients presented a satisfactory response to treatment and the pregnancy progressed without any complications. Median gestational week of birth was 38 with a median birth weight of 3490 grams.

Conclusion
This is the first reported series from Pakistan of intentional infliximab use throughout pregnancy. Our data, combined with many other studies, suggests that anti-TNF is safe during pregnancy and its benefits in achieving control of IMIDs may outweigh the risk of foetal exposure to the drug. This is further supported by the available data suggesting the inflammatory activity as the main risk factor for unfavourable outcome. However, the benefits and risks must be discussed with the patient and management decisions should be taken on individual basis.

Disclosure
Z. Tayyab: None. M. Haroon: None.
P051 Trends in consultations for musculoskeletal pain in children and young people presenting to United Kingdom primary care: an electronic health record study
Authors: Mason Kayleigh J , Jordan Kelvin P , Bailey James , Jöud Anna , Jowett Sue , Protheroe Joanne , Mughal Faraz , Snell Kym I E , Thomas Martin , Dunn Kate M 
Published: April 2024

Abstract

Background/Aims
Musculoskeletal pain in childhood increases the risk of such pain in adulthood but there is an absence of management guidance for this group, not helped by a lack of evidence on the extent and nature of pain in children. The aim was to determine the extent and patterns of consultations for musculoskeletal pain in children and young people (CYP) presenting to UK primary care.

Methods
Data were obtained from an anonymised nationally representative UK primary care electronic health record database (Clinical Practice Research Datalink, CPRD). The study population was patients aged 8-18 years between 2005-2021 with consultations for musculoskeletal pain. Consultation prevalence was calculated per 10,000 registered population for each calendar year, and by age (8-11, 12-15 and 16-18 years), gender and body site (prevalence presented for 2019 prior to COVID-19 pandemic).

Results
1.12 million children and young people (48% female; median age 14 years) were recorded with musculoskeletal pain, with an annual consultation prevalence of over 9% (932/10,000, 95% CI 928-937). Consultation prevalence increased until 2015, stabilised until 2019, and was lower during 2020 due to the COVID-19 pandemic, but climbed slightly in 2021. Consultation prevalence in 2019 was highest for those aged 12-15 years (1105/10,000 vs 8-11 years 736/10,000 and 16-18 years 984/10,000) and for females. Age and gender differences were observed by body site with foot/ankle the most common site of pain in younger children (ages 8-11: females 277/10,000, males 229/10,000,), back the most common site in older females (ages 16- 18: 247/10,000) and knee the most common site in older males (ages 16-18: 178/10,000).

Conclusion
Musculoskeletal pain in CYP is common with almost one in ten consulting primary care annually, but pain sites vary by age and gender. Understanding the extent and nature of musculoskeletal pain in CYP presenting to primary care can help inform targeted and effective care, and underpin much needed intervention studies, potentially reducing risk of continued pain into adulthood.

Disclosure
K.J. Mason: None. K.P. Jordan: None. J. Bailey: None. A. Jöud: None. S. Jowett: None. J. Protheroe: None. F. Mughal: None. K.I.E. Snell: None. M. Thomas: None. K.M. Dunn: None.
P102 Should Fibromyalgia be Diagnosed in Primary or Secondary Care?
Authors: Sykes Mark P 
Published: April 2024

Abstract

Background/Aims
Both the Rheumatology Getting It Right First Time (GIRFT) report, published in February 2021, and the British Society for Rheumatology (BSR) referral guidelines from October 2021 recommend not referring patients with suspected Fibromyalgia to Rheumatology services. In contrast the Royal College of Physicians (RCP) guidelines on Fibromyalgia from 2022 recommend that for unequivocal cases, referral is not necessary, but that referral is appropriate if there is diagnostic uncertainty. We undertook an evaluation of our Rheumatology service to assess whether following either of these guidelines would be appropriate.

Methods
A prospective analysis of all patients referred to one general Rheumatologist over 18 months to assess the accuracy of suspected fibromyalgia diagnoses from primary care. The included cases were all patients referred with possible fibromyalgia on the referral letter, along with patients with an end diagnosis of fibromyalgia.

Results
Seventy-two patients were referred to one consultant with possible fibromyalgia on the referral letter. Of these, only 44 (61%) were confirmed as having fibromyalgia. Common other problems felt by the GP to be fibromyalgia included 2+ areas of localised soft tissue rheumatism (seven patients), localised chronic back pain (six patients) and biomechanical lower limb pains due to flat feet (three patients). Another 39 patients were diagnosed as fibromyalgia when not considered by primary care; nine of these patients were referred on the early arthritis pathway and two patients to the axial spondyloarthritis clinic. Overall this workload only constituted approximately 9% of new patients to the service, with patients with an end diagnosis of fibromyalgia making up approximately 7% of the overall new referrals.

