bluuebunny/crossref_metadata_2025_split huggingface dataset:
P251 A rare case of cauda equina syndrome complicating axial spondyloarthropathy
Authors: Byravan Swetha , Javaid Farhan , Neame Rebecca 
Published: April 2022

Abstract

Background/Aims
Cauda equina syndrome is a rare but disabling neurological complication of axial spondyloarthropathy (axSpA) that occurs many years after disease onset, and often in the absence of inflammatory symptoms. Its insidious onset in long-standing axSpA means that this is a condition that can easily be missed, and this case report describes such an instance.

Methods: Case report
An 82-year-old man diagnosed with HLA-B27 positive axSpA in 1972 developed symptoms of lumbar pain and thigh pain in 2012. He had nerve conduction studies which demonstrated an axonal sensory and motor peripheral neuropathy thought to be multifactorial in cause. He was unable to have a spinal MRI scan due to back pain. Over the years he had ongoing lumbar and sacral pain with increased lower limb weakness, and he became wheelchair bound. In 2014 he started adalimumab, then switched to golimumab. He felt some improvement in pain but never mobility. Over the next few years, he started to experience gastro-urological symptoms including diarrhoea, tenesmus, incontinence, and urinary retention. In March 2021 he presented to hospital with shortness of breath. He was found to have a pleural effusion and enlarged mediastinal lymph nodes consistent with lymphoma and/or lung malignancy. It was also noted that a spinal MRI scan had been requested a few months ago by his GP for ongoing sciatic pain, constipation, and tenesmus. This scan had showed an ankylosed spine, but also abnormal tissue occupying the thecal sac between S1 and S2 and the presence of arachnoiditis. It then came to light that the patient had also undergone a spinal MRI scan in 2014 after being admitted due to a fall. This scan had shown chronic distal cauda equina distortion and even then, had presence of an enlarged thecal sac at S1/2 and chronic arachnoiditis. These results had been overlooked.

Results
Cauda equina syndrome complicating long-standing axSpA was first reported in 1961. The pathophysiology in axSpA is not well understood but seems to occur in longstanding disease suggesting chronic progressive dural stiffening causes a damaging rise in CSF pressure that is transmitted to the sacral nerve roots. It is not considered to be due to active inflammation, and anti-TNF treatment can be non-beneficial. MRI imaging may show nerve clumping and distortion of the thecal sac. Management for this condition is not well established and surgical intervention may not be successful. The resulting neurological deficit can be severe and irreversible and high index of suspicion is needed to investigate and diagnose it.

Conclusion
Neurological symptoms should not be overlooked by the rheumatology team or attributed to a joint issue. Safety netting should be in place for following up the results of imaging investigations.

Disclosure
S. Byravan: None. F. Javaid: None. R. Neame: None.
P252 Physiotherapy services in axial spondyloarthritis in the North West of England. An ASSIGNw benchmarking survey
Authors: Gregory William J , Brazendale Jane , Greenall Carol , McCall Gary 
Published: April 2022

Abstract

Background/Aims
The physiotherapist's role in the assessment and management of axial spondyloarthritis (axSpA) is evolving. The axSpA Specialist Interest Group North-West (ASSIGNw) surveyed practices of its members in 2016. This abstract reports on a 5-year follow-up survey, exploring how our North-West physiotherapy axSpA services are running following the impact of the COVID-19 pandemic. The aim is to benchmark practice of physiotherapists working with axSpA, identifying discrepancies between services and recommending ways forward.

Methods
In June 2021, members of ASSIGNw identified areas of practice to benchmark; questions were formulated to elucidate these, creating a SmartSurveyTM sent to ASSIGNw members August-September 2021.

Results
Sixteen Trusts replied, two more than the 2016 survey. Ratios of physiotherapy:medical staffing range from 1:1 to 1:8. All centres intended to offer virtual appointments as a long-term option. The majority of centres (60%) offered yearly follow up; 40% offered 6-monthly follow up. The median appointment duration had reduced from 45 minutes in 2016 to 30 minutes in 2021. The number of centres offering 60 minute slots reduced from 36% in 2016 to 20% in 2021. The vast majority of consults were undertaken independently by the physiotherapist (86%), a small number offering combined appointments with medical colleagues (7.1%). Half of centres surveyed had no access to onsite hydrotherapy, most of these actively signpost to local pools for self-led water-based exercise (62.5%). A dedicated flare/emergency access service was not offered by 60% of centres. Most centres undertake patient education on a one-to-one basis (94%); formal axSpA education programmes are only offered in one centre surveyed.

