bluuebunny/crossref_metadata_2025_split huggingface dataset:
P211 Comparing standing and stepping activity in people with rheumatoid arthritis with and without foot and ankle pain
Authors: Quinn Karen , Murphy Grainne , Larkin Louise , Leary Helen O' 
Published: April 2022

Abstract

Background/Aims
Foot and ankle pain is common in people with RA and is reported to influence physical activity levels. However there is limited objective data exploring differences in physical activity behaviours in RA in those with and without foot/ankle pain. This cross-sectional study aimed to examine the differences in objectively measured step count, cadence and standing time in people with RA reporting foot/ankle pain compared to those with no foot/ankle symptoms.

Methods
Adults with RA recruited from a rheumatology outpatient department wore an ActivPAL4 accelerometer over a 7-day period. A step cadence of &gt; 100 steps per minute was estimated to correspond to moderate physical activity. Assessments of pain intensity, location of painful joints and disease activity (Clinical Disease Activity Index-CDAI) were conducted. Cadence characteristics, total step count and standing time between groups with and without foot/ankle pain were compared using independent sample t-tests.

Results
Participants (n = 72) clinical characteristics are presented in Table 1. Current foot/ankle pain was reported by 66% (n = 47). Those with foot/ankle pain had higher disease activity as measured by CDAI and higher BMI scores. Daily standing time was less in the group with foot/ankle pain with a mean (SD) of 257 (77.7) minutes compared to 300 (95.9) minutes in those without. No significant differences in daily total step count or in any cadence characteristics were identified between groups (Table 1). No difference was observed in the minutes spent in moderate physical activity- foot/ankle pain group 10.6 (15.4) minutes versus no foot/ankle pain 10.6 (15.2) minutes.

Conclusion
People with RA who report foot and ankle pain spend less time standing. Interestingly this study did not show differences in step count and cadence between those with and without foot and ankle pain. Participants included in this study had relatively well controlled disease. This study also only examined the presence or absence of foot pain and there was wide variation in pain levels and also daily step counts recorded. Further research exploring the relationship between activity behaviours and foot pain is warranted, particularly in populations with higher pain levels and more active disease.

Disclosure
K. Quinn: None. G. Murphy: None. L. Larkin: None. H. O' Leary: None.
P213 HLA-DRB1 haplotypes predict cardiovascular mortality in inflammatory arthritis
Authors: Sharma Seema D , Plant Darren , Bowes John , Macgregor Alex , Barton Anne , Viatte Sebastien 
Published: April 2022

Abstract

Background/Aims
Haplotypes defined by amino acids at HLA-DRB1 positions 11, 71 and 74 associated with susceptibility to rheumatoid arthritis (RA), are associated with radiological outcome, anti-TNF response and all cause-mortality. RA is associated with cardiovascular (CV) morbidity and mortality, but increased prevalence of risk factors of CV disease in RA only partially explains this association. The aim was to investigate whether haplotypes associated with RA disease susceptibility and disease severity are associated with CV mortality.

Methods
The Norfolk Arthritis register (NOAR) is a primary care-based inception cohort of patients with inflammatory polyarthritis (IP). NOAR patients with at least 2 years of follow-up and available mortality and genetic data were included. Mortality data was provided by the Office for National Statistics. Univariate Cox proportional hazard models were applied using STATA/IC 14.0. Models for CV mortality were adjusted for CV risk factors selected using stepwise regression: namely obesity, gender and hypertension. Hazard models were applied to the entire cohort of patients with inflammatory polyarthritis (IP). When calculating differences between highest and lowest risk genetic factors, bivariate analysis was used.