Conclusion
The problems with diagnosing fibromyalgia in primary care are likely multifactorial - general practitioners (GP’s) are very busy and there is an increasing use of allied health professionals (AHP) in primary care, who do not always have the experience or training to diagnose fibromyalgia or other common musculoskeletal conditions. Some GP’s do not feel comfortable diagnosing fibromyalgia and some patients are just not happy with a primary care opinion. Overall, we do not feel that the diagnosis of fibromyalgia can be left solely in the hands of primary care; if the patients in this review had not been referred, then a significant number would have been incorrectly labelled as fibromyalgia, with all the problems that may bring. In view of this, the RCP guidelines would appear more appropriate than the BSR referral guidelines, but even then some of the patients in this review may still have ended up with an incorrect diagnosis, so overall Rheumatology departments should be very cautious about declining referrals for possible fibromyalgia and we continue to see these referrals in our department.

Disclosure
M.P. Sykes: None.
P115 Thousands of rheumatoid arthritis & juvenile idiopathic arthritis patients benefit from interactive National Rheumatoid Arthritis Society broadcasts
Authors: Jacklin Clare B 
Published: April 2024

Abstract

Background/Aims
Pressures on NHS services results in many rheumatology patients missing out on vital information that can support them in understanding and managing their conditions. During the COVID pandemic, NRAS took to social media to host regular live interactive broadcasts to keep people informed on the latest regarding vaccines, staying safe and treatments etc. These proved such a successful way of communicating with people not just across the entire UK but often those from other countries that ‘NRAS Lives’ have become a monthly resource offering covering a multitude of relevant to RA and JIA topics.

Methods
Originally utilising just Facebook NRAS became aware that this particular platform wasn’t being accessed by all our beneficiaries. At the beginning of 2023 NRAS began to use a new streaming platform ‘StreamYard’ that opened up the opportunity to stream broadcasts on Facebook, Twitter, LinkedIn and YouTube simultaneously, hence reaching many more people living with RA or JIA and rheumatology health professionals. NRAS Lives are hosted on the last Wednesday of every month with usually a panel of guests presenting on a chosen topic and individuals having the ability to pre-submit questions to be addressed on the night relating to the topic as well as the opportunity to post live questions throughout the broadcast.

Results
As of September 2023 NRAS has hosted eight interactive educational broadcasts reaching almost 15,000 people. Providing people with inflammatory arthritis the opportunity to hear from key opinion leaders and experts regardless of where they are located in the UK or across the world, or their ability to access such opportunities locally. Topics covered include BSR’s new Pregnancy Guidelines; Foot Health & Orthotics; Mental Health & Wellbeing; Support for young adults with IA; Importance of Exercise; Rheumatology Research for All; Remote Monitoring explained with upcoming topics in 2023 being Stress & RA (uneasy bedfellows) and Men with RA ‘The Men’s Rheum’. All live broadcasts are recorded and then hosted on the NRAS YouTube channel and are being freely accessed for ongoing patient and health professional education.

Conclusion
With more and more patients being moved onto PIFU pathways as well as NHS resources being severely restricted in their ability to offer face to face patient education or indeed for health professionals to have access to experts from a wide variety of backgrounds, these NRAS Lives are bridging those increasing gaps in knowledge sharing. The NRAS YouTube channel is a developing accessible, free library of information which complements other NRAS and NHS resources for both patients and health professionals.

Disclosure
C.B. Jacklin: None.
P139 Self-assessment of scleroderma skin: validation of the PASTUL questionnaire
Authors: Spierings Julia , Ong Voon H , Welsing Paco M J , Hughes Michael , Pauling John D , Galdo Francesco Del , Herrick Ariane L , Denton Christopher P 
Published: April 2024

Abstract

Background/Aims
The PASTUL (Patient self-Assessment of Skin Thickness in Upper Limb) questionnaire was developed during the COVID pandemic to allow self-assessment of skin remotely in systemic sclerosis (SSc). The aim of this study was to validate PASTUL, evaluate responsiveness and assess impact of skin on quality of life.

Methods
SSc patients were included in four centres. The PASTUL questionnaire specifies a grading of skin (normal, mild, moderate, severe thickness (0-3)) at eight sites corresponding to the modified Rodnan Skin Score (mRSS) with maximum score assigned to each site. Validity was assessed by comparing PASTUL scores with mRSS assessed by trained rheumatologists. Health Related Quality of Life (EQ5D5L and SSc HRQoL) and Scleroderma Skin Patient reported Outcome (SSPRO) were collected for construct validity, using Pearson’s correlation coefficient (0-0.19 = negligible, 0.2-0.39 = weak, 0.4-0.59 = moderate, 0.6-0.79 = strong, 0.8-1.0 = very strong). Test-retest reliability was estimated using intraclass correlation coefficient (ICC). Patients were followed for six months.