Conclusion
This survey, as in 2016, has highlighted a large inter-trust variation in physiotherapy:medic staffing ratio. A broad collection of outcome measures was collected and there is an unchanged general consensus that the BASMI and BASDAI are essential. The average and maximum appointment durations have both reduced. Urgent/flare and hydrotherapy access remains limited. Formal patient education is yet to be adopted, one-to-one education remains the prevalent model. Further work on standardising axSpA physiotherapy-led services is warranted. As we drive forwards best-care, the enhanced use of the full rheumatology multi-disciplinary team and standardisation of staffing levels is recommended.

Disclosure
W.J. Gregory: Honoraria; WG has received honoraria from Abbvie, Novartis, Pfizer and UCB. J. Brazendale: None. C. Greenall: None. G. McCall: None.
P283 Hydrotherapy and aquatic therapy provision in a post-COVID NHS
Authors: Hamilton Jill , Jeffries Claire , Whalley Simon , Webb Dale 
Published: April 2022

Abstract

Background/Aims
Hydrotherapy remains an important part of treatment for a range of rheumatological, musculoskeletal and other conditions. As there is little robust clinical evidence, hydrotherapy is scarcely included in national guidelines, with the exception of the National Institute for Health and Care Excellence (NICE) Guidance for Spondyloarthritis which recommends hydrotherapy as an adjunct therapy. In recent years, hydrotherapy services have often been targeted in cost-saving exercises by commissioners and providers. There was a concern that this would be further exacerbated by the pandemic with pools closing to become storage space and remaining closed beyond this.

Methods
Via the All Party Parliamentary Group (APPG) for axial spondyloarthritis (axial SpA), we submitted a Freedom of Information Request (FOI) to establish the status of hydrotherapy pools pre- and post-pandemic. The FOI was sent to all NHS trusts in England asking them about the status of their pool before and after COVID, future plans and reasons for any delay in re-opening.

Results
90 trusts (69%) responded. 72% of those had an onsite hydrotherapy pool prior to the pandemic, 90% of which were open. 27% of pools had already re-opened and there were plans to re-open 49%. 2% were due to remain permanently shut with 21% unsure of the future of their pool. The most common reasons for delays in pools re-opening were linked to infection prevention control restrictions, including changing area capacity (23%), social distancing and ventilation (38%). The most common reasons for the uncertainty of when they would re-open were changing area capacity (46%), staff to clean (23%), access to pool i.e., still being used for other purposes (30%), social distancing and ventilation (23%). Of those pools that were already open or due to re-open, 93% had a reduced capacity with an average capacity of 37%. This was largely due to changing area capacity (54%), staff to clean (44%), access to the pool (28%), social distancing and ventilation (55%). Of the pools that were open prior to the pandemic, the condition areas which used them included MSK (92%), neurology (74%), physical disability (77%) and children (77%). 8% of users had axial SpA.

Conclusion
There is a very real threat to NHS hydrotherapy facilities in England. A lack of robust clinical evidence often leaves therapists and patients in limbo, with anecdotal testimony as to the benefits often not being enough to convince of its value. A co-ordinated cross-condition alliance is needed to ensure: clear local pathways are established into hydrotherapy; pools are considered in new build and refurbishments; robust clinical evidence is produced; hydrotherapy is included in national guidelines; tools are available at local level to audit and promote hydrotherapy; local services can become self-funding via community and patient groups.

