bluuebunny/crossref_metadata_2025_split huggingface dataset:
E058 The effects of a pain management programme for patients with an inflammatory arthritis
Authors: Corcoran Kelley , Hung Isabelle , Stovell Rachel , Manson Jessica , Moore Samantha , Soni Anushka , Williams Amanda 
Published: April 2023

Abstract

Background/Aims
This study examines the benefits of Pain Management Programmes (PMPs) for patients with inflammatory arthritis who still report pain and fatigue despite optimal medical management. PMPs are widely recommended (e.g. NICE 2021) for people living with persistent pain, using cognitive behavioural therapy and acceptance and commitment therapy. Programmes aim to enable participants to develop self-management ways of living with their pain, so that pain interferes less in their lives and people feel more confident, and positive about the future. We developed a PMP for patients with an inflammatory rheumatological condition with the additional aim of helping participants to identify when they could self-manage their pain and when they needed healthcare to treat their condition and manage acute pain crises.

Methods
Patients were offered the programme in an information session, followed by assessment with a psychologist and physiotherapist where treatments options were discussed, among them the PMP. Selection criteria were: any type of inflammatory rheumatological condition and persistent pain diagnosed at least 18 months earlier and relatively stable in terms of current treatment; over the age of 18; and able to speak English. The programme ran for eight weekly, 5-hour sessions, with reviews at one and 9 months afterwards. Groups of between 3-11 patients were run in person by a multidisciplinary team of specialists from both outpatient pain management and rheumatology services. Between April 2016 and September 2020, 45 patients (8 men, 37 women) attended 6 programmes and 33 completed outcome measures on pain, disability and distress on the first and last day and at reviews.

Results
Post-treatment results showed significant improvement in confidence in managing pain, less interference of pain with everyday life, less fear, greater acceptance and a more positive outlook. Mood, pain intensity and relief from the pain did not change. Improvements gained post-treatment were sustained at one month and nine-months. The effect size of the improvements was medium or large.

Conclusion
This study shows that attending a PMP can improve quality of life for people with inflammatory arthritis even without reducing pain intensity. Across the programme, patients grew in confidence to engage in life alongside their pain; with significant changes sustained at nine months. However, follow-up outcomes were not returned by two thirds of those who completed the programme, in part due to the pandemic, making it hard to generalise to the wider population of patients.
Disclosure
K. Corcoran: None. I. Hung: None. R. Stovell: None. J. Manson: None. S. Moore: None. A. Soni: None. A. Williams: None.
E062 Calcium pyrophosphate dihydrate crystal in operated rheumatoid arthritis of the knee
Authors: Nishikawa Masataka 
Published: April 2023

Abstract

Background/Aims
Calcium pyrophosphate dihydrate (CPPD) crystals are also one of the common types of crystals causing crystal-induced inflammatory arthritis. Several studies have elucidated important aspects of the molecular and cellular mechanisms of CPPD crystal formation. CPPD crystal deposition disease is a common arthritic disorder in mainly elderly patients. CPPD crystals are found in multiple joints (e.g. knee, wrist joints) in association with severe cartilage degeneration in osteoarthritis. However, there are few reports concerning about CPPD crystals in patients with rheumatoid arthritis (RA). In this study, I investigated the relationship between CPPD crystal and operated RA of the knee.

Methods
Seventy-seven total knee arthroplasties were performed for RA knees from January 2016 to September 2021. I defined the lower extremity alignment (LEA) base on the femorotibial angle (FTA) as valgus (FTA&lt;170°), neutral (170°≤FTA&lt;180°), and varus (FTA≥180°). I also defined the osteophyte formation degree (OFD) in the knee (grade 0-3). At the operation, joint fluids were collected from 70 knees (average age 71.6; male 8; female 72 body mass index (BMI) 24.4kg/m2,; C-reactive protein (CRP) 1.20mg/dL; erythrocyte sedimentation rate (ESR) 49.5mm/h; matrix metalloprotease (MMP)-3 289.5ng/dL; OFD (0/1/2/3) 0/38/25/7; FTA 177.9°; LEA: varus 35; neutral 22; valgus 13). We evaluated the relationship between CPPD crystals and age, gender, FTA, BMI, CRP, ESR, MMP-3, OFD and LEA. When I analyzed the risk factors using the logistic regression method, LEA were defined as valgus (FTA&lt;175°) and varus (FTA≥176°).