Results
149 patients were included, mean age 56.6 years (SD 13.2), 79.7% female, 78 (56.1%) had limited cutaneous SSc (lcSSc) and 61 (43.9%) diffuse cutaneous SSc (dcSSc). Mean disease duration was 12.8 years (SD 9.2), mean mRSS was 9.2 (SD 6.2). At baseline and six months follow-up, PASTUL and mRSS were strongly correlated (r = 0.63 and r = 0.78, p &lt; 0.001, respectively).
Test-retest reliability, assessed in 75 patients, was very good (ICC of 0.83, 95% CI 0.74-0.89, p &lt; 0.001). Mean PASTUL scores were 9.3 (SD 6.2) at baseline and 8.5 (SD 6.6) at six months follow-up. In patients with &gt;2 points increase in mRSS, change in PASTUL was significant (p = 0.042). The standardized response mean (SRM) of mRSS and PASTUL in patients with clinically significant change in HRQoL (&gt;0.082) was 0.29 and 0.24, respectively. Correlation between PASTUL and mRSS was moderate in lcSSc and strong in dcSSc (r = 0.54 p &lt; 0.001, and 0.63 p &lt; 0.001, respectively). In patients with disease duration &lt; 4 years, PASTUL was very strongly correlated with mRSS (r = 0.84, p &lt; 0.001), and strongly correlated with HRQoL (EuroQoL, r= -0.67, p = 0.004).
SSPRO scores were not correlated with mRSS or PASTUL, but were moderatedly associated with SSc HRQoL scores (r = 0.425, p &lt; 0.001).

Conclusion
Our preliminary results show that PASTUL is a valid and feasible outcome tool that adds a self-reported measure of skin severity to impact assessments like SSPRO. HRQoL was associated with skin thickening in patients with early disease. SRM was low and needs further assessment in a larger group.

Disclosure
J. Spierings: None. V.H. Ong: None. P.M.J. Welsing: None. M. Hughes: None. J.D. Pauling: None. F. Del Galdo: None. A.L. Herrick: None. C.P. Denton: None.
P164 Fracture risk in axial spondyloarthritis: a retrospective analysis of the use of the Fracture Risk Assessment Tool in a cohort of affected patients
Authors: Mulkerrin Patrick , O'Shea Finbar , Fitzgerald Gillian 
Published: April 2024

Abstract

Background/Aims
Fractures are common in axial spondyloarthritis (axSpA) patients. The FRAX (Fracture Risk Assessment Tool) score is a validated tool for the assessment of fracture risk. Unlike axSpA, rheumatoid arthritis (RA) is counted as a risk factor in FRAX. The primary aim was to calculate a FRAX score in a cohort of axSpA patients. In addition, a second FRAX score was determined by ticking the “RA risk” as positive on the second assessment.

Methods
Data were examined on a cohort of axSpA patients attending the St James’s Hospital Spondylitis service. Bone mineral density was assessed at the neck of femur on the patient’s dual x-ray absorptiometry (DXA). This, plus the individual patient’s risk factors, were added to the FRAX score calculator. The analysis was then repeated with the RA risk box ticked as positive. The effect of such an adjustment (taking account of their diagnosis of axSpA) on the fracture risk status of these patients was made to assess if this resulted in an additional number of patients within the cohort being at risk of fracture. A patient with a 10-year hip fracture risk of &gt; 3% or 10-year major osteoporotic fracture risk of &gt; 20% is high risk.

Results
Table 1 summarises the characteristics of the cohort. All (100%) of the patients met ASAS axSpA criteria and 85% met Modified New York (mNY) criteria for ankylosing spondylitis. Five patients had known osteoporosis and an additional 9 patients were classified as being at increased fracture risk using the FRAX Tool. A further 7 patients could be classified as being at increased fracture risk when the FRAX was adjusted for the axSpA diagnosis, by ticking the RA risk box as positive.

Conclusion
Fracture risk is a significant issue in patients with axSpA; however, this risk is frequently under-recognised. The use of the FRAX score improves the detection of those at fracture risk, and its use should be strongly encouraged in all rheumatology clinics managing axSpA patients. When the same weighting is given to axSpA as RA, there is a further increase in the identification of patients at risk of fractures.

