bluuebunny/crossref_metadata_2025_split huggingface dataset:
P081 Is it necessary to test vitamin D prior to zoledronate or denosumab treatment?
Authors: Keasley James , Stevens Chloe , Kumar Aman , Sapkota Hem 
Published: April 2023

Abstract

Background/Aims
Prior to each treatment of zoledronate (ZA) or denosumab, it is routine clinical practice to test for vitamin D. If vitamin D levels are low, patients must be started on replacement therapy prior to treatment. Other studies suggest that osteoporosis patients not taking vitamin D supplementation are likely to have subtherapeutic vitamin D levels. Awaiting vitamin D levels can delay timely treatment and organising these tests is labour intensive. In this service evaluation, we examined whether patients could have been treated empirically with vitamin D without testing.

Methods
We included all 542 patients from the New Cross Hospital osteoporosis treatment clinic lists between November 2021 to June 2022. The only patients excluded were those not taking ZA or denosumab. Data collected included demographics, medication history, and vitamin D levels. Vitamin D levels were measured as follows: &lt;15 nmol/L: severe deficiency, 15-30 nmol/L: deficiency, &gt;30-50 nmol/L: insufficiency, &gt;50-250 nmol/L: adequate, &gt;250 nmol/L: potential toxicity.

Results
484 patients were included of which 88.6% were female. The mean age was 76.8. 90.0% were either on vitamin D and calcium supplementation, or on vitamin D supplementation alone. Of these patients on supplementation, vitamin D levels were adequate in 79.8%, insufficient in 7.8%, deficient in 0.4%, severely deficient in 0.2% and not available for the remaining patients. Of those not on supplementation, vitamin D levels were adequate in 45.9%, insufficient in 16.2%, deficient in 10.8% and severely deficient in 4%, and not available for the remaining patients. None of the patients had toxic levels of vitamin D. On contacting the 3 patients prescribed vitamin D supplementation but with deficient or severely deficient vitamin D levels, 2 were not taking the supplements and 1 was taking alfacalcidol (which is not measured in the standard trust vitamin D test). Therefore, of those patients taking vitamin D supplementation as prescribed, their vitamin D levels were all above 30 nmol/L.

Conclusion
This service evaluation therefore supports an approach of not testing vitamin D levels in patients who are due to receive either ZA or denosumab and are taking vitamin D supplementation. A small number of patients taking vitamin D supplementation still had insufficient levels of vitamin D; therefore, it could be recommended to treat all patients on vitamin D supplementation with a short course of high does vitamin D prior to ZA or denosumab treatment. In addition, any patients not taking vitamin D supplementation could also be treated with a course of high dose vitamin D prior to treatment without testing vitamin D levels. This will ensure safe levels of vitamin D and timely treatment of osteoporosis. This will save time and money and reduce waste.
Disclosure
J. Keasley: None. C. Stevens: None. A. Kumar: None. H. Sapkota: None.
P132 A late and rapid increase in ultrasound joint inflammation occurs when anti-CCP positive at-risk individuals with subclinical synovitis progress to inflammatory arthritis
Authors: Harnden Kate , Di Matteo Andrea , Almeida Diogo Esperança , De Lorenzis Enrico , Duquenne Laurence , Garcia-Montoya Leticia , Nam Jacqueline , Emery Paul , Mankia Kulveer 
Published: April 2023

Abstract

Background/Aims
Anti-CCP positive individuals with musculoskeletal (MSK) symptoms and subclinical synovitis on ultrasound (US) are at high risk of developing inflammatory arthritis (IA). Treatment initiation in these individuals is not accepted practice as they do not have clinical synovitis. We aimed to determine whether imaging characteristics change when individuals with pre-RA progress to IA in order to inform the optimal window of opportunity for therapeutic interventions.

Methods
Anti-CCP+ at-risk individuals with MSK symptoms from the Leeds CCP cohort were selected for having US subclinical synovitis [Grey scale (GS)≥1 and Power Doppler (PD)≥1] prior to IA development and an US scan performed at clinical synovitis onset. The US protocol included the metacarpophalangeal joints (MCPJs), proximal interphalangeal joints (PIPJs), wrists, elbows, knees, second-fifth metatarsophalangeal joints (MTPJs), extensor carpi ulnaris (ECU) and finger flexor tendons (FFTs). US PD and GS synovitis were scored semi-quantitatively (0-3) according to EULAR/OMERACT. At patient level, total GS and PD scores were compared between scans. Change on US in the joints that became clinically swollen was also assessed. Wilcoxon signed-rank tests were conducted for comparisons.