Results
CPPD crystals were detected from 19 RA knees (27.1%). There were no significant differences between CPPD(+) and (-) groups about age, gender, FTA, BMI, CRP, ESR and MMP-3. The more severe osteophyte formation showed higher CPPD(+) rate tendency; however, there was no significance. CPPD(+) rates were 34.2% in varus knees, 23.1% in valgus knees and 18.2% in neutral knees, respectively. We reported that age, valgus knee, severe osteophyte and low BMI were the risk factors of CPPD(+) in operated osteoarthritis (OA) knees, previously. In this study, there was no difference between CPPD(+) and (-) groups about these factors. Especially, CPPD(+) rate in RA valgus knees was one third of that of OA valgus knees.

Conclusion
It may be suggested that CPPD production mechanism in RA knees is different from that in OA knees.
Disclosure
M. Nishikawa: None.
E070 How well is the mental health of rheumatoid arthritis patients assessed in the routine rheumatology clinic?
Authors: Cooney Hannah , Ellis Jessica , Mulhearn Ben , Allard Andrew 
Published: April 2023

Abstract

Background/Aims
All patients with rheumatoid arthritis (RA) should have an annual review appointment (NG100). This should involve monitoring for the development of co-morbidities including depression and offer psychological interventions where appropriate. The current literature suggests that the prevalence of depression in RA patients is as high as 38.8% and is associated with poorer disease outcomes. We undertook a retrospective record review of our RA cohort to assess adherence to the NICE RA guidance, including mental health monitoring specifically.

Methods
340 patients were selected using convenience sampling from the total population of 3400. The letters 12 months prior to an identified appointment in January 2019 were reviewed looking at: age, gender, DAS28 score, other long-term conditions, whether mental health was discussed that year, and who initiated the conversation. Data was collected, reviewed, and analysed by HC, JE and AA.

Results
The mean age was 65.9 (SD = 12.3), the female to male ratio was 2.3:1 (70% female), the median DAS28 score was 2.94 (IQR=2.01), and the median VAS score was 40.0 (IQR=63.5). 73.2% (n = 249/340) had at least one other documented co-morbidity, 12.1% (n = 41/340) had a documented chronic pain syndrome, 3.5% (n = 12/340) had a documented mental health diagnosis. 7.9% (n = 27/340) of patients discussed mental health at their appointment; this increased to 58.3% (n = 7/12) of the patients with a known mental health diagnosis. Mental health discussions were initiated by the clinician 18.5% (n = 5/27) of the time, and by the patient 81.5% (n = 22/27) of the time. Of the 5 patients who were asked directly about their mental health: 100% (n = 5/5) were female, the mean age was 63.8, the median DAS28 and VAS scores were lower than the overall cohort at 2.56 (IQR=0.93) and 28.5 (IQR=15.3) respectively. Of the 22 patients who initiated a discussion about their mental health: 72.7% (n = 16/22) were female, the mean age was 62.3, the median DAS28 and VAS scores were higher than the overall cohort at 3.55 (IQR=2.45) and 60.0 (IQR=51.3) respectively. Of the 27 patients who had a mental health discussion: 76.0% (n = 19/27) had another documented co-morbidity, 22.2% (n = 6/27) had a documented chronic pain syndrome, and 25.9% (n = 7/27) had a mental health diagnosis.

