bluuebunny/crossref_metadata_2025_split huggingface dataset:
P087 Predictors of long-term functional outcomes of juvenile idiopathic arthritis-enthesitis-related arthritis: a single-centre experience
Authors: Ravichandran Naveen , Guleria Shivika , Mohindra Namita , Aggarwal Amita 
Published: April 2023

Abstract

Background/Aims
Long-term functional outcomes in enthesitis-related arthritis (ERA), is limited from developing countries. We assessed the clinical and genetic factors that predicted the long-term functional outcome in ERA.

Methods
Patients with ERA having &gt;5 years of disease and &gt; 16 years of age were included in this cross-sectional study. Data on clinical features within 6 months of disease onset was collected from hospital records. Bath indices, HAQ-DI, and WHO-QOL were assessed at last visit. Poor functional outcome (PFO) was defined as BASFI&gt;1.5 or HAQ-DI&gt;1. Persistent disease activity (PDA) was defined as BASDAI&gt;4. ERAP-1 and IL23R SNP genotyping was done by TaqMan method and HLA-B27 by PCR.

Results
181 patients [170-male, age of disease onset 12.5 (10-15) years, disease duration 7 (5-11) years] were recruited. There was delay in diagnosis of 3 (1-5) years. The median ASDAS-ESR, BASDAI, HAQ-DI, and BASFI at inclusion were 2.6 (1.8-3.6), 2.6 (1-5.2), 0.5 (0-0.5) and 1.6 (0.3-3.2) respectively. BASFI and HAQ-DI correlated with ASDAS-ESR, ASDAS-CRP and WHO-QOL-BREF. Those with PFO (n = 98) had a longer delay in diagnosis (4 vs 2 years, p &lt; 0.001), lower prevalence of arthritis at onset (OR = 0.3, 95%CI:0.1-0.8), higher prevalence of ERAP1(rs27044) allele C (OR = 7.2, 95%CI:1.5-33.7), and higher disease activity currently. Delay in diagnosis (OR = 1.2; 95%CI:1.08-1.4) was the sole predictors of PFO in multivariate analysis. One-third of patients had PDA. Tarsitis at disease onset was the sole predictor of PDA (OR = 2.3; 95%CI:1.009-5.4).

Conclusion
Poor functional outcome was seen in one-half of JIA-ERA in the long-term and was associated with active disease with delay in diagnosis as its sole predictor.
Disclosure
N. Ravichandran: None. S. Guleria: None. N. Mohindra: None. A. Aggarwal: None.
P105 Mode of hospital rheumatology appointments in people with rheumatoid arthritis: the impact of the pandemic in England
Authors: Costello Ruth E , Hollick Rosemary J , Parker Michael , Kennedy Jonathan , Mackenna Brian , Brophy Sinead , Tomlinson Laurie , Humphreys Jenny H 
Published: April 2023

Abstract

Background/Aims
During the COVID-19 pandemic rheumatology services were advised to limit face to face contact, with remote telemedicine used instead. Although suitable for some people, issues have been highlighted with telemedicine. The frequency and proportion of remote appointments during the pandemic has not been described, or the socio-demographic characteristics of those accessing remote or in-person rheumatology care. This study aims to describe rheumatology healthcare utilisation and mode of appointment (remote/in-person) in people with rheumatoid arthritis (RA), prior to, and during the pandemic in England.

Methods
A retrospective prevalent cohort study of people with RA, identified using a validated algorithm, as of 1st April 2019 using electronic health record data (OpenSAFELY). Outpatient rheumatology appointments between 1st April 2019 and 31st March 2022 were identified. For each year, the number of outpatient appointments, mode of appointment (remote/in-person) and patient socio-demographic characteristics were described.

Results
130,884 people with RA were identified. Since the start of the pandemic, the proportion of people without any appointments in a 12-month period increased from 28.5% in 2019/20 to 33.3% in 2020/21 and has not recovered. Older people were most frequently not seen (51% of people &gt;80 years in 2020/21 and 2021/22). Of appointments where mode was known, 54.4% of people with appointments in the year from April 2020 were only seen remotely, reducing to 35.1% in the year from April 2021 (Table 1). The proportion with all remote appointments increased with increasing age, comprising 62% of people &gt;80 years in 2020. This age gradient persisted in 2021, though proportions of those &gt;80 years with all-remote appointments was lower (44%). Compared to urban dwellers, a higher proportion of those living in rural areas had all remote appointments in 2020 (58% vs 53%) and 2021 (38% vs 34%).

