bluuebunny/crossref_metadata_2025_split huggingface dataset:
P171 Bimekizumab in bDMARD-naïve patients with active psoriatic arthritis: improvements in PsARC over 24 weeks in the Phase 3 BE OPTIMAL trial
Authors: McInnes Iain , Ink Barbara , Bajracharya Rajan , Taieb Vanessa , Tillett William R 
Published: April 2023

Abstract

Background/Aims
Bimekizumab (BKZ) is a humanised monoclonal IgG1 antibody that acts by selectively inhibiting IL-17F in addition to IL-17A and has demonstrated clinical efficacy vs placebo (PBO) in both joint and skin outcomes in patients with active psoriatic arthritis (PsA). We report interim 24-week (wk) PsARC response rates along with HRQoL estimates in bDMARD-naïve patients with active PsA from the phase 3, pivotal BE OPTIMAL trial (NCT03895203).

Methods
BE OPTIMAL is a randomised multicentre, double-blind, PBO-controlled to wk 16, followed by 36-wks maintenance phase, active reference, parallel-group, phase 3 study. Patients were randomised (2:3:1) to receive PBO, BKZ 160 mg every 4 weeks (Q4W), or active reference (adalimumab [ADA]) 40 mg every 2 weeks (Q2W). At wk 16, patients receiving PBO were switched to BKZ 160 mg Q4W; other patients remained on their original dose. We report PsARC to wk 16 and wk 24, and the association of PsARC response with HRQoL-related outcomes for the randomised set. Data are reported as non-responder imputation (NRI) and observed cases.

Results
852 patients were randomised at the baseline (PBO: 281; BKZ: 431; ADA: 140). Baseline characteristics were comparable between the three groups (mean age: 48.7 yrs; BMI: 29.20 kg/m2; disease duration: 5.9 yrs and 46.8% were males). At wk 16, PsARC response (NRI) was achieved by: PBO, 40.2%; BKZ, 80.3% and ADA, 82.1%. At wk 24, PsARC response increased in those PBO patients switched to BKZ: PBO/BKZ, 76.2%; BKZ, 77.3% and ADA, 80.0% (Table). Clinically meaningful improvement in HAQ-DI and SF-36 physical component summary (PCS), and improvements in FACIT-Fatigue were achieved from baseline among PsARC responders compared to non-responders (Table). Over the course of 24 weeks, safety was consistent with previous BKZ studies and no new safety signals were observed.

Conclusion
BKZ in bDMARD-naïve PsA patients demonstrated rapid and clinically relevant improvements in musculoskeletal outcomes compared to PBO at wk 16 and patients who switched to BKZ from PBO at wk 16 have a similar response rate at wk 24. Patients with PsARC response had numerically greater improvements in HRQoL-related outcomes. No new safety signals were observed.
Disclosure
I. McInnes: Grants/research support; IM has received grants/research support from Astra Zeneca, Abbvie, BMS, Compugen, Cabaletta, EveloBio, Eli Lilly, GSK, Janssen, Novartis, Moonlake, Novartis, Sanofi, UCB Pharma, XinThera. B. Ink: Shareholder/stock ownership; BI is a shareholder of AbbVie, GlaxoSmithKline and UCB Pharma. R. Bajracharya: Other; RB is an employee of UCB Pharma. V. Taieb: Other; VT is employee of UCB Pharma. W.R. Tillett: Other; WRT has received Research Grant, consulting or speaker fees from Abbvie, Amgen, Eli Lilly, Janssen, GSK, MSD, Novartis, OVA Pharma, Pfizer and UCB Pharma.
P173 Evaluating disease activity in established psoriatic arthritis with ultrasound
Authors: Sundanum Sonia , Darcy Hannah , Gallagher Philomena , Young Francis , O'Neill Lorraine , Veale Douglas J 
Published: April 2023

Abstract

Background/Aims
Early diagnosis, tight disease activity control and a treat-to-target approach are now recognised as critical factors that improve the outcome of patients with psoriatic arthritis (PsA). The traditional method used to assess disease activity is clinical examination (CE) by counting the number of tender and swollen joints. Ultrasound (US) has proven its superiority over CE for assessing the presence of synovitis in some studies. We aimed to identify the frequency and location of subclinical synovitis in a cohort of PsA patients with established disease.

