bluuebunny/crossref_metadata_2025_split huggingface dataset:
P016 To rescreen or not to rescreen, that is the question: an evaluation of practice of rescreening for infections when switching advanced therapies in rheumatology patients
Authors: Masood Ammara , Xiang Yawen , Rose-Hartwell Safiya , Subesinghe Sujith 
Published: April 2023

Abstract

Background/Aims
The 2018 British Society for Rheumatology guidelines mandate pre-treatment screening for infections (including tuberculosis [TB], viral hepatitis and HIV) in patients prior to treatment initiation with advanced therapies. It is increasingly common for patients to switch advanced therapies due to inefficacy or intolerance. There is no established guideline stipulating the frequency of rescreening patients for infections when switching advanced therapies. Rescreening is expensive and can delay the prescribing process. This audit reviewed the current practice at a single tertiary rheumatology centre.

Methods
A retrospective case note analysis of 100 consecutive patients who underwent biologic switch between April 2021 to March 2022 was included. Data extraction included patient demographics, rheumatic diagnosis, drug exposures, co-morbidities including past infections and rescreening tests were undertaken (including T-SPOT.TB, chest X-ray and serological tests for hepatitis B, C and HIV).

Results
The median age of this cohort (64 female, 36 male) was 53 (IQR 41 - 60). The most common diagnosis was rheumatoid arthritis (n = 62), followed by psoriatic arthritis (n = 27) and ankylosing spondylitis (n = 7). Seven patients were identified as high-risk individuals: two patients with hepatitis B, one with latent TB, one with previous positive TSPOT.TB and three with underlying lung diseases. 69 patients were partially rescreened for infections and 21 patients had a complete re-screen including chest X-ray, TSPOT.TB, HIV serology, HBsAg, Anti-HbC and Anti HCV. 31 patients did not have any re-screening tests when switching to a different biological drug. The range since the previous pre-advanced therapy screening was between 6 months and 5 years. There was no significant difference in the rate of rescreening investigations between those who switched drugs within the same class, versus those switching drug classes (p = 0.874). No new infections, active or latent, were identified on rescreening. The total cost involved in rescreening this cohort of patients was estimated at £5930.

Conclusion
Our audit data showed that rescreening for infections at 18 months or less has a low yield for identifying new incident infections. The decision to rescreen patients was primarily driven by the clinician’s judgement. It is pertinent to standardise the practice by establishing an evidence-based guideline based on a robust risk assessment which may then lead to long-term cost-savings.
Disclosure
A. Masood: None. Y. Xiang: None. S. Rose-Hartwell: None. S. Subesinghe: None.
P032 Starting work as a rheumatology doctor: how to do it well
Authors: Benson Rosalind , Appleby Edward , Gledhill-Flynn Charlie , Maxey Kate , Southam Daisy , Little Jayne , Watson Pippa A 
Published: April 2023

Abstract

Background/Aims
Starting work in a specialty for the first time can be extremely challenging. This has implications for patient care, junior and supervising doctor enjoyment and future career choices. A focus group was established to explore what resources junior doctors would want when starting Rheumatology. This determined that a blended learning package with podcasts, webinars and eLearning with topics including history and examination skills, understanding investigations and prescribing disease modifying drugs (DMARDs) would be ideal. Furthermore, it would be well placed to include resources to help junior doctors consider a career in Rheumatology.

Methods
The focus group results were used to design online ‘how to’ resources guiding doctors through tasks that they might be expected to do as a Rheumatology doctor. These were created by teams of junior doctors alongside Consultant Rheumatologists with creative support from the British Society for Rheumatology (BSR) education team. Content was pitched at an introductory level to help doctors when they first start working in Rheumatology. The most appropriate delivery modalities were selected for each topic e.g. a podcast for ‘how to talk to patients about DMARDs’ and eLearning including a video for ‘how to do disease activity scoring’. The resources are hosted on the BSR eLearning site and are free for anyone to use (no membership required) https://www.rheumatology.org.uk click eLearning. BSR communications and twitter were used to advertise the launch of the ‘how to’ series prior to junior doctor rotations in August.