Results
Forty-six CCP2+ at-risk individuals were identified (Table). The median US scan interval was 3.5 months (IQR 1.25-8.75). At patient level the overall burden of PD in the joints increased at IA progression, trending towards significance [3 (IQR 1.25-5) vs 4 (IQR 2-7.25) p = 0.063]. Overall burden of GS did not increase. There was an increase in PD in the MCPJs [0 (IQR 0-2) vs 1.5 (IQR0-3) p = 0.008] and MCP and wrist joints combined [1 (IQR 0.25-3) vs 2 (IQR 1.25-4.75) p = 0.002]. GS at the elbows also significantly increased. At joint level PD [1 (IQR(0-2) vs 2 (IQR 0-3) p = 0.036] increased in joints swollen at progression and GS increased with a trend towards significance. Non-swollen joints did not change.

Conclusion
A marked increase in US joint inflammation is seen when CCP+ at-risk individuals with subclinical synovitis on US progress from pre-RA to clinical arthritis. This is particularly evident in the MCPJs, wrist joints and joints that become clinically swollen. Intervening when at-risk individuals have subclinical synovitis may represent a window of opportunity to prevent the rapid increase in joint inflammation which accompanies the onset of joint swelling.
Disclosure
K. Harnden: None. A. Di Matteo: None. D. Esperança Almeida: None. E. De Lorenzis: None. L. Duquenne: None. L. Garcia-Montoya: None. J. Nam: None. P. Emery: None. K. Mankia: None.
P159 Clinical trajectories and predictors of hand function deterioration in systemic sclerosis
Authors: De Lorenzis Enrico , Kakkar Vishal , Di Donato Stefano , Wilson Michelle , Green Lorraine , Alcacer-Pitarch Begonya , Del Galdo Francesco 
Published: April 2023

Abstract

Background/Aims
Hand impairment is a major driver of disability and reduced quality of life in Systemic Sclerosis (SSc) patients. It is multifactorial and the risk and predictability of functional deterioration are unknown. The aim of this study is to describe hand function changes and predictors of functional deterioration in an observational cohort of SSc patients.

Methods
Consecutive SSc patients were longitudinally evaluated every 6 months for 3 years for SSc-related hand involvement. Patient-reported hand symptoms were captured with Cochin Hand Disability Score (CHFS), Raynaud Condition Score (RCS) and overall pain intensity on a visual analogue scale (VAS pain). Their minimal clinical important difference (MCID) and patient-acceptable symptom state (PASS) were evaluated according to validated thresholds. Clinical association with CHFS change over time and 36-month clinically meaningful worsening (MCID-Wor) were assessed via ANOVA and binomial logistic regression, respectively.

Results
One-hundred-seventy-six SSc patients were enrolled in this analysis, 13.6% of them were male and the mean age was 55.1± 12.3 years, the median disease duration was 5.0 years and 31.8% presented a diffuse cutaneous variant. Overall, CHFS worsened over time (p &lt; 0.001); 34.1% of patients reported a clinically significant worsening by the end of follow-up. Accordingly, the proportion of participants reporting CHFS≥PASS increased from 26.1% at baseline to 34.7% at the last follow-up. MCID-W after 36 months was associated with diffuse cutaneous variant [OR 2.44 (95% CI 1.27-4.76), p = 0.008], baseline active-late capillaroscopy pattern [OR 3.00 (95% CI 1.17-7.70), p = 0.013], VAS pain [OR 1.02 (95% CI 1.01-1.03), p = 0.003], RCS [OR 1.03 (95% CI 1.02-1.04), p &lt; 0.001], forearm-hand-finger skin score [OR 1.12 (95% CI 1.00-1.26), p = 0.044], history of digital ulcers [OR 2.39 (95% CI 1.24-4.61), p = 0.008] or flexor contractures [OR 2.52 (95% CI 1.29-4.92), p = 0.007], as well as baseline CHFS [OR 1.03 (95% CI 1.01-1.05), p = 0.001]. A regression model based on these clinical variables could correctly classify 76.7% of cases.