Methods
Patients with established PsA were recruited. All gave informed, written consent and local ethical approval was obtained. All patients had a standard CE including 68/66 tender/swollen joint count. Grayscale (GS) and power doppler (PD) US of a standard set of 44 joints was performed using a GE logiq-P9 machine utilising 6-15-MHz and 8-18-MHz linear transducers. GS and PD were scored on a 0-3 semiquantitative scale for each joint. The presence of US active joints was defined as a GS-score ≥2 and/or PD-score ≥1.

Results
78 patients were enrolled; 46/78 were female with a median age = 61 years (range 41-80). Median duration of PsA disease = 31.5 years (range 41-80), 40/78 were on bDMARDs and 27/78 on csDMARDs. The median TJC = 2 (range of 0-6) and mean CRP = 3.2 (SD 3.5). The most common sites for subclinical synovitis were wrists, knees, and metatarsophalangeal joints (see Table 1). 36 patients (46.2%) achieved a clinical state of minimal disease activity (MDA). 11 patients in MDA (30.5%) had a PD-score of &gt; 1, suggesting they did not achieve minimal ultrasound disease activity (MUDA).

Conclusion
These data demonstrate that a proportion of established PsA patients deemed to have MDA actually have sonographic evidence of active disease. A previous study showed that PD-synovitis in PsA patients in clinical remission was a strong predictor of disease flare. It is unclear if subclinical synovitis in PsA is linked to radiographic progression. Combining CE and sonographic evaluation is an attractive approach to identifying subclinical disease. However, a validated ultrasound composite index, which includes the key joint areas frequently affected in PsA, is needed.
Disclosure
S. Sundanum: None. H. Darcy: None. P. Gallagher: None. F. Young: None. L. O'Neill: None. D. Veale: None.
P175 Creating a social movement for change to transform care and drive down diagnostic delay in axial SpA
Authors: Eddison Joe , Webb Dale , Hamilton Jill , Marshall Liz , MacAuley Fiona 
Published: April 2023

Abstract

Background/Aims
It should be possible for every person experiencing symptoms of axial SpA to receive a diagnosis within one year of symptom onset. In June 2021, NASS published a route map to achieve a gold standard time of one year. Starting from a current baseline average of 8.5 years, the achievement of this goal will require transformational change. Above all, to attain such a dramatic change in time to diagnosis, we must win hearts and minds, build a movement of people who want to work with us to create change, and demonstrate proof of concept for our ideas.

Methods
Our campaign is designed around two key considerations. Firstly, a broad theory of change that describes how we can create system-wide change. Secondly, an understanding of the patient journey from symptom onset to diagnosis by a rheumatologist. Our theory of change first builds a ‘burning platform’, setting out why action and change is needed; we will use this to influence the thinking and behaviour of the public, policy makers and health care professionals. We will use a range of levers to create change in care processes; these will result in earlier diagnosis. Our first impact report described our work and impact to date in implementing this theory of change.

Results
We have been successful in building the burning platform for change, including commissioning the first economic model of the economic costs of delayed diagnosis. We have brought these, and other new data, to the attention of Ministers, other parliamentarians, policymakers, and HCPs. We have influenced the funders of the National Early Inflammatory Arthritis Audit to include new datapoints on time to diagnosis so that, for the first time, we will have comprehensive national audit data to track changes in performance. We have supported the Best MSK Health Collaborative to embed our approach in a new national axial SpA patient pathway. We are working with 19 rheumatology departments to implement the gold standard through our Aspiring to Excellence programme, and our new cadre of 12 Champions in Primary Care will be working together to drive improvement in identification and referral of suspected axial SpA patients. We have presented our burning platform to conferences and regional SpA academies. We have demonstrated proof of concept in our public awareness campaign which has reached 1.5 million people through social media, with 900,000 people watching our campaign videos, and already 5,000 people completing the online symptom checker.