Conclusion
During the pandemic, one third of people with RA were not seen at all over a 12-month period and these were more frequently older people. Over half of people were only seen remotely in 2020, decreasing to one-third in 2021. Given the limitations of remote appointments it is unknown whether this increased frequency of remote appointments will impact long-term outcomes.
Disclosure
R.E. Costello: Shareholder/stock ownership; AstraZeneca. R.J. Hollick: None. M. Parker: None. J. Kennedy: None. B. Mackenna: None. S. Brophy: None. L. Tomlinson: None. J.H. Humphreys: None.
P113 Attitudes to Technology supported Rheumatoid Arthritis care Questionnaire study: Barriers to People with RA & their clinicians using Technology in the care pathway
Authors: MacBrayne Amy , Soyel Hamit , Marsh William , Fenton Norman , Pitzalis Costantino , Curzon Paul , Humby Frances 
Published: April 2023

Abstract

Background/Aims
Rheumatoid arthritis (RA) outcomes have significantly improved with the treat-to-target paradigm, however, this necessitates intensive monitoring. Demand outstrips capacity in rheumatology services, making Mobile Health (mHealth) an attractive prospect. However, software developers often design without understanding the needs of ultimate users, solving non-existent problems. EULAR’s ‘Points to Consider’ for remote care specifies that interventions “should be developed in collaboration with all stakeholders including the healthcare team … and people with RMDs” as an overarching principle. This study sought to understand the barriers to end-users utilising technology within RA care.

Methods
Questionnaires were devised collaboratively between Rheumatologists and Computer scientists, informed by discussions with an RA patient group. Patients &gt;18 with a diagnosis of RA completed paper surveys (utilising likert scales, ranking preferences, and tick-box answers) whilst awaiting appointments at Mile End Hospital (Barts Health NHS Trust). Clinicians were recruited to complete an online survey via mailing lists from multiple centres across London & South-East England, from October 2019-March 2020. The study was registered (CMPS ID [43816]). Ethical approval was obtained through the Bloomsbury Research and Ethics Committee (19/LO/1345). This work forms part of a larger mixed-methods study funded by the PAMBAYESIAN project grant.

Results
109 people with RA returned paper questionnaires, 41 clinicians completed the online survey. Most used technology daily (87.2% patients; 100% clinicians), but few used RA apps (75.3% patients never used). Whilst clinician use was higher (54.8%), only 2/31 (6.4%) recommended Rheumatology apps to patients. People with RA were willing to share & record monitoring data, with only 8.3% unwilling to share via technology, 53.8% preferring monthly submissions. Clinical data, e.g. pain scores & joint counts, was preferred to sharing personal data. Sharing with clinicians was preferred to self-monitoring. 83.9% clinicians responded positively to using technology, but cited NHS technical capabilities, cost, need for clinical trials, and concerns for data saturation as the most significant barriers.

Conclusion
In spite of reasonable tech-literacy, willing to use, and many existing apps, people with RA and their clinicians do not utilise technology in RA care. Clinicians identified data saturation and insufficient evidence as barriers, in addition to systemic healthcare system barriers.
Disclosure
A. MacBrayne: None. H. Soyel: None. W. Marsh: None. N. Fenton: None. C. Pitzalis: None. P. Curzon: None. F. Humby: None.
P122 Changes in Serum Levels of Cytokines with Methotrexate Monotherapy in Active Rheumatoid Arthritis: Results from a Multicentre, Randomized Controlled Trial on Methotrexate Escalation In Rheumatoid Arthritis
Authors: Jain Siddharth , Dhir Varun , Aggarwal Amita , Gupta Ranjan , Maurya Supriya , Leishangthem Bidyalaxmi , Khullar Aastha , Naidu Shankar , Sharma Shefali K , Sharma Aman , Jain Sanjay 
Published: April 2023

Abstract

Background/Aims
Identification of novel biomarkers of disease activity and prediction of treatment response in rheumatoid arthritis (RA) is an area of active research. Reliable biomarkers of methotrexate (MTX) response in RA are yet to be identified. We sought to study the change in serum levels of IL-6, MMP-3, and TNF-α with MTX monotherapy in patients with active RA.

Methods
Patients with active RA (SJC≥2 and TJC≥4) not on DMARDs (except HCQ and low-dose prednisolone) who had been enrolled in the multicentre, parallel-group RCT comparing two different MTX escalation strategies in RA (MEIRA) were included. All these patients received MTX monotherapy started at 15 mg/week and escalated to 25 mg/week by 4-8 weeks. Serum levels of IL-6, MMP-3, and TNF-α were measured by ELISA before starting MTX and after 16 weeks of MTX therapy. Responders were defined as patients who achieved a EULAR good or moderate response (based on DAS28ESR-3v) at 16 weeks. Analyses were intention-to-treat.