Results
Since the ‘how to’ eLearning site was launched there have been 258 users. All content has been accessed. To date the most popular topics have been ‘how to’
- Interpret antibodies-Use DMARDs safely-Interpret x-rays-Score disease activity
Feedback has been extremely positive with an overall satisfaction of 4/5. An example of written feedback from a user “ … it was a good overview, I would recommend to new IMT doctors starting in departments, or those considering Rheumatology as a career, I like how you have incorporated different modalities for learning e.g. mixture of lectures, podcasts, reading.”

Conclusion
The response to the resources created so far have been extremely positive. 258 users is a good start but increasing awareness of the resources should allow many more doctors to benefit from these resources. The authors plan to develop and improve content and welcome any feedback or suggestions for future topics.
Disclosure
R. Benson: None. E. Appleby: None. C. Gledhill-Flynn: None. K. Maxey: Other; Kate is a member of the Education team at the British Society for Rheumatology. D. Southam: Other; Daisy is employed by the British Society for Rheumatology as Head of Education. J. Little: None. P.A. Watson: Other; I am employed by the British Society for Rheumatology as eLernaing Editor.
P061 COVID vaccine made my joints hurt: effect of COVID vaccine on systemic rheumatic disease
Authors: Munir Asif , Awais Hafiz 
Published: April 2023

Abstract

Background/Aims
Vaccination against SARS-CoV-2 is crucial for patients with systemic rheumatic diseases (SRDs) who may be at increased risk of severe outcomes post-COVID-19. Sparse data suggests vaccines used for COVID -19 may be associated with SRD flares, possibly from molecular mimicry triggering immune activation or non-specific adjuvant effects. As SRD flares are associated with disease deterioration, increased flares could have serious clinical implications. We report the interim results of a survey evaluating SRD flare incidence post-SARS-CoV-2 vaccine.

Methods
We surveyed 200 patients of different age group with different SRDs via telephone or paper copy during their appointment in Rheumatology department at North Cumbria Integrated Care NHS Foundation Trust, from September 2022 to March 2022 who received at least one dose of Pfizer or Astra Zeneca vaccine. The results of the survey were recorded.

Results
The mean age of the patients was 62.5 years. 63% of the patients (N-126) were females. 53 (26.5 %) of these patients had Rheumatoid Arthritis (RA), 43 (21.5 %) had Psoriatic Arthritis, 37 (18.5%) had Sero-ve Spondyloarthropathy, 22 (11%) had Ankylosing Spondylitis, 16 (8 %) had CTD, 12 (6%) had PMR, 10 (5%) Vasculitis and 7 (3.5%) had Palindromic arthritis. 96 (48%) of these patients were on synthetic DMARDs, 56 (28%) on Biologic DMARDs and 41 (20.5%) were on combination. 7(3.5%) patients were on NSAIDS. The most common adverse effects from the vaccine were pain at the site of injection and generalized body aches in 90 % of patients followed by fatigue in 80%. 22% had fever. 21 (10.5 %) patients had flare up of their existing rheumatic disease after the first dose and 22 (11%) had a flare after 2nd dose and another 24 (12%) after the 3rd dose. 30 (15%) patients had some flare up after two doses. Out of these 26 had mild flare up and improved with Paracetamol/codeine. 30 had mild to moderate flare required different NSAIDs and 21 had severe requiring a course of prednisolone. 3 of these patients required step up of DMARDS. These flares were described as typical, suggesting these symptoms were not vaccine’s adverse effects being misreported as disease flares.