Conclusion
We are building a social movement for change. We are influencing the thinking and behaviour across rheumatology. We are starting to see tangible changes in care processes. We have more work to do to translate this into the achievement of a one year time to diagnosis.
Disclosure
J. Eddison: None. D. Webb: None. J. Hamilton: None. L. Marshall: None. F. MacAuley: None.
P197 Evaluating the safety and factors associated with treatment cessation in Takayasu arteritis
Authors: Maughan Robert T , Porter Andrew , Dahanayake Chanaka , Ianonne Claudia , Alapat Ritu , Pericleous Charis , Youngstein Taryn A , Mason Justin 
Published: April 2023

Abstract

Background/Aims
Immunosuppression in Takayasu arteritis (TA) reduces the risk of arterial disease progression. However, long-term use of glucocorticoids (GC) and other agents carries risk, particularly as patients age. GC tapering practice can vary and there are no guidelines on the safety of treatment cessation due to a lack of data. This study describes the cessation of treatment in a large single-centre cohort and evaluates the baseline, clinical and treatment parameters associated with successful treatment stop.

Methods
The Imperial College Takayasu Arteritis Cohort (UK) was reviewed retrospectively; 158 patients, median follow-up 8.4 [5-13.6] years. Patients with data available within 1 year of audit (31/03/2021) were analysed. Treatment was defined as &gt; 6 months of GC, csDMARD or biologic medication and cessation as stopping treatment for &gt;1 year. Cessation safety was assessed by serial angiography (whole aorta MRI or CT) and NIH disease activity scoring. Baseline demographic, clinical and treatment parameters as well as initial treatment responses were compared for cessation and non-cessation cases. Data are median [IQR], comparisons are non-parametric for continuous variables.

Results
Of 129 (82%) cases requiring treatment, 107 (83%) remained in care. 29 (27.1%) cases of cessation were identified, time off-treatment was 3.6 [2.5-8.2] years. For 25 (86%) cessation cases, treatment withdrawal was due to sustained quiescence. Infection, non-adherence and tolerance accelerated cessation in 4 cases. Long-term inactivity was confirmed by disease activity scoring in all cases and by angiography where available (23 cases). No instances of treatment restart were observed. Baseline demographic and disease severity parameters were similar in cessation and non-cessation patients (Table). Cessation cases had lower GC doses after 2 years of treatment and a trend towards lower disease activity, suggesting better responses. Relatedly, biologic administration (reserved for refractory disease) was markedly lower in the cessation group. Finally, cessation cases had earlier treatment start years, were older at audit and had an increased proportion of Numano Type V classification.

Conclusion
In TA, complete treatment cessation is feasible and safe in a proportion of cases. Initial treatment response, treatment duration and Numano type V arterial involvement are potential predictors of successful treatment cessation and may aid future stratification strategies after validation.
Disclosure
R.T. Maughan: None. A. Porter: None. C. Dahanayake: None. C. Ianonne: None. R. Alapat: None. C. Pericleous: None. T.A. Youngstein: None. J. Mason: None.
P200 The relationship between patient and physician global assessment in patients with anti-neutrophil cytoplasmic antibody associated vasculitis
Authors: Bhonsle Ajinkya , Coughlan Tim , Graven Rachel , Bussa Paula , Gingold Michael , Polkinghorne Kevan , Ryan Jessica , Kitching A Richard 
Published: April 2023

Abstract

Background/Aims
Patients with anti-neutrophil cytoplasmic antibody associated vasculitis (AAV) often have reduced health-related quality of life (HRQoL) as assessed by the SF-36 questionnaire. Global assessment provides a patient and physician’s view on the patient’s overall health and wellbeing. The aim of this project was to examine the level of agreement between the patient and physician global assessment (PtGA and PhGA) in patients with AAV.

Methods
Patients attending our dedicated tertiary vasculitis clinic were recruited into this prospective study. PtGA and PhGA scores, out of 100, were assessed via a visual analog scale, with higher scores representing better health. SF-36 assessed HRQoL. Discordance was defined as an absolute difference of ≥ 20 between PhGA and PtGA. Active disease was defined as a BVAS of ≥ 1.