Conclusion
Mental health problems may be under-recognised amongst our patients; this may reflect lack of documentation or limited routine screening. The majority of conversations about mental health appear to be initiated by patients. Patients with lower disease activity appear to be more likely to have mental health discussions. The study is limited by small numbers, and further research in this area would be beneficial.
Disclosure
H. Cooney: None. J. Ellis: None. B. Mulhearn: None. A. Allard: None.
E072 Real-world single-centre experience of JAK inhibitor use in RA
Authors: Anjum Aqeel Maqsood , Ghanem Khaled , Smale Shaun , Srinivasan Usha , Duffill Suzanne , Jenkins Charlotte 
Published: April 2023

Abstract

Background/Aims
The use of Janus Kinase Inhibitors (JAKi) has been gradually increasing overtime in the management of rheumatoid arthritis (RA) and other inflammatory arthritis and these appeal to patients. being oral agents. Nevertheless, rheumatologists have become cautious about their use since recent trials have shown safety concerns about VTEs, MACE and malignancies.

Methods
We decided to study use of JAKi at our centre in Princess of Wales Hospital Bridgend. The aim was to assess whether appropriate patients were selected (considering cautions about MACE, VTEs and malignancies). We also wanted to see whether all patients had required pre-treatment safety testing and post-treatment monitoring performed.

Results
These were 70 patients; 59 were females and 11 were males. All of them were diagnosed as RA. Average age was 61.1 years (20—85), average duration of disease 129.9 months (16—340) and average duration of treatment was 58.1 weeks. The most common JAKi being used was baricitinib (84%) followed by tofacitinib (12%) and upadacitinib (4%). 50% patient were on concomitant csDMARDs among whom two-thirds were on methotrexate. Looking at previous biologic use, 9 patients were biologic naïve, 22 had one biologic, 15 had two biologics used in the past. All patients were appropriately selected (severe RA and no significant risk factors for MACE, VTEs and malignancies). All patients had pre-treatment Hepatitis B, Hepatitis C, latent TB, FBC and LFTs checked. All patients had FBC and LFTs monitored post treatment. No patient developed VTE, MACE or cancer on treatment. 84.2% patients had lipids tested before starting JAKi. 22.8% patients had abnormal lipids before Rx initiation and 62.5% of these were on lipid lowering Rx. All patients had lipids tested post treatment, but the timing was quite variable and only 62.5% of patients had lipids tested on the recommended time. There were 2 deaths recorded in this cohort. One of those was an 80-year-old RA patient on baricitinib 2 mg OD, who died due to chest infection on the background of ILD. He was not on steroids or csDMARDs. The second patient was 63 years' old (on baricitinib 4mg OD), and died due to respiratory sepsis, and was also on azathioprine. She had RA with advanced ILD. The reasons for discontinuing JAKi were inefficacy (46%), side effects (39%) and both inefficacy and side effects (15%). 41.4 % of patient experienced side effects due to JAKi. These included infection 28%, deranged lipids 17%, cytopenia 14%, deranged LFTs 14%, GI side effects 10%, skin rash 7% and varicella zoster 3%.

Conclusion
There has been steady increase in the use of tsDMARDs for RA and other rheumatic conditions. Due to short half-life, these drugs became a popular choice during COVID-19 pandemic but on the other hand safety monitoring became extremely challenging during this time.
Disclosure
A. Anjum: None. K. Ghanem: None. S. Smale: None. U. Srinivasan: None. S. Duffill: None. C. Jenkins: None.
E078 Inflammation modifies the effect of rheumatoid arthritis in overall mortality among females
Authors: Banerjee Sri 
Published: April 2023

Abstract

Background/Aims
Rheumatoid arthritis (RA) is a common autoimmune condition which is difficult to control. This condition causes three times as likely of death than the general population. However, the precise levels of inflammatory biomarkers is unknown. In this study, we tried to understand the relationship rheumatoid arthritis and overall mortality and C-reactive protein modifies this effect on females.

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. C-reactive protein was determined by latex nephelometry. Prospective analysis was performed using complex samples Cox regression with adjustment for known confounders to determine the relationship of RA and mortality, as experienced by the inflammatory biomarker of C-reactive protein.