Conclusion
Interim data from our cohort demonstrates about 12% of patients had severe flare up, with some lasting for weeks requiring switching of DMARDs.
Although SARS-CoV-2 vaccine might be associated with some flare up in SRD, but the morbidity and mortality of non-vaccinated patients with SRD can be very devastating signifying the importance of the vaccine. Further data is required for a wider cohort.
Disclosure
A. Munir: None. H. Awais: None.
P092 Imagined Futures: How can digital storytelling empower young people with JIA to engage in ideas about health, wellbeing and transition
Authors: Woolf Anna , Wilson Debbie 
Published: April 2023

Abstract

Background/Aims
During February half-term 2022, seven young people with JIA ranging in age from 11 to 16 coalesced at the Unicorn Theatre in London to participate in a week-long series of workshops exploring filmmaking, digital storytelling, and health. Led by Creative Health PhD researcher Anna Woolf (Royal Central School of Speech and Drama), and Debbie Wilson, Young People’s Project Manager from JIA-at-NRAS, the facilitators engaged the young people in a series of digitally-led practices which allowed the young people to explore their lived experiences in a creatively-led group setting. Utilising TikTok methodologies (Pomerantz, 2021) the young people created and performed content that explored themes of identity and emerging self-hood. The project enabled young people’s understanding of their JIA to be explored in relation to their hopes and fears about their future health, self-management, and ideas about transition.

Methods
The approach included pre-project qualitative and quantitative surveys detailing young people’s attitudes and experiences to having JIA, semi-structured interviews with the young people and thematic qualitative analysis of filmed stories.

Results
Young people expressed that they had never met another young person with JIA or arthritis ever before despite several of them attending the same paediatric centres such as Great Ormond Street or the Evelina hospital in London. The project coalesced young people around their collective health conditions and the use of digital mediums made space for places of powerful solidarity between young people experiencing the same health problems.

Conclusion
Despite young people with JIA having good relationships generally with their doctors and support from their families, the work created by them in the project showed the researcher very clearly that they need much better peer support structures, help and understanding from other adults such as teachers, and in general, more understanding and empathy from the world at large about their lived experience. Utilising TikTok, filmmaking and online creative formats such as meme-making and online journaling, the young people were clearly engaged and adeptly expert at producing creative testimony and performance which illustrated their experiences of health. Assumptions such as believing that young people struggled with their patient-doctor relationships were replaced with a real understanding of the young people’s struggles, such as learning that teachers and other adults in the world are far more problematic, oftentimes labelling them as lazy or difficult for not participating in life in ways that their fully able-bodied peers do. The researcher also learnt much more about the effects of poor mental health that JIA engenders for young people with arthritis and reflected on the need for more creative peer-led spaces to explore this.
Disclosure
A. Woolf: None. D. Wilson: None.
P126 Cycling of JAK inhibitors: Experience from a large UK teaching hospital
Authors: Quinlan Eavan M , Cox Miriam , Maxwell James R 
Published: April 2023

Abstract

Background/Aims
JAK inhibitors (JAKi) are relatively recently licenced for treatment of inflammatory arthritis. Therefore, long term data regarding outcomes for patients cycling through multiple JAKi are lacking. However, one recent international cohort study (Pombo Suarez et al) suggested cycling JAKi is similarly efficacious as switching to an alternative biologic DMARD after initial treatment failure. The aim of this study was to assess outcomes for patients switching JAKi in a large, UK teaching hospital.

Methods
This was a retrospective cohort study of patients prescribed a JAKi for inflammatory arthritis at Sheffield Teaching Hospitals. Patients who had received two or more JAKi were identified through a local biologic database. Demographic data, antibody status, concomitant medications, previous biologics, and reasons for switching therapy were collected.

Results
We identified 20 patients who had cycled through JAKi. The diagnosis was Rheumatoid arthritis in 75% (n = 15) of patients. The remaining patients had Psoriatic arthritis (n = 3), seronegative inflammatory arthritis (n = 1) or axial spondyloarthritis (n = 1). 95% (n = 19) of patients were female. 50% of patients used concomitant DMARD therapy and 15% were prescribed concomitant steroids. 85% (n = 17) of patients had received two JAKi and 15% (n = 3) had received three. Initial JAKi prescribed was Baricitinib in 40%, Tofacitinib in 40%, Filgotinib in 10% and Upadacitinib in 10% of patients. The most frequent reason for cycling JAKi was secondary loss of efficacy, affecting 40% (n = 8) of patients. The duration of treatment before loss of effect ranged from 6-45 months (IQR 12-31 months). 100% of these patients remain on their second JAKi with good response. 35% (n = 7) of patients stopped initial JAKi therapy due to side effects. These included gastrointestinal upset, headaches, and rash. 86% (n = 6) of these patients did not tolerate a second JAKi due to re-occurrence of the same side effect, including one patient with recurrence of the same side effect on a third JAKi. One patient who had headaches with their first JAKi has remained well on their second JAKi. 20% (n = 4) of patients changed therapy due to primary nonresponse to initial JAKi. One patient failed to respond sufficiently to either JAKi and alternative treatment was commenced. Three patients responded to a second JAKi, although two later lost efficacy and are currently responding well to a third JAKi. One patient switched JAKi due to cardiovascular risk with Tofacitinib.