Results
Ninety-seven patients (mean age 58 years, 46% male) participated. Forty-three (44%) patients had active disease. The majority (88%) were on immunosuppressive therapy with renal (79.4%), lung (42.3%) and sino-nasal (40.2%) being the most commonly involved systems. The mean (SD) PtGA and PhGA was 63.4 (22.2) and 60.8 (24.8) respectively (t = 2.63, p = 0.0049). Mean (SD) PtGA in active versus inactive disease was 59 (22.8) and 66 (21.5) respectively (t = 1.49, p = 0.07). PhGA scores were higher than PtGA in 44 patients with an overall mean difference of + 13.7 (95% confidence interval [CI] 9.97, 17.46, p &lt; 0.001). PtGA scores were higher than PhGA in 48 patients (mean difference +17.9, 95% CI 22.6, 13.3, p &lt; 0.001). Scores were discordant in 26 patients, with PhGA&gt;PtGA (negatively discordant) in 10 (38%). Mean (SD) PhGA in discordant patients versus non-discordant patients was 47.5 (24.7) versus 65.7 (23.1) respectively (t = 1.71, p = 0.001). Mean (SD) age in positively discordant versus negatively discordant patients was 58.8 (17.3) versus 69.1 (8) respectively (t = 1.71, p = 0.026). The percentage of patients with active disease (n=number of patients) in positively discordant versus negatively discordant patients was 50% (n = 8) versus 30% (n = 3) respectively (p = 0.008). Bland-Altman plots showed no systematic bias as global scores increased.

Conclusion
Overall, physicians did not overestimate patients' global health when using the global assessment tool. Discordance rates were 26%, within which physicians were likelier to assess the patient's global health as lower than patients did themselves. Positively discordant patients (PhGA&lt;PtGA) were likelier to have active disease and were younger on average.
Disclosure
A. Bhonsle: None. T. Coughlan: None. R. Graven: None. P. Bussa: None. M. Gingold: None. K. Polkinghorne: None. J. Ryan: None. A. Kitching: None.
E002 Management of adults with systemic lupus erythematosus (SLE) in 2021: a multi-centre audit within Wales as part of an ongoing quality improvement exercise
Authors: Wright Sarah E , O'Beirn Patrick , Rhys-Dillon Ceril 
Published: April 2023

Abstract

Background/Aims
Significant changes to working practices within rheumatology have occurred since the beginning of the COVID-19 pandemic: virtual consultations have now become commonplace. This audit was undertaken as part of ongoing quality improvement work to assess the standards of care provided to patients with SLE attending rheumatology departments across Wales. Care was audited against the standards outlined in the 2018 British Society of Rheumatology guideline for the management of adults with SLE. Results were compared with the previous multi-centre audits of SLE care in Wales and the UK. We were interested to see whether changes to working practices had significantly affected the care of patients with SLE across Wales.

Methods
Rheumatology services in Wales were invited via email to participate. Data collection occurred between June and August 2021. Data was collected via online questionnaire, held securely by the Dudley Group NHSFT. Unit questionnaires were submitted by a lead clinician in each centre. Five centres across Wales submitted data from 62 clinical encounters with patients with SLE.
Results:

Conclusion
Results of this multi-centre audit do not demonstrate any widespread significant changes in care for patients with SLE in Wales between 2019 and 2021, despite 48% of consultations audited being undertaken virtually. Blood pressure and urinalysis were not consistently measured in 2021, likely secondary to the increased prevalence of virtual consultations. Group education has been undertaken as to the importance of facilitating observations in the virtual environment and centres have shared their experiences of how they tackle this challenge locally.
Disclosure
S.E. Wright: None. P. O'Beirn: None. C. Rhys-Dillon: None.
E006 An audit showing the successful operation of a nurse-led gout clinic during the COVID-19 pandemic
Authors: McWilliams Lesley-Ann , Stewart Roger G A 
Published: April 2023

Abstract

Background/Aims
Research has shown nurse-led gout clinics provide better outcomes compared to usual care. This District General Hospital set up a pilot nurse-led gout clinic in autumn 2019. This aimed to improve patients’ understanding of their condition, achieve better control of serum uric acid levels (SUA), reduce flares and prevent Emergency Department attendances.