Results
HLA-DRB1 amino acids, haplotypes or haplotype groups associated with RA susceptibility are also associated with CV mortality as shown in the table. HLA-DRB1 polymorphisms encoding amino-acid haplotypes associated with an increased or decreased susceptibility to RA consistently show the same magnitude and direction of association for overall and CV mortality in IP. For example, the SEA-haplotype, associated with the lowest susceptibility to RA, and the best radiographic outcome, was found to be associated with decreased CV mortality (HR 0.67, 95% CI 0.47, 0.91, p = 0.023). The relative difference in CV mortality between carriers of the high susceptibility VKA haplotype and carriers of the SEA haplotype was significant (HR 1.67, 95% CI 1.13, 2.48, p = 0.01). Associations were independent of anti-CCP status.

Conclusion
HLA-DRB1 haplotypes associated with susceptibility to RA also predispose to increased risk of CV mortality in IP, independent of known CV risk factors and anti-CCP status, which suggests that, in the future, genetic factors will add to prediction of risk of cardiovascular mortality beyond serological markers.

Disclosure
S.D. Sharma: None. D. Plant: None. J. Bowes: Grants/research support; British Heart Foundation. A. Macgregor: None. A. Barton: Grants/research support; BMS. Other; Speaker Fees from Roche Chugai. S. Viatte: None.
P214 Classifiable early RA shows heterogeneous imaging features and potential means of stratification
Authors: Shukla Rudresh , Levy Roxanne , Ho Pauline , Mankia Kulveer , Wakefield Richard J , Emery Paul , Buch Maya H 
Published: April 2022

Abstract

Background/Aims
Synovitis and tenosynovitis (TS) are key findings seen in patients with rheumatoid arthritis (RA) on musculoskeletal ultrasound (MSUS). Both power Doppler TS (PDTS) and power Doppler synovitis (PDUS) have also been reported in preclinical-RA. We aimed to describe the prevalence of PDTS and PDUS in a treatment-naïve, new-onset RA trial cohort and their association with clinical and disease activity data.

Methods
The VEDERA (Very early Etanercept and Methotrexate versus Methotrexate with/without Delayed Etanercept in RA) trial recruited 120 treatment-naïve, new-onset RA patients fulfilling ACR-EULAR 2010 classification criteria with at least moderate DAS28-ESR to either first-line etanercept + methotrexate (ETN+MTX) or methotrexate treat-to-target (MTX-TT), and included clinical and dominant hand (MCP 1-5, wrist, flexor tendons 1-5 and extensor carpii ulnaris tendon) MSUS assessments. Joint Grey scale (GS), PDUS and PDTS were assessed semi-quantitatively and converted to dichotomous scale (absent = total score 0; present = total score ≥ 1). Patients were categorised in one of four groups based on presence of PDUS and/or PDTS: no PDUS or PDTS (PDUS-PDTS-), PDTS alone (PDUS-PDTS+), PDUS alone (PDUS+PDTS-) and both PDUS and PDTS (PDUS+PDTS+). Clinical and GS features are described for these groups.

Results
At time of diagnosis, 17% (20/120) were PDUS-PDTS-, 16% (19/120) PDUS-PDTS+, 15% (18/120) PDUS+PDTS- and 53% (63/120) PDUS+PDTS+. Table 1 details demographic, clinical and disease activity data.
GS was present in 60% (12/20) and 74% (14/19) of PDUS-PDTS- and PDUS-PDTS+ groups respectively, while all patients with PDUS + (PDUS+PDTS- and PDUS+PDTS+ groups) demonstrated GS (table 1). The PDUS+PDTS+ group had the shortest symptom duration. PDUS-PDTS- group had lower DAS28ESR, tender/swollen joint counts (28 joints), CRP and pain. The two groups with PDTS + (with/without PDUS) had higher visual analogue pain scores.

Conclusion
Heterogeneous imaging features of classifiable, new-onset RA likely reflect different rates of progress along the continuum and presentation, and timing in capturing PDUS and PDTS. Severe clinical and imaging features associate with more rapid presentation. A minor proportion show no clear features of PDUS or GS yet are classifiable as RA indicating other contributors to diagnosis. MSUS features may offer a means of stratifying patients and tailoring treatment approaches.