Results
Prevalence of RA in this population was 1.2% among males and 3.8% among females. The mean follow-up was 10.1 years. For all-cause mortality, the overall unadjusted hazard ratio (HR) of RA to no RA was 2.98 (95% confidence interval [CI], 2.11-4.22, p &lt; 0.001). Adjusted HR was elevated, 2.62 (CI 0.62-11.11, p &gt; 0.05), among patients with elevated C-reactive protein with RA but closer to 1.0 (1.28 CI 0.94-1.74, p &gt; 0.05) among patients without elevated C-reactive Protein, after controlling for medical and demographic risk factors. Similar patterns did not apply for males.

Conclusion
There was a clear connection between RA and increased mortality. Additionally, among females the connection of inflammatory biomarkers is more pronounced while this not affected in females. Inflammatory biomarkers such as C-reactive protein must be closely monitored.
Disclosure
S. Banerjee: None.
E082 A review of the development of gangrene in patients with systemic lupus erythematosus: a 44-year follow-up study
Authors: Rua Joana , Isenberg David 
Published: April 2023

Abstract

Background/Aims
Gangrene is a well-recognised complication of diabetes, peripheral arterial disease, frostbite and meningococcal disease amongst other conditions but is rare in patients with systemic lupus erythematosus [SLE]. Most reports describe individual patients and the prevalence in cohorts is very scarce. In 2008, our group reported five patients who had developed digital gangrene and two patients with “near gangrene”. We reviewed all the SLE patients seen in our lupus clinic between January 1978 and June 2022.The main goal was to address the prevalence and identify the possible trigger factors, aiming to find common clinical and serological features. We have also reviewed the acute and long-term management of gangrene in these patients as well as their long-term outcome.

Methods
We reviewed 820 patients with SLE attending the SLE Clinic in our UK tertiary referral center, followed up over 44 years, assessing demographics, clinical and serological features, treatment in the acute phase, outcome and long-term management.

Results
Eight out of 820 patients (0.97%) have developed gangrene. The age of onset of disease ranged from 12 to 26 years (mean 17.5 years, SD 4.609). The first episode of gangrene ranged from between presentation to 27 years after SLE onset, with a mean duration of SLE at the onset of the gangrene of 15.5 years (SD 11.711). All had active SLE at the time of critical peripheral ischaemia and anti-phospholipid (PL) antibodies were present in five out of the eight reported patients. The acute treatment was intravenous (IV) iloprost infusions with antiphospholipid-positive patients being anti-coagulated, most staying on long term anticoagulation therapy. The possible identified triggers (such as infection and cancer) were treated accordingly. Two patients did not respond to the initial treatment and needed further immunosuppression. All of these patients suffered digit loss.

Conclusion
Gangrene is a rare complication of SLE in patients with active disease but potentially able to cause severe damage. Anti-phospholipid antibodies are overrepresented in these patients but infection and cancer are other possible contributors. Anticoagulation therapy, steroids and iloprost are the first line therapy but in non-responders further immunosuppression may be needed to stop the evolution of gangrene.
Disclosure
J. Rua: None. D. Isenberg: Honoraria; Servier, Anges, Astrazeneca, UCB, Eli Lilly.
Magnetic resonance imaging characteristics in patients with psoriatic arthritis and axial manifestations from the MAXIMISE cohort
Authors: Baraliakos Xenofon , Pournara Effie , Coates Laura C , Navarro-Compán Victoria , Blanco Ricardo , O’Brien Eamonn , Schulz Barbara , Landewe Robert 
Published: April 2023

Abstract

Objective
The current analysis of the MAXIMISE trial was conducted to investigate the presence of post-inflammatory and degenerative spinal changes and inflammatory changes in spinal processes identified in baseline MRIs and their potential for predicting differential treatment effects in a cohort of PsA patients with axial manifestations.

Methods
Baseline spinal MRIs from the MAXIMISE trial were re-read to identify additional inflammatory (spinal process), post-inflammatory, and degenerative changes, and investigate the differential treatment effect of these imaging features using logistic regression modelling.