Disclosure
P. Mulkerrin: None. F. O'Shea: None. G. Fitzgerald: None.
P175 The Psoriatic Arthritis Impact of Disease 12-item questionnaire can replace other patient-reported outcome measures to facilitate disease monitoring in clinical practice
Authors: Hum Ryan M , Hasanein Khaled , Hao Leow T , Williams Jacob C , Cheung Annie , Adhikarla Aditya , Choyce Annabel , Newton Alice , Clegg Caroline , Barton Anne , Ho Pauline 
Published: April 2024

Abstract

Background/Aims
The Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID-12) was developed and validated to improve assessment of disease activity from the patient’s perspective. Several patient-reported outcome measures (PROMs) are relevant to PsA but completing several questionnaires at each clinic visit creates a time and administrative burden for patients and clinicians. Furthermore, the Minimal Disease Activity (MDA) for assessing disease activity in PsA requires the Health Assessment Questionnaire (HAQ) to be collected; however, a Canadian study found that PsAID-12 can replace HAQ in the MDA using a cut-off of &lt; 3.7. A previous study also found sex-specific differences in PsAID-12 scores, with scores being higher in females. The aim of this study was to assess whether PsAID-12 correlates well and could replace other PROMs in clinical practice, and to validate previously published findings related to the use of PsAID-12 instead of HAQ in determining MDA, and sex-specific differences in PsAID-12 scores.

Methods
Clinical data were collected from 75 consecutive patients attending a PsA clinic in a tertiary centre at their first review in 2023. Clinical characteristics, PROMs, examination findings, and measures of disease activity were recorded. Correlation with PsAID-12 was assessed using Spearman’s rank correlation coefficient. Sex-specific differences were assessed using Mann-Whitney U tests. Bonferroni correction was used to adjust for multiple comparisons.

Results
PsAID-12 scores were significantly correlated with all PROMs, and with composite measures of disease activity (DAPSA, MDA), but not with clinical measures of disease activity (TJC, SJC, PASI, BSA), or acute-phase reactants (CRP, ESR). PsAID-12 scores were not affected by age or disease duration. There was no sex-dependent difference in PsAID-12 scores; however, female patients had significantly higher HAQ and HAD scores. MDA scores using PsAID-12 correlated significantly with MDA scores using HAQ.

Conclusion
PsAID-12 is a suitable replacement for other PROMs in clinical practice, and for HAQ when determining MDA status to reduce the time and administrative burden on patients and clinicians, and to facilitate monitoring of disease activity in patients with PsA regardless of age or disease duration. Contrary to previous studies, there were no sex-dependent differences in PsAID-12 scores.

Disclosure
R.M. Hum: None. K. Hasanein: None. L.T. Hao: None. J.C. Williams: None. A. Cheung: None. A. Adhikarla: None. A. Choyce: None. A. Newton: None. C. Clegg: None. A. Barton: None. P. Ho: None.
P187 Fatigue in people with polymyalgia rheumatica: a key unmet need?
Authors: Muller Sara , Belcher John , Hider Samantha , Helliwell Toby , Mallen Christian D 
Published: April 2024

Abstract

Background/Aims
Polymyalgia rheumatica (PMR) is common in older adults, causing severe pain and stiffness, particularly in the shoulder and hip girdles. Glucocorticoids treatment generally focusses on reducing pain and stiffness, but there are other aspects to quality of life. Fatigue is a well-recognised symptom in other inflammatory rheumatological conditions and has been highlighted by people with PMR as a neglected symptom.

Methods
People with newly diagnosed PMR in English general practice (2012-2014, n = 652) were recruited to a postally-administered cohort study. Surveys included items relating to PMR, general health and well-being. The FACIT-Fatigue questionnaire was included in the survey at diagnosis, 1, 12, 24 and (mean) 61 months follow-ups. Latent class growth analysis was used to define trajectories, based on FACIT-Fatigue scores over time. Trajectories were characterised and compared at baseline and over time.

Results
244 people participated at 24 months and 197 at 61 months. Individuals were allocated to one of five fatigue trajectories. Each represented a different average level of fatigue at diagnosis that remained stable over time (Table). From least to most fatigued, trajectory sizes were 111, 122, 211, 133 and 75. Two thirds of the cohort (the three “worst” trajectories) were, on average, more fatigued than reported in the general population. Worse fatigue trajectory was associated with female sex, higher pain and stiffness, higher levels of anxiety, depression, insomnia, and poorer physical function at baseline and throughout.

Conclusion
Fatigue is common in inflammatory conditions, but under-recognised in PMR. Fatigue severity at the time of diagnosis appears indicative of fatigue levels up to five years later and is associated with a broad range of health constructs at diagnosis and later. This represents an unmet need in a sizable proportion of those with PMR, who may need more help to manage their condition and allow them to return to full function. These findings also present a potential avenue for early identification of those with a poor prognosis related to their PMR.

Disclosure
S. Muller: None. J. Belcher: None. S. Hider: None. T. Helliwell: None. C.D. Mallen: None.