Conclusion
This study supports recent studies in finding that cycling JAKi in patients who lose efficacy or do not respond to initial JAKi can be an effective treatment strategy. However, in patients who stop initial JAKi due to side effects, cycling to a further JAKi is less likely to be successful, with recurrence of side effects in most cases.
Disclosure
E.M. Quinlan: None. M. Cox: None. J.R. Maxwell: Honoraria; BMS, Pfizer, Abbvie, Lilly, Gilead.
P137 First-line tumour necrosis factor inhibitor (TNFi) treatment is associated with high multi-criteria remission early on compared to treat-to-target in a treatment naïve RA cohort
Authors: Shukla Rudresh , Plant Darren , Emery Paul , Buch Maya H 
Published: April 2023

Abstract

Background/Aims
In rheumatoid arthritis (RA) disease assessment, SDAI and Boolean remission criteria are known to be more stringent in comparison to DAS28-ESR. Comparing remission rates across multiple assessment indices provides a more comprehensive evaluation of disease control. In an early RA trial cohort, we aimed to investigate stringent and multi-criteria remission (MCR) rates and evaluate their proportional change in response to treatment.

Methods
The ‘VEDERA’ trial randomised 120 treatment-naïve, new-onset RA patients to first-line etanercept+methotrexate (ETN+MTX) or methotrexate treat-to-target (MTX-TT) with escalation to ETN+MTX if not in DAS28-ESR remission at week24. Clinical assessments were completed at baseline, weeks12/24/48 (protocolised phase) up to week96 (standard-of-care). Remission cut-points included: DAS28-ESR ≤2.6, SDAI ≤3.3 and Boolean score for individual components≤1. MCR was defined as patients who were in DAS28-ESR, SDAI and Boolean remission concurrently. Descriptive analyses were undertaken to address the above aims.

Results
Overall, at week12, 26%(31/120) were in SDAI and 13%(16/120) in Boolean remission. This increased to 41%(49/120) and 23%(28/120) respectively by week48.
In the ETN+MTX group at week12, 30%(18/60) were in SDAI and 17%(10/60) in Boolean remission. This increased to 43% (26/60) and 32%(19/60) respectively by week48. Stringent remission rates were lower in MTX-TT compared to ETN+MTX and significantly different for Boolean at week48 (15% vs 32%, odds ratio 2.6, 95% confidence interval 1.1 to 6.5, nominal p &lt; 0.05) (Table 1).
Of those in remission by the three different criteria, 36%(14/39) were in MCR at week12, with a greater proportion in ETN+MTX group [42%(10/24) compared to 27%(4/15) in MTX-TT]. MCR remained unchanged up to week48 but improved with treatment by week 96 to 45%(27/60). MCR rates did not converge between the 2 treatment groups at week 96 (ETN+MTX 55%; MTX-TT 38%).