Methods
A modified clinic protocol, closely modelled on BSR guidance was agreed within the department. With consultant supervision, one nurse specialist provided a mix of in-person and telephone appointments. Targets were set aiming for SUA &lt;360µmol/L for most patients and &lt;300µmol/L for those with erosive change or tophi. All patients were offered prophylaxis. Patients required a rheumatologist’s diagnosis of gout or crystal confirmation for enrolment. Exclusion criteria were significant renal or hepatic derangement. Within 3 months of the service starting SARS-CoV-2 impacted the operation of healthcare worldwide and led to the closure of routine outpatient clinics in Northern Ireland. A decision was made to switch the gout clinic to run entirely by telephone. Blood testing was facilitated through primary care and phlebotomy hubs.

Results
Over a 19-month period, 78 patients were treated and audited through this clinic: 69 men and 9 women. Average age was 57, mean SUA 509 µmol/L at referral and 322 µmol/L on discharge. 69 patients received allopurinol and 9 received febuxostat. No patients required uricosuric drugs. All patients were offered and agreed to take prophylaxis with a majority (85.8%) remaining on it for 3-6 months. Patients required a mean of 3.38 appointments prior to discharge from the clinic. The mean dose of urate lowering therapy on discharge was 315.9mg allopurinol and 93.3mg febuxostat. 95% experienced ≤2 flares during their enrolment in the clinic with no patients requiring Emergency Department attendance due to gout flare.

Conclusion
The nurse-led gout clinic was well received by patients and was effective as a telephone service during the pandemic when so many services were stood down. The clinic was able to continue to provide education, deliver effective reductions in uric acid as well as reduce incidence of flares and Emergency Department attendances. Lower doses of urate lowering therapy than expected were needed to achieve target. A small number of patients were discharged prior to enrolment for initial non-engagement which may have been exacerbated by the lack of face-to-face appointments. Our COVID-19 model did struggle with those patients needing an interpreter. In-person initial appointments have since been restarted; however, a greater proportion of reviews will continue to be offered by telephone given the unexpected success of the model. This audit showed that a nurse-led gout clinic can run successfully, even during a pandemic with a significant reliance on telephone consultations.
Disclosure
L. McWilliams: None. R.G.A. Stewart: None.
E009 A review of MRI indications and outcomes to identify a clinical predictor for joint inflammation
Authors: Barry Lucinda , Roberts Abigail , Menon Bina , Subesinghe Sujith 
Published: April 2023

Abstract

Background/Aims
Due to the nature of symptoms there is often a delay in diagnosing axial spondyloarthritis (AxSpA), the median delay from initial symptoms is over 8 years. A Rheumatology IBP (inflammatory back pain) service can reduce this to 3 years. MRI is highly sensitive for recognising early spine and sacroiliac joint (SIJ) changes. The objective of this project was to evaluate the value of spinal and SIJ MRI requests in a rheumatology department to try and identify a clinical predictor of MRI inflammation.

Methods
A retrospective review of 107 patients who underwent a spinal and SIJ MRI. An assessment of the clinical indications, MRI findings, and the management impact. Numerous parameters were assessed for each patient, including appointment type (face-to-face vs telephone), referrer grade, AxSpA ASAS criteria, CRP, HLA-B27 status, MRI result and management impact.

Results
41.25% of patients who had ≥2 AxSpA features had inflammation on MRI. However, only 11.54% of patients with ≤1 AxSpA feature had inflammation on MRI. ≥2 AxSpA features was a significant predictor for MRI inflammation, with a p-value of 0.00545 and sensitivity 91.67%. Additionally, just 33% of patients had HLA-B27 status documented, providing scope for improvement when using AxSpA features as a predictor. An active BASDAI score was not found to be a predictor of MRI inflammation. Additionally, there was no statistical difference in the MRI findings following face-to-face or telephone consultations; 35.53% had inflammation on MRI compared to 32.26%, respectively.

Conclusion
≥2 AxSpA features is a statistically significant predictor of active MRI inflammation. This could be used to support a new triage assessment pathway for inflammatory back pain referrals to rheumatology.
Disclosure
L. Barry: None. A. Roberts: None. B. Menon: None. S. Subesinghe: None.