Disclosure
R. Shukla: None. R. Levy: None. P. Ho: None. K. Mankia: None. R.J. Wakefield: None. P. Emery: None. M.H. Buch: None.
P216 Promoting physical activity using mobile health technology in people living with rheumatoid arthritis: MOTIVATE RA
Authors: Bannell Daniel J , Cocks Matthew , Goodson Nicola , Taylor Chloe , Peçanha Tiago , Jones Helen , Low David A , Sprung Victoria S 
Published: April 2022

Abstract

Background/Aims
People with rheumatoid arthritis (RA) commonly experience pain and stiffness which reduces engagement in physical activity (PA). The range of health benefits associated with PA are now well established, and include improvements in cardiovascular health and symptoms associated with RA. However, people with RA are more inactive than the general population and face unique barriers to becoming more active. Mobile health (mHealth) technology (i.e. fitness watches and apps) may provide an effective and economical solution to promoting PA in this population. Therefore, the aim of the current study is to assess the effectiveness of mHealth technology to increase PA levels and reduce disease activity in people living with RA.

Methods
Following ethical approval, 13 females diagnosed with RA were randomised to either an mHealth (n=7, age 47 ± 14 years; BMI 30 ± 5 kg/m2) or a conventional care (CC) intervention group (n=6, age 50 ± 11 years; BMI 25 ± 3 kg/m2). The CC group were provided with online educational material to increase PA whereas the mHealth group were provided with a personalised, progressive walking programme delivered via mHealth technology with ongoing support throughout the 12-week intervention. Prior to (week 0) and following (week 12) the intervention, participants conducted assessments remotely, with guidance from the research team. At each time point all participants wore a GT9X ActiGraph PA monitor for 7 days to quantify PA and completed a RADAI-5 questionnaire to monitor disease activity Change data between weeks 0 and 12 were analysed using independent t-tests and reported as mean difference (95% confidence intervals).

Results
Intervention groups were well matched in terms of age [3 years (95% CI= -12, 19); P=0.66] but differed for BMI [-5 kg/m2 (95% CI= -10, -0.1); P=0.05]. Preliminary analyses reveal no significant difference in steps per day between the mHealth vs. CC groups [323 steps/day (95% CI= -2273, 1632; P=0.72]. Similarly, no difference in RADAI-5 score was observed between the mHealth and CC groups [0.09 (95% CI= -0.28, 4.6); P=0.61].

Conclusion
These preliminary data identify the potential effectiveness of a PA programme to increase PA levels in people with RA delivered via mHealth, though positive changes in mHealth are very small at this early stage. These data, in full, will be important in identifying whether this technology could be used as a cost effective, non-pharmacological management strategy for RA.

Disclosure
D.J. Bannell: None. M. Cocks: None. N. Goodson: None. C. Taylor: None. T. Peçanha: None. H. Jones: None. D.A. Low: None. V.S. Sprung: None.
P221 Autoantibodies are common in patients with idiopathic interstitial lung disease, suggesting a high prevalence of undiagnosed autoimmune connective tissue disease
Authors: Tansley Sarah , Cotton Caroline , McMorrow Fionnuala K , Lu Hui , New Robert P , Spencer Lisa G , McHugh Neil J , Cooper Robert G ,   UK-BILD Collaboration
Published: April 2022

Abstract

Background/Aims
In some patients, interstitial lung disease (ILD) may be the dominant or even sole manifestation of an otherwise unrecognised autoimmune connective tissue disease (CTD). Accurate diagnosis can be challenging given considerable overlap of the clinical, radiological and histological disease features. Distinguishing CTD related ILD (CTD-ILD) from idiopathic ILD, enables appropriate immunosuppressive treatment, informs prognosis and facilitates monitoring for other CTD associated complications. Occasionally a lung biopsy may be necessary to ensure accurate diagnosis. Autoantibodies are a hallmark feature of CTD, are highly disease specific and their presence is strongly suggestive of covert CTD-ILD. We investigated patients with idiopathic ILD for the presence of autoantibodies that may suggest misdiagnosis.