Results
16 weeks of MTX therapy led to a decline in serum levels of both MMP-3 (p = 0.03, n = 129) and IL-6 (p = 0.048, n = 151). The decline in IL-6 levels was seen only in MTX responders (p = 0.003), but not in non-responders, while the decline in MMP-3 levels was seen in both MTX non-responders (p = 0.015) and responders (p = 0.44) (Table 1). Baseline (pre-treatment) serum levels of both IL-6 and MMP-3 were similar between MTX responders and non-responders. Correlations of serum levels of IL-6 (but not MMP-3) with measures of disease activity (DAS28, tender joint count) were weak but significant at 16 weeks. Serum TNF-α levels (n = 137) were undetectable in a majority of patients (93%). Serum IL-6 was not detectable in 67 (44%) patients at baseline.

Conclusion
Although serum levels of both MMP-3 and IL-6 reduced significantly with MTX therapy, the decline of IL-6 was seen only in MTX responders but not in non-responders. Pre-treatment serum levels did not predict future MTX response or non-response. IL-6 levels also correlated weakly but significantly with disease activity. Serial measurement of serum IL-6 merits further exploration in larger studies as a potential biomarker of MTX response in RA.
Disclosure
S. Jain: None. V. Dhir: None. A. Aggarwal: None. R. Gupta: None. S. Maurya: None. B. Leishangthem: None. A. Khullar: None. S. Naidu: None. S.K. Sharma: None. A. Sharma: None. S. Jain: None.
P136 T-cell-Specific Biomarkers of Early Treatment Response in Patients with Rheumatoid Arthritis Treated with a Tumour Necrosis Factor Inhibitor
Authors: Sutcliffe Megan A , Ling Stephanie , Banyard Antonia , Rumker Laurie , Viatte Sebastien , Morris Andrew , Barton Anne , Raychaudhuri Soumya , Plant Darren 
Published: April 2023

Abstract

Background/Aims
The use of tumour necrosis factor inhibitors (TNFi) has advanced the clinical management of rheumatoid arthritis (RA). However, only 30-40% of patients who receive initial treatment with a TNFi experience a beneficial response. The discovery of reliable biomarkers of TNFi response is, therefore, a priority. Whilst T-cell dysfunction is documented in RA pathophysiology, T-cell involvement in TNFi treatment response is unclear. We aimed to phenotype peripheral blood-derived T-cells in RA patients over a number of time-points through the first 12-weeks of TNFi treatment; and to apply a cluster-free association testing method developed on single-cell CITE-seq data—co-varying neighbourhood analysis (CNA)—to high-dimensional single-cell CyTOF data.

Methods
16 TNFi-naïve RA patients commenced treatment with a TNFi (10 on Adalimumab, 6 on Etanercept) and peripheral blood samples were collected at 6-7 time-points between pre-treatment and 12-weeks. Peripheral blood mononuclear cells were extracted, and stained with a 35-marker CyTOF panel. Treatment response was classified using the EULAR response criteria, and patients were characterised as good, moderate or non-responders. Data were cleaned in FlowJo and analysed using both i) a cluster-based approach, where data were clustered into 12 populations, and linear mixed models were fitted per cluster to test for significant differences in population abundance and ii) a cluster-free approach called CNA where association testing is purely data-driven. Both analyses controlled for age, sex, type of TNFi and TNFi concentration.

Results
Cluster-based analysis showed at 12-weeks, 1 of the 12 clusters (CD4+CD39+HLA-DR+) significantly increased in abundance in the non-responder cohort compared to the good and moderate responders (adjusted p = 0.037). Interestingly, HLA-DR and CD39 genetic effects have previously been associated with TNFi response. No significant differences were observed with CNA.

Conclusion
These results demonstrate that significant differences in T-cell abundance can be seen as early as 12-weeks after commencing treatment with a TNFi. Validation of these findings is required before the predictive value of this T-cell population can be tested.
Disclosure
M.A. Sutcliffe: None. S. Ling: None. A. Banyard: None. L. Rumker: None. S. Viatte: None. A. Morris: None. A. Barton: None. S. Raychaudhuri: None. D. Plant: None.
P147 Predictors of interstitial lung involvement in systemic sclerosis
Authors: Santos Cristiana Sieiro , Rego Salgueiro Rúben , Morales Clara Moriano , Castro Carolina Álvarez , Álvarez Elvira Díez 
Published: April 2023

Abstract

Background/Aims
Interstitial lung disease (ILD) and pulmonary hypertension are the leading cause of death in patients with systemic sclerosis (SSc). Identifying SSc-ILD development and initiating treatment is essential to optimize therapeutic benefit. We aimed to identify predictors of SSc-ILD and compared early (&lt;5 years from diagnosis) versus late (&gt;5 years from diagnosis) onset.