Disclosure
J. Hamilton: None. C. Jeffries: None. S. Whalley: None. D. Webb: None.
P291 Long-term use of glucocorticoids for polymyalgia rheumatica: follow-up of the PMR cohort study
Authors: Muller Sara , Hider Samantha L , Sokhal Balamrit Singh , Lawton Sarah A , Helliwell Toby , Mallen Christian D 
Published: April 2022

Abstract

Background/Aims
Polymyalgia rheumatica (PMR) is a common inflammatory rheumatological condition in older adults, characterised by pain and stiffness in the shoulder and hip girdles. The mainstay of treatment is oral glucocorticoids (GCs). Classically, treatment is tapered to a stop over two years, but there is growing evidence this does not happen in practice. International guidelines recommend early referral to specialist services for patients at risk of prolonged treatment. However, they do not specify who these patients are. This study considers the factors at, and shortly after, diagnosis that might be associated with prolonged glucocorticoid treatment, and therefore who may benefit from early specialist review.

Methods
652 people with incident PMR were recruited from English general practice between 2012 and 2014. They completed up to seven questionnaires over two years and a further long-term follow-up questionnaire (LTFUQ) 4.5-6.5 years after diagnosis. The first seven questionnaires have previously been used to allocate people to pain-stiffness trajectory classes. In the LTFUQ, participants reported current symptoms and other general health and lifestyle characteristics, as well as whether they were still taking GCs and whether they self-managed their GC use. Characteristics of those having successfully stopped GCs were compared to those still taking them.

Results
A median 5.16 years after diagnosis, 179 people responded to the LTFUQ. Of these, 67 (40.1%) were still on GCs with a mean daily dose of 5mg (1.5, 9). Those still taking GCs were more likely to be older (72.5 vs 70.2 years, p = 0.035), to live alone (31.8% v 15.0%, p = 0.01), and to report having self-managed their GCs (39.1% versus 11.0%, p &lt; 0.0001). They were also more likely to have reported sustained pain-stiffness symptoms in the first two years, as defined by their trajectory class in earlier work (trajectory class [n{%} still treated]; partial recovery, sustained moderate symptoms [23 {34.3%}]; recovery before worsening [17 {25.4%}]; rapid and sustained recovery [15 {22.4%}]; Slow and continuous recovery [11 {16.34%}]).

Conclusion
PMR is not always the typically-described, time-limited condition. There are few patient characteristics that are associated with prolonged treatment early in the disease course, but those who are older and have sustained or recurrent pain and stiffness over two years appear to be at greater risk of remaining on GCs. Whilst accurate prediction of long-term treatment need is not possible from our data, people with sustained symptoms may benefit from specialist review to ensure diagnostic accuracy and consider need for additional therapies to reduce their GC burden.

Disclosure
S. Muller: None. S.L. Hider: None. B. Singh Sokhal: None. S.A. Lawton: None. T. Helliwell: None. C.D. Mallen: None.
P292 Follow up of giant cell arteritis patients with ultrasound: can cranial giant cell arteritis phenotype evolve towards large vessel vasculitis?
Authors: Ciechomska Anna , Melville Andrew R 
Published: April 2022

Abstract

Background/Aims
Ultrasound (US) is well-established in diagnosis of giant cell arteritis (GCA) but its value in follow-up is not yet adequately defined. The large vessel vasculitis (LVV) phenotype of GCA has less favourable outcomes and more often requires steroid-sparing treatment compared to the cranial phenotype. Evolution towards LVV might account for first-line treatment failure and impact on further therapeutic decisions. Here we review follow-up data from the NHS Lanarkshire GCA service and describe several relevant cases.

Methods
We performed a retrospective review of routine clinical and ad hoc US data from the NHS Lanarkshire GCA service between November 2018 and October 2021. Patients with cranial GCA at baseline and no involvement of large vessels were identified; demographic and clinical data of those who later developed US signs of LVV were reviewed. US positivity was defined by temporal artery intima media thickness (IMT) ≥0.5mm or LV IMT &gt;1.0mm.

Results
53 patients were diagnosed with GCA during the study period. At initial visit, 35 had cranial GCA on US, 12 had LVV, 6 were US negative. Five patients with cranial GCA developed US signs of LVV during follow-up. One of these was in remission clinically and had borderline IMT of 1.0mm. The other four had clinical relapse with mean LV IMT of 1.8mm (range 1.6-2.2); relapses occurred at mean 40 weeks (range 29-53), on prednisolone doses 0-15mg; all were subsequently commenced on steroid-sparing treatment (Table).