Methods
The serum from three subgroups of patients recruited to UK Biomarkers of Interstitial Lung Disease (BILD) were analysed: 171 with a diagnosis of idiopathic ILD and non-specific organising pneumonia on HRCT and 27 with a diagnosis of idiopathic ILD and cryptogenic organising pneumonia on HRCT. Autoantibody status was determined by radio-immunoprecipitation.

Results
Results are summarised in Table 1. Overall CTD-autoantibodies were identified in 15.6% of patients with idiopathic ILD, and were more common in those with NSIP, see table. Autoantibodies identified included those readily detectable e.g. anti-Jo1, in addition to rarer antibodies not included in standard assays e.g. anti-EIF3. Nearly half of all autoantibodies detected were anti-synthetase autoantibodies.

Conclusion
Covert-CTD is likely to be common amongst patients diagnosed with idiopathic ILD, particularly idiopathic NSIP. More specific guidance on autoantibody testing could improve diagnosis and ensure patients receive appropriate immunosuppressive treatment.

Disclosure
S. Tansley: None. C. Cotton: None. F.K. McMorrow: None. H. Lu: None. R.P. New: None. L.G. Spencer: None. N.J. McHugh: None. R.G. Cooper: None.
P234 The effect of calcitriol on the expression of interferon signature genes in dendritic cells and macrophages in systemic lupus erythematosus
Authors: Magro Rosalie , Seria Elisa , Grech Godfrey , Borg Andrew A , Scerri Christian 
Published: April 2022

Abstract

Background/Aims
A number of studies have demonstrated the inverse association between vitamin D and (i) disease activity and (ii) interferon (IFN) signature gene expression in systemic lupus erythematosus (SLE). The aim of the study was to establish the effect of calcitriol supplementation to cultured macrophages and dendritic cells (DC) from a SLE patient and control, on the expression of 12 IFN signature genes, interferon regulatory factor (IRF)7 and IRF8.

Methods
Blood samples were collected from a 41-year-old female SLE patient who fulfilled the SLICC classification criteria for SLE and from a 36-year-old healthy female control after obtaining informed consent. Both patients had a serum 25-hydroxyvitamin D level of 25ng/ml. Peripheral blood mononuclear cells (PBMC) were isolated by using histopaque®-1077. CD83 and CD14 expression was measured by flow cytometry and cell count and viability were assessed. The PBMC suspension was cultured in 6-well plates using: (i) ImmunoCultTM DC culture kit (following kit protocol) for DC differentiation, (ii) culture medium for macrophage differentiation containing RPMI 1640 Medium, DMEM, fetal bovine serum and LPS. Following 7 days of incubation, differentiation of cells was confirmed using microscopy and flow cytometry to measure CD83 and CD14 expression. Calcitriol at a concentration of 20nM was added to half of the wells of each sample category. Following 24 and 48 hours, RNA extraction was carried out on treated and untreated samples. QuantiGene Plex technology was used to measure the expression of 12 IFN signature genes, IRF7, IRF8 and four housekeeping genes in the extracted RNA. The normalised median florescence intensity for the 12 IFN signature genes was used to calculate the IFN score.

Results
A significantly lower IFN score was noted at 24 hours in SLE patient dendritic cell and macrophage cell cultures and in control macrophage cell cultures treated with calcitriol when compared with respective untreated samples (p = 0.014, p = 0.034, p = 0.031 respectively). On comparing IRF8 expression in treated and untreated cell cultures, a significantly lower IRF8 expression was noted in treated macrophage cell cultures obtained from both SLE patient and control (p = 0.034, p = 0.041). No difference in IRF7 expression was noted in treated and untreated cultures for all samples.