Conclusion
SSc-related hand disability affects more than one-third of patients and tends to worsen over time in both cutaneous subsets despite the current standard of care. Identifying patients at risk of deteriorating hand function should inform targeted intervention strategies to prevent hand disability in SSc.
Disclosure
E. De Lorenzis: None. V. Kakkar: None. S. Di Donato: None. M. Wilson: None. L. Green: None. B. Alcacer-Pitarch: None. F. Del Galdo: Other; FDG received consultancies and research support from Abbvie, AstraZeneca, Boheringer-Ingelheim, Capella, Chemomab, Ergomed, Janssen, Kymab, Mitsubishi-Tanabe.
P188 Measurement of response to treatment in axial spondyloarthritis using quantitative imaging biomarkers: a prospective observational cohort study
Authors: Jones Alexis , Bray Timothy J P , Sakai Naomi , Bainbridge Alain , Ciurtin Coziana , Hall-Craggs Magaret A 
Published: April 2023

Abstract

Background/Aims
Objective assessments of disease activity and response to treatment in axial spondyloarthritis (axSpA) remain a challenge. Diffusion-weighted magnetic resonance imaging (DW-MRI) and chemical shift-encoded MRI (CSE-MRI) inform on bone marrow oedema and fat content and could provide more accurate assessments of disease activity and therapeutic response. This study aims to determine the responsiveness and validity of quantitative imaging biomarkers (QIBs) obtained from DW-MRI and CSE-MRI using the partially-automated Bone Edema and Adiposity Characterisation with Histograms (BEACH) tool in patients with axial spondyloarthritis undergoing biologic therapy.

Methods
Conventional MRI, DWI and CSI was performed on 30 patients with active axSpA at baseline and after 12 - 16 weeks of biologic treatment. Apparent diffusion coefficient (ADC) and proton density fat fraction (PDFF) measures were analysed using the BEACH tool. Conventional MR images were assessed using established visual scoring methods. QIBs were assessed in terms of change after treatment and correlation with clinical and conventional MRI measures of disease activity.

Results
There were significant reductions for ADC values, while PDFF-scores showed nonsignificant reductions. Responsiveness to therapy was moderate for ADC measures and comparable to established visual scoring methods for bone marrow oedema. ADC and PDFF correlated well with conventional bone marrow oedema and fatty change scores respectively. Inter-observer variability was lower for QIBs compared with conventional visual scores methods.

Conclusion
ADC measures are sensitive to changes in inflammation in axSpA following biologic therapy and show promise as a biomarker of disease activity in axSpA.
Disclosure
A. Jones: None. T.J.P. Bray: None. N. Sakai: None. A. Bainbridge: None. C. Ciurtin: None. M.A. Hall-Craggs: None.
P201 Inactive Takayasu’s arteritis: a case series analysis of presentations to a tertiary vasculitis centre
Authors: Hanlon Samuel , Nouza Jan , Colquhoun Matthew , Satara Japna , Porter Andrew , Maughan Robert , Youngstein Taryn , Mason Justin 
Published: April 2023

Abstract

Background/Aims
At diagnosis, a proportion of Takayasu’s arteritis (TAK) cases present with imaging evidence consistent with TAK without evidence of active arteritis or systemic disease. Inactive TAK is considered the end-point of a triphasic disease process characterised by a “burnt-out” non-inflammatory fibrotic state. Current EULAR/ACR guidelines recommend immunosuppressive treatment and routine imaging for active TAK but data guiding the management of inactive disease are scarce. The purpose of this case series was to examine baseline characteristics of patients presenting with inactive TAK and investigate disease progression.

Methods
We performed a retrospective review of the Imperial College Takayasu Arteritis Cohort. TAK diagnosis was based on imaging evidence in combination with clinical history. Disease was determined inactive by activity scoring indices (ITAS2010 + NIH) together with inflammatory markers. MR Angiogram (28/30 cases) and CT Angiogram (2/30) were utilised as imaging modalities to determine vascular involvement. Disease distribution was characterised using the Numano Classification (Table 1).