Conclusion
Cranial and LVV phenotypes of GCA may represent different stages of disease. US can be used to confirm evolution to LVV; identification of LVV US signs may explain clinical relapse and support the introduction of steroid sparing treatment.

Disclosure
A. Ciechomska: Other; Speaker, travel and registration fee sponsorship from Novartis, Abbvie, Chugai Pharma, Colgene, Roche and Lilly. A.R. Melville: Other; Dr Melville is a Medical Research Council (MRC) and GlaxoSmithKline (GSK) Experimental Medicine Initiative to Explore New Therapies clinical training fellow.
P294 Improved relapse-free survival with the Norwich prednisolone regimen for giant cell arteritis
Authors: Ducker Georgina , Mills Karen , Yong Cee , Jones Colin , Mukhtyar Chetan 
Published: April 2022

Abstract

Background/Aims
Glucocorticoid therapy is the mainstay treatment for giant cell arteritis (GCA). There is no consensus on the dose of prednisolone to be used. Prednisolone regimens used in clinical trials have reported relapse rates of 66-92%. The long-term follow-up of tocilizumab and prednisolone for one year showed a relapse rate of 74% at two years. The Norwich Regimen is a bespoke prednisolone plan with an initial dose of 1mg/kg of lean body mass. It delivers 164.64 mg/kg of lean body mass in a logarithmic taper over 100 weeks. It was devised to reduce the risk of relapse and allow patients to be in control of their prednisolone reduction.

Methods
All patients were diagnosed by biopsy, ultrasonography or PET scan and provided with a printed prednisolone plan at diagnosis. All individuals were assessed at approximately 3-6 monthly intervals in addition to suspected relapse, toxicity or other need for course correction. Relapses were confirmed objectively using a modification of the Kerr criteria. Relapse free survival was recorded at 100 weeks. Patients were given an open invite to contact us in the event of a suspected relapse after coming off prednisolone. A notes review was done to record events at 150 weeks.

Results
150 consecutive people with objectively diagnosed GCA (mean age 74) since 10/01/2012 have completed 150 weeks since starting prednisolone. Drug-free, relapse-free survival at 100 weeks was met by 133/150 (89%). Seven individuals died and 20 relapsed. A further five died and 15 relapsed by week 150; 103/150 (69%) survivors were in prednisolone-free remission. Of the 12 deaths, six died of cancer, one subdural haemorrhage, one ischaemic bowel, one septicaemia, and one general decline (aged 93). The cause of death was not available for two individuals who died in the community. The median time to relapse for the 35 individuals was 80 weeks (IQR 64,109).

Conclusion
We report the first results of a bespoke prednisolone taper to be used in real life. The Norwich Regimen for the treatment of GCA results in drug-free relapse-free survival of 89% at 100 weeks and 69% at 150 weeks, which is superior to all other reports published so far.

Disclosure
G. Ducker: None. K. Mills: None. C. Yong: None. C. Jones: None. C. Mukhtyar: None.
P303 Development of a Behçet’s disease specific patient concerns inventory
Authors: Mukhtar Saman , Moots Robert 
Published: April 2022

Abstract

Background/Aims
Behçet’s Disease (BD) is a rare multi-system variable vessel vasculitis. It is characterised by oral ulcers, genital ulcers and ocular involvement; however, expression can vary, with patients experiencing a range of symptoms affecting several body systems. This creates the need for an individual and holistic approach to management in order to optimise patient care. A patient concerns inventory (PCI) is a validated tool used to encourage patient-led reviews by exploring areas of concern and unmet needs, and has shown to increase patient satisfaction in oncology and rheumatology consultations. The aim of this study was to develop a novel BD-specific PCI and to assess the impact of this tool in clinic following ethical approval.

Methods
Phase I: Literature search conducted to identify concerns and areas of unmet need in BD patients to create an initial PCI across four separate domains, including physical and functional well-being, psychological and emotional well-being, social care and social well-being, and treatment related side effects. Phase II: PCI presented to the BD multi-disciplinary team for feedback and refinement. Members were asked to rate each item based on how frequently that issue was discussed in consultations, from ‘never’, to ‘sometimes’, ‘most of the times’ or ‘every time’. Phase III: Updated version of PCI presented to patient groups in association with Behçet’s Society UK. Patients were asked to rate on an identical scale. Collective feedback allowed for a final version of the PCI to be created. Phase IV: Pilot study to test the effectiveness of the PCI in BD clinics. Pre- and post-PCI groups will be created. The mean differences in consultation time, number of concerns and patient satisfaction will be compared.