Methods
We conducted a retrospective cohort study by including patients diagnosed with SSc from 1980 to 2020 followed in our unit and compared the clinical profile of patients with SSc-ILD to control SSc-non-ILD patients. Demographic features, clinical and immunological characteristics and baseline pulmonary function were retrieved. Logistic regression modelling was run to identify factors associated with SSc-ILD development. Factors associated with ILD were determined as factors associated with early or late onset. Bonferroni correction was used to limit Type I errors.

Results
We have included 103 patients from our patient registry from 1980 to 2021 (42% with SSc-ILD). Logistic regression identified risk factors associated with increased or decreased odds ratio for developing ILD is summarized in table 1: smoking history, male sex, the presence of myositis, anti-Scl70 and anti-Ro52 positivity, baseline pulmonary function including FVC and DLCO, mMRC (modified medical research council) dyspnea scale&gt;2, mMSS (modified rodnan skin score)&gt;3 and late pattern in capillaroscopy. Older age at SSc diagnosis, the presence of telangiectasias and smoking status was associated with increased odds of SSc-ILD onset before 5 years, while male gender, the presence of myositis and antiphospholid antibodies were associated with late-onset SSc-ILD.

Conclusion
We identified 11 factors significantly associated with risk of developing SSc-ILD. We identified early and late-onset predictors for ILD-SSc.
Disclosure
C. Sieiro Santos: None. R. Rego Salgueiro: None. C. Moriano Morales: None. C. Álvarez Castro: None. E. Díez Álvarez: None.
P168 Factors associated with adverse outcomes in uveitis related to spondylarthritis (SpA-U) - development of a prognostic outcome score in patients with SpA-U
Authors: Santos Cristiana Sieiro , Sendino Tenorio Isabel , Castro Carolina Álvarez , Díez Álvarez Elvira 
Published: April 2023

Abstract

Background/Aims
Uveitis is the most frequent extra-articular manifestation of spondylarthritis (SpA), characterised by a sudden onset, often unilateral, anterior and recurrent, and may be the first clinical manifestation of the disease. The lack of standardised and validated outcome measures in uveitis makes it difficult to evaluate the efficacy of and refractoriness to treatment and determine factors associated with adverse outcomes. The objective of our study was to develop a prognostic outcome score for patients with uveitis associated with spondylarthritis (SpA-U) and determine factors associated with adverse outcomes in uveitis associated with SpA-U in patients under systemic treatment.

Methods
The outcome score was defined by best-corrected visual acuity (BCVA), anterior chamber inflammation, macular edema and inflammation of posterior chamber, global assessment, and refractoriness to treatment. Factors associated with adverse outcomes in uveitis were studied using linear regression. For categorical factors, marginal averages and their standard errors are displayed together with linear regression coefficients with 95% confidence intervals (CI). For continuous factors, averages and standard deviations are reported in addition to linear regression coefficients with 95% CI. Two regression coefficients are reported for each variable: unadjusted and adjusted for age at diagnosis and sex.

Results
250 uveitis outbreaks were included. 62 uveitis outbreaks (31%) were classified as severe, 42 as moderate (21%), and 93 as mild (47%) based on the definition and construction of outcome score. The results of the linear regression model revealed that the uveitis activity was more severe in patients with smoking history (β = 0.34), axial and peripheral involvement (β = 0.43), a BASDAI&gt;4 (β = 0.32), positive HLA-B27 (β = 0.29), female sex (β = 0.19), patients with CRP elevation (β = 0.002) and bilateral ocular involvement (β = 0.32). At the same time, shorter disease evolution (β=-0.02) was associated with less severe uveitis activity.

Conclusion
We have determined factors associated with adverse outcomes in SpA-U by developing an outcome score that integrates ocular inflammatory activity, visual acuity, global assessment, and refractoriness to treatment.
Disclosure
C. Sieiro Santos: None. I. Sendino Tenorio: None. C. Álvarez Castro: None. E. Díez Álvarez: None.
P181 Assessing and improving mental health in axial spondyloarthritis through digital solutions
Authors: Chan Antoni , Rigler Kathryn , McDougall Arran 
Published: April 2023

Abstract

Background/Aims
Mental health issues in axial spondyloarthritis (AxSpA) such as anxiety and depression can affect up to two thirds of patients. We aimed to detect the prevalence of anxiety and depression in our AxSpA patients in order to provide interventions to improve the condition. This is part of our work in the National Axial Spondyloarthritis Society’s (NASS) Aspiring to Excellence programme to improve patient outcomes. We have provided an online mental health assessment and self-management video that signpost patients to psychological help and resources.