Results
19% (30/158) of patients presented with “inactive disease” at diagnosis. Inactive cases had a median age of diagnosis of 37.8 years, compared to 33.8 in patients with active disease. 48% of inactive cases experienced &gt;2 year delay in reaching diagnosis. Inactive cases did not display significantly elevated inflammatory markers (CRP 3.86, ESR 27.0) at baseline visit and demonstrated arterial lesions on angiography consistent with standard TA definitions in terms of anatomical distribution and characteristics. Inactive patients were followed up with interval MR imaging, allowing us to chart natural disease course without treatment. Of 30 total cases, only five patients developed progression of vascular lesions. Three patients displayed marginal imaging progression without active symptoms together with normal inflammatory markers; these patients did not receive immunosuppression and serial interval imaging demonstrated stable disease, suggesting a non-inflammatory aetiology. Two patients developed progression attributed to active disease, necessitating treatment with immunosuppression.

Conclusion
A significant proportion of patients have inactive disease at TAK diagnosis. This presents a challenge to the treating clinician and further uncertainty for patients. This case study provides evidence that cases of burnt-out TAK can be managed safely without immunosuppressive treatment using routine imaging surveillance and serum biomarkers.
Disclosure
S. Hanlon: None. J. Nouza: None. M. Colquhoun: None. J. Satara: None. A. Porter: None. R. Maughan: None. T. Youngstein: None. J. Mason: None.
P202 A study on myocardial dysfunction in Indian patients with Takayasu's arteritis
Authors: Bajaj Rohit , Ghosh Shounak , Tanna Dhaval , Yadavalli Durgarao , Kazi Wasim , Singal Vinay , Gupta Rajiva 
Published: April 2023

Abstract

Background/Aims
Takayasu’s arteritis (TA) is a form of predominantly large vessel vasculitis affecting young individuals. Signs of vascular insufficiency or systemic inflammation may be seen in the vast majority of patients, with cardiac involvement noted in more than one-third of the cases. Previous histopathologic studies from India have revealed the presence of myocarditis in up to 50% of patients. We conducted this study to assess myocardial dysfunction using Speckle Tracking Echocardiography (STE), a novel method to assess global longitudinal systolic strain (GLSS), in TA patients and healthy controls.

Methods
This was a cross-sectional, case-control study. Between August 2018 and May 2021, all consenting adult patients classified as per the ACR 1990 Criteria as Takayasu’s arteritis were included in the study after taking their informed consent. Age and gender-matched healthy controls without known comorbidities like hypertension, diabetes, or coronary artery disease were included for comparison. Demographic, clinical, and laboratory parameters were assessed. All enrolled participants underwent 2D echocardiography with speckle tracking and GLSS evaluation as well as B-mode ultrasonography to measure carotid intimal medial thickness (CIMT) of bilateral carotid arteries, by a single, blinded cardiologist with over 20 years of experience in his field. The study was approved by the Institutional Ethics Committee.

Results
Fifty patients with TA who consented to the study were included, with fifty healthy controls. 66% of the cohort were female. TA patients had significantly lower mean LVEF (56% vs 60%, p &lt; 0.0001), worse mean GLSS (-19.3% vs -20.9%, p = 0.003), more patients with GLSS &gt;-19.7 (48% vs 24%, p = 0.01), and higher mean CIMT values (0.58mm vs 0.44mm, p = 0.001) than the healthy controls. Cases with GLSS less negative than -19.7% (24 out of 50) were significantly older (mean age 42.8 vs 35.4 years, p = 0.049), had more cardiac (62.5% vs 19.2%, p = 0.02) and coronary artery involvement (37.5% vs 7.7%, p = 0.011). Mean CIMT values were significantly more in patients with active disease as per the ITAS 2010 score. GLSS could not differentiate between active and inactive disease, nor did they correlate with raised inflammatory markers. There was no significant correlation between higher CIMT values and worse GLSS.

Conclusion
This is a pilot study comparing TA cases with healthy controls using STE and CIMT values. While mean CIMT values and GLSS were increased in patients with TA, GLSS did not correlate with disease activity status. Older age and a greater proportion of patients with cardiac involvement were the only significant differences noted in patients with worse GLSS. Longitudinal studies based on STE may help us document changes in subclinical myocarditis in TA.
Disclosure
R. Bajaj: None. S. Ghosh: None. D. Tanna: None. D. Yadavalli: None. W. Kazi: None. V. Singal: None. R. Gupta: None.
E004 Inpatient admission pathway for patients with rheumatological disorders
Authors: Hall Andrea , Botros George , Panthakalam Sathianathan 
Published: April 2023

Abstract

Background/Aims
Rheumatology is a complex specialty covering many conditions of varying severity, from muscle pain through inflammatory arthritis such as Rheumatoid arthritis (RA) and connective tissue diseases. Most of the conditions can be managed in an outpatient/day case setting. However, acutely ill patients require safe and prompt inpatient management including specific intravenous infusions. This need to be done urgently and cannot wait to be accommodated through the Infusion unit at our hospital. Historically Medicine Acute Admission Unit has been the route to bring in these patients. However, operational bed pressures faced challenges leading to instances of delayed treatment with complications including fatality. This led to creating a direct inpatient admission pathway to the specialist ward.