Results
Phase I: Following the application of an inclusion and exclusion criteria, 35 papers yielded a total of 54 items for the initial PCI. Phase II: 12 responses were received, which led to the exclusion of 9 items based on 60% of the respondents reporting this issue was ‘never’ discussed in clinic. A total of 2 items were added, which led to a 47-item PCI. Phase III: 239 responses received from BD patients. 3 items eliminated and 4 added on. Final 48-version PCI created. Phase IV: Pilot study will commence following ethical approval.

Conclusion
A PCI is a holistic tool used to improve communication and encourage patient-led consultations. Phases I to III have led to the creation of a 48-item BD-specific PCI which will be tested in clinic as a pilot following ethical approval. We hope to demonstrate an increase in patient satisfaction following the introduction of a PCI in BD clinics.

Disclosure
S. Mukhtar: None. R. Moots: None.
Professional Social Work and Public Libraries in the United States: A Scoping Review
Authors: Lee Sunwoo , Bae Junghee , Sharkey Caroline N , Bakare Olaoluwa H , Embrey Jenna , Ager Mary 
Published: April 2022

Abstract
This study aims to investigate how professional social work is practiced in U.S. public libraries using a scoping review method. Following Arksey and O’Malley’s framework for conducting a scoping review, the research team undertook a scoping review of academic literature, such as peer-reviewed studies, academic conference presentations, and dissertations/theses, as well as so-called gray literature, including news articles and web search results. After every author’s review, a total of 53 materials were included in the review. The findings from this study provide evidence that collaborations between social work and libraries are documented in the academic and gray literatures, and the collaborations have been rapidly increasing since 2015. The findings also show that these collaborations tend to operate in three main ways: (1) professional social workers and social work interns directly working with library patrons, (2) professional social workers providing consultation with or training to library staff, and (3) social workers providing linkages between library staff and community-based social services agencies.
Hyperspectral and Laser Speckle Contrast Imaging for Monitoring the Effect of Epinephrine in Local Anesthetics in Oculoplastic Surgery
Authors: Bunke Josefine , Merdasa Aboma , Stridh Magne , Rosenquist Pernilla , Berggren Johanna , Hernandez-Palacios Julio E. , Dahlstrand Ulf , Reistad Nina , Sheikh Rafi , Malmsjö Malin 
Published: April 2022

Purpose:
Epinephrine is used in local anesthetics to induce vasoconstriction and thus reduce bleeding and prolong the anesthetic effect. Finding the optimal delay between the administration of the anesthetic and skin incision to ensure vasoconstriction and minimize bleeding is important and has recently become the subject of debate. This is the first study to assess blood perfusion and oxygen saturation (sO2) simultaneously in response to a local anesthetic containing epinephrine in human oculoplastic surgery.

Methods:
A local anesthetic consisting of lidocaine and epinephrine (20 mg/ml + 12.5 μg/ml) was injected in the eyelids of 9 subjects undergoing blepharoplasty. The perfusion and sO2 of the eyelids were monitored using laser speckle contrast imaging and hyperspectral imaging, respectively.

Results:
Laser speckle contrast imaging monitoring showed a decrease in perfusion over time centrally at the site of injection. Half-maximum effect was reached after 34 seconds, and full effect after 115 seconds, determined by exponential fitting. The drop in perfusion decreased gradually further away from the injection site and hypoperfusion was less prominent 4 mm from the injection site, with a spatially dependent half-maximum effect of 231 seconds. Hyperspectral imaging showed only a slight decrease in sO2 of 11 % at the injection site.

Conclusions:
The optimal time delay for skin incision in oculoplastic surgery is approximately 2 minutes after the injection of lidocaine with epinephrine. Longer delay does not lead to a further decrease in perfusion. As sO2 was only slightly reduced after injection, the results indicate that the use of epinephrine is safe in the periocular region.