Results
In addition to bone marrow oedema assessed at primary analysis, spinal process inflammation and post-inflammatory changes evaluated by FAt Spondyloarthritis Spine Score were documented in 11.1% and 20.2% patients, respectively. At least one type of degenerative change was noted in 64% patients, with Pfirrmann grade ≥3 (51.1%) being the most common. Combining primary and re-read MRI findings, 67.1% of patients presented with inflammatory or post-inflammatory changes while 21.2% had degenerative changes alone. Although not statistically significant, post-inflammatory changes were associated with a trend for better efficacy outcomes in terms of ASAS20, ASAS40 and BASDAI50 responses; a trend for worse outcomes was observed in the presence of degenerative changes.

Conclusion
The current analysis revealed the occurrence of additional inflammatory and post-inflammatory changes suggestive of axial PsA (axPsA) and a trend for better clinical outcomes for patients treated with secukinumab. These results elucidate the imaging characteristics and improve our current understanding of axPsA thereby supporting the interpretation of future trials.

Trial registration
ClinicalTrials.gov, NCT02721966.
PATIENT DOSIMETRY SURVEY OF PEDIATRIC DIAGNOSTIC AND THERAPEUTIC CARDIAC CATHETERISATION IN JAPAN
Authors: Ishibashi Toru , Takei Yasutaka , Kato Mamoru , Yamashita Yukari , Tsukamoto Atsuko , Matsumoto Kazuma , Sakamoto Hajime , Masuda Takanori , Miyazaki Osamu 
Published: April 2023

Abstract
To propose reference values for air-kerma at the reference point (Ka,r), air-kerma area product (PKA), fluoroscopy time (FT) and number of cine images (CI) for four age groups in Japan, a nationwide questionnaire was posted to 132 pediatric catheterisation of certified facility in Japan, using the conventional post system, to which 43 facilities responded. For diagnostic cardiac angiography, reference values were as follows: Ka,r: 86, 102, 165 and 264 mGy; PKA: 9.3, 9.5, 16 and 34 Gy.cm2; FT: 33, 29, 26 and 30 min and CI: 1904, 1966, 2405 and 1871 images. For therapeutic cardiac angiography, reference values were as follows: Ka,r: 107, 163, 103 and 202 mGy; PKA: 7.5, 18, 7 and 24 Gy.cm2; FT: 56, 52, 42 and 30 min and CI: 3886, 3232, 2212 and 4316 images for less than 1, 1–5, 6–10 and 11–15 y, respectively. To optimal patient exposure from diagnostic and therapeutic cardiac catheterisation, it is therefore necessary to establish reference values for pediatric cardiac catheterisation examinations for four age groups.
Monoclonal antibody: future of malaria control and prevention
Authors: Nema Shrikant , Nitika Nitika 
Published: April 2023

ABSTRACT
Monoclonal antibodies (mAbs) are extremely specialized proteins that are cloned from B cells and bind to pathogen epitopes. There are currently no known prophylactic immune-based strategies or efficient, widespread treatments to stop the spread of malaria. In order to lower the prevalence of malaria and its associated mortality, we need mAbs that are capable of offering immediate passive protection against the disease. mAbs have become more crucial in the treatment or prevention of several other infectious diseases. Recently, mAb development for malaria prevention and control has greatly evolved and widespread use in public health settings is now a possibility.
Nurse Educators’ Perceptions of Teaching Patient-Centered LGBTQ+ Gender-Affirming Care to Undergraduate Students
Authors: Webb Cibele C. , Zablocki Grace M. 
Published: April 2023

Abstract
Nurse educators are uniquely positioned to equip students with the knowledge, skills, and attitudes to provide LGBTQ+ persons with culturally congruent inclusive care. Using Quality and Safety Education for Nurses’ patient-centered care competency as a framework, this study used a qualitative exploratory-descriptive design to investigate nine undergraduate nurse educators’ perceptions of teaching LGBTQ+ gender-affirming care. Three themes emerged from the interviews denoting challenges: importance of patient-centered care, limited knowledge, and barriers to curricular integration. Incorporating LGBTQ+ topics across the undergraduate nursing curriculum is necessary to support the delivery of person-centered care.