Methods
Ward Matron designed the following robust pathway for direct patient admission to our specialist Rheumatology ward, Jevington ward. This was implemented in February 2022 after discussion and agreement with Clinical Lead consultant, pharmacist, clinical site managers and other colleagues.
Rheumatology team and nurses covered the ward during working hours and by the on-call team out of hours. The overall responsibility remained with the rheumatology team. The referrals accepted only after completing appropriate paperwork. Patients carried out Lateral Flow Test (LFT) at home prior to admission. We ensured negative results and followed the Trust COVID 19 screening protocols. Subsequent screenings were done according to the updated guidelines. The planned assessment and treatments were carried out by the ward team complying with BSR/EULAR Guidelines, infusion protocols such as standard and continuous Iloprost Infusion Protocols of the Trust.

Results
We assessed the delay in patient's admission, length of stay, patient outcome and experience after implementing the pathway. The significant change has been in the time to admit; from two weeks in 2018 & 19 to two days this year. This is reflected in the patient feedback. All our acutely ill patients were assessed, treated and discharged promptly on this specialist ward.

Conclusion
This pathway allowed safe and prompt treatment, prognosis and excellent experience for acutely ill patients with rheumatological disorders. This additionally enabled reduced length of stay supporting financial sustainability of the Trust.
Disclosure
S. Panthakalam: None.
E005 An audit of demographics, symptoms & investigations: Part of the survey of GCA in the SEHSCT during the COVID-19 pandemic
Authors: Tan Han Jun , Brennan David , Masih Claire , Joyce Amy , French Blathnaid 
Published: April 2023

Abstract

Background/Aims
Giant cell arteritis (GCA) is the most common vasculitis in adults aged over 50 years old with the highest incidence among persons aged 70-79. It is more commonly seen in female patients. Most cases have been reported in whites of Northern European descent. A broad range of symptoms can be reported including headache, jaw or tongue claudication, visual disturbances, PMR and other systemic features including weight loss, fever and sweats. In recent years new evidence has emerged regarding the investigation and treatment of GCA. This audit is to review the demographics, symptoms and investigations of patients who presented to the Rheumatology Department in SEHSCT with features concerning for possible GCA.

Methods
Retrospective collection of data from January 2020 to July 2021 using the regional Electronic Care Record NI with reference to presentations, investigation results, clinic records and follow-up letters.

Results
70 patients were included (24 males and 46 females). Mean age was 72 years old. Table 1 shows the percentages of clinical symptoms reported. All patients investigated had an ESR (mean 57.8) and CRP (mean 54.1) checked. 43 patients had ANCA checked with 3 positive results. 40 patients underwent CT brain with 2 abnormalities reported unrelated to GCA. TA ultrasound was performed on one occasion with a positive result demonstrating “halo” sign recorded. 6 patients underwent CTPET with 3 diagnoses of LVV and 1 of PMR. 70 TAB performed with 12 positive results and 4 ‘suggestive’ of GCA.

Conclusion
Our cohort of patients demonstrated demographics similar to the current global geographic trends in GCA. There are a broad range of clinical symptoms that can present in GCA, none of which are entirely specific or pathognomonic. Clinical diagnosis is based on clinical symptoms, signs and laboratory tests, each of which are imperfect markers for GCA. Our audit demonstrated that the use of additional confirmatory diagnostic tests including temporal artery ultrasound and CTPET was being under-utilized in the SEHSCT. Use of these tests may improve the diagnostic yield in this challenging condition. As a result of this audit, a quality improvement project to provide a rapid access GCA pathway is being designed.
Disclosure
H. Tan: None. D. Brennan: None. C. Masih: None. A. Joyce: None. B. French: None.