Methods
We used the Hospital Anxiety and Depression Score (HADS) for AxSpA patients attending the clinic in January to March 2020. We also collected the BASDAI, Spinal Pain, BASFI and BASG. The HADS scores are divided into three groups, 0-7 (normal), 8-10 (borderline abnormal) and 11-21 (abnormal). Patients were invited to watch a self-help video on managing anxiety and depression, which we produced in house with our clinical psychologist. Patients were directed to online mental health resources and self-management programmes. Follow up HADS were collected post watching the video.

Results
All patients met the ASAS criteria for AxSpA. 100 patients were assessed and invited to watch the video. 90/100 (90%) of patients completed the baseline and follow up score. The mean (SD) age was 44.7 (13.2) years. The male:female ratio was 3:1. The mean disease duration was 9 years. The number of patients on biologics was 36 (40%). At baseline, the mean (SD) HADS was 10 (6), BASDAI 4.4 (2.3), Spinal pain 4.2 (3), BASFI 3.7 (2.7) and BASG 4.3 (2.7). The number of patients with a HADS score 0-7 was 28 (31%), 8-10 was 18 (20%) and &gt;11 was 44 (49%). All patients participated in the viewing of the video and used the self-management programme. 34 (38%) patients reported engaging with psychological services such as talking therapies. At follow up, the mean (SD) HADS score was 9 (6), BASDAI 3.7 (2.1), Spinal pain 3.8 (2.2), BASFI 3.4 (2) and BASG 3.9 (2.4). The number of patients with a HADS score 0-7 was 38 (42%), 8-10 was 28 (31%) and &gt;11 reduced to 24 (27%). There was a reduction in the number of patients with HADS &gt;11 (from 49% to 31%) and a trend towards lower HADS (HADS 0-7 increased from 31% to 42%) and AxSpA outcome scores (reduction in all four AS scores from baseline).

Conclusion
Mental health issues in AxSpA can be improved through the use of digital mental health assessment and self-management programmes. This study shows that this is a useful method of delivering care. There was a trend towards the improvement of the mental health and AS disease activity scores using the digital video.
Disclosure
A. Chan: None. K. Rigler: None. A. McDougall: None.
E012 An audit examining specialist referral for osteoporosis treatment for rheumatoid arthritis patients using new NOGG (National Osteoporosis Guideline Group) Guidelines 2022
Authors: Rauf Atif , Moss Kaite 
Published: April 2023

Abstract

Background/Aims
Major osteoporotic fractures remain an important cause of mortality and morbidity. Rheumatoid arthritis patients have significantly increased risk of fracture. New NOGG 2022 guidance recommends specialist referral for certain patients based on FRAX and other risk factors, to consider parenteral and anabolic treatment. Our aim was to assess how many rheumatoid arthritis patients would now require specialist referral.

Methods
We identified 38 patients with rheumatoid arthritis who had been referred for DEXA scanning in January 2022. FRAX was used to estimate fracture risk, this was then adjusted as per NOGG guidance to account for risk factors not included in FRAX. Intervention thresholds from new and old guidance were compared.

Results
90% of patients were female. Average age was 63.2 years. Mean major osteoporotic fracture risk is 15.6 and mean hip fracture risk is 4.7 over 10 years. 31.6% had previous fracture, 8% had recent fracture, and 8% had vertebral fractures. 26.3% were taking steroids, 10.5% were taking high dose steroids. 5% had received parenteral treatment at time of audit.

Conclusion
Rheumatoid arthritis patients have an increased fracture risk and therefore require robust bone protection/fracture risk reduction. This is because of a combination of disease pathogenesis, and concurrence of fracture risk factors. Our cohort reflected this; fracture risk was high and risk factors, particularly steroid use, and previous fracture, were common. Under previous guidance, some patients would eventually be referred to a specialist at the discretion of their physician. New NOGG guidance recommends referral as first line for certain patients. When applied to this cohort, we can see that a significant number of patients would be referred to a specialist. This represents a significant shift away from oral therapies and towards consideration of specialist treatment. Under new guidance, a significant number of rheumatoid arthritis patients need specialist referral. This requires a substantial number of resources and means that parenteral therapies will have a much larger place in osteoporosis management.
Disclosure
A. Rauf: None. K. Moss: None.