Conclusion
First-line ETN+MTX is associated with higher rates of stringent remission from week 12 compared to MTX-TT, with improvement gradually over time with both strategies. Significantly higher proportion of patients treated with first line ETN+MTX compared to MTX-TT achieved Boolean and MCR. Early TNFi treatment associates with more complete and better cumulative disease activity profile. Patients not meeting MCR early following treat-to-target approach should be considered for more aggressive treatment strategies.
Disclosure
R. Shukla: None. D. Plant: None. P. Emery: None. M.H. Buch: None.
P138 Inequity in Clinical Commissioning Group funding across England for high-cost biologic drugs in rheumatoid arthritis
Authors: Buckeldee Olivia , Khanna Rajakshi , Snell Laura , Attipoe Laura 
Published: April 2023

Abstract

Background/Aims
Biologic, and targeted, disease-modifying antirheumatic drugs (bDMARDs/tDMARDs) are recommended for patients in England with high disease activity score rheumatoid arthritis (HDAS-RA) who do not respond to two or more conventional synthetic DMARDs. To prescribe bDMARDs/tDMARDs in England, prescribers must apply for funding via their local clinical commissioning group (CCG). The project aim was to review whether CCGs across England had defined high cost drugs pathways for bDMARDs/tDMARDs use in HDAS-RA and if so, what this pathway looked like regarding drug choice, order of availability, and ability to prescribe as monotherapy.

Methods
We submitted a freedom of information (FOI) request in October 2021 to all CCGs within England to obtain their high cost drug pathway for bDMARDs/tDMARDs use in HDAS-RA. We then manually reviewed the pathways to determine whether the CCG specified an order of drug prescribing. Data was also gathered on whether CCGs allowed abatacept (ABT), rituximab (RTX), and golimumab (GOL) to be prescribed as monotherapy.

Results
All 107 CCGs in England responded to the FOI request. 69 out of 107 CCGs (65%) had a pathway for bDMARDs/tDMARDs prescribing. 60 out of 69 CCGs (87%) specified an order for drug prescribing in RA. Within their pathways, CCGs generally fell into 3 prescribing preferences. Table 1 summarises these pathway recommendations. 39 (57%), 59 (86%), and 6 (9%) CCGs allowed ABT/RTX/GOL to be prescribed as monotherapy respectively. RTX monotherapy was specifically allowed outside of special indications such as cancer, interstitial lung disease and multiple sclerosis.

Conclusion
These findings show there is significant variation across England regarding which bDMARDs/tDMARDs patients can receive for HDAS-RA resulting in a postcode lottery. Several studies support the use of ABT/RTX/GOL as monotherapy and registry data shows that 30-40% of RA patients are administered ABT/RTX/GOL as monotherapy for methotrexate intolerance/contraindication. Lack of NICE appraisal, however, means some CCGs mandate individual funding requests for monotherapy prescribing. We would like to use these results to help negotiate equitable access to bDMARDs/tDMARDs nationwide.
Disclosure
O. Buckeldee: None. R. Khanna: None. L. Snell: None. L. Attipoe: None.
P143 Depression modifies the effect of Rheumatoid on Overall Mortality among Females
Authors: Banerjee Sri 
Published: April 2023

Abstract

Background/Aims
Depression is a mental health condition that affects many individuals. When compounded by an autoimmune condition like rheumatoid arthritis, there can be harmful consequences. In this article, we explored if depression modified the connection between rheumatoid arthritis (RA) and overall mortality.

Methods
The study was conducted on participants aged 20 years or older living in the United States. We assessed RA status by using the arthritis question in the NHANES survey for the years 1999 to 2010 with mortality follow-up. We determined depression by Patient Health Questionnaire (PHQ-9). Prospective analysis was performed using complex samples Cox regression with adjustment for known confounders to determine the relationship of RA and mortality, and how depression has an overall relationship in females.

Results
The mean follow-up was 9.1 years. For all-cause mortality, the overall unadjusted hazard ratio (HR) of rheumatoid arthritis to no rheumatoid arthritis was 1.94 (95% confidence interval [CI], 1.25-4.01 p &lt; 0.001). Adjusted HR was elevated, 2.13 (CI 0.98-4.62, p &gt; 0.05), among patients with elevated C-reactive protein with RA but closer to 1.0 (1.90 CI 1.21-1.99, p &gt; 0.05) among patients without depression, after controlling for medical and demographic risk factors. Similar patterns did not apply for males.

Conclusion
RA has poorer outcomes especially when they have depression. These patterns exist among females but do affect males in the same way. Screening for depression should be a part of how rheumatologists treat patients.
Disclosure
S. Banerjee: None.