Conclusion
The suppression of the interferon signature genes in dendritic cell and macrophage cell cultures with vitamin D was confirmed in the in vitro experiment carried out. In this experiment a decrease in the expression of IRF8 (known to have a VDR binding site) was also observed in macrophage cultures from both SLE patient and control.

Disclosure
R. Magro: None. E. Seria: None. G. Grech: None. A.A. Borg: None. C. Scerri: None.
P238 Pre-pregnancy switching from mycophenolate to azathioprine in patients with lupus nephritis: a retrospective outcome analysis
Authors: Ali Saadia S , Sangle Shirish , D'Cruz David 
Published: April 2022

Abstract

Background/Aims
Mycophenolate mofetil is not recommended in pregnancy due to teratogenic effects. A previous small prospective study found that switching from MMF to AZA rarely led to renal flares. Our aim was to assess the impact of switching from MMF to AZA on renal flares and pregnancy outcomes in a lupus nephritis cohort.

Methods
A retrospective analysis of the records of patients attending the renal and antenatal clinics at St Thomas’s Hospital in London who underwent pre-pregnancy counselling and switched from MMF to AZA was undertaken between January 2019 and December 2020. Inclusion criteria included a diagnosis of SLE based on the 2019 EULAR/ACR classification criteria for SLE and lupus nephritis assessed by a biopsy and classified according to the International Society of Nephrology/Renal Pathology Society 2003 classification. A flare was defined as rising urine PCR, decreasing serum albumin, decreasing serum complement and rising dsDNA antibodies and/or an increase in serum creatinine. Analyses included descriptive statistics [mean (standard deviation) and median (interquartile ranges) for continuous variables and frequency (percent) for categorical values].

Results
Twenty-seven patients were included in this study. 55% were of Afro-Caribbean or Asian background and remaining were Caucasian. The median age at SLE diagnosis was 22 (18-26) years. The average disease duration prior to treatment switch was 8 years. The median time between biopsy and switching was 32 months (17-69). 25.9% of patients had a diagnosis of APS. 48% were Ro positive, while 85.2% were positive for dsDNA antibodies. The median serum creatinine was 69 umol/L (58-84), median serum albumin was 42g/L (38-47) and median PCR was 26.5mg/mol (12-61) prior to switching. Our study showed that nine patients (33.3%) flared after switching. five patients (18.5%) flared during pregnancy. 10 (37%) patients went onto have successful pregnancies, two (7.4%) had miscarriages, three (11.1%) patients developed preeclampsia. 46% of patients with class III/IV Nephritis on biopsy developed complications in pregnancy. 36% of patients with dsDNA had poor pregnancy outcomes compared to 25% who were dsDNA negative. 42.2% of patients of Afro-Caribbean/Asian background flared during pregnancy compared to 25% of their Caucasian counterparts.

Conclusion
Although azathioprine is an option in patients with lupus nephritis who are planning pregnancy, there is a need to identify patients at risk of a disease flare on switching from MMF. This study showed that patients with low serum albumin, creatinine &gt;65, urine PCR &gt;50 and positive dsDNA antibodies at the time of the switch were more likely to flare after switching and in pregnancy.

Disclosure
S.S. Ali: None. S. Sangle: None. D. D'Cruz: None.
P249 Analysis of the performance of a newly developed axial spondyloarthritis clinic at a district general hospital
Authors: Newdick Lisa A , Sykes Mark P 
Published: April 2022

Abstract

Background/Aims
Traditionally, patients with ankylosing spondylitis (AS) and axial spondyloarthritis (axSpA) have been managed in general rheumatology clinics at district general hospitals, which can potentially lead to delays in diagnosis or treatment. In order to improve the service, a fortnightly axSpA clinic was set up at West Suffolk Hospital, with appointments with either a consultant or nurse specialist.

Methods
A retrospective case note review was performed for patients diagnosed with axSpA prior to the establishment of the axSpA clinic in April 2019 (comparator group), who were subsequently followed-up in the axSpA clinic. The ‘active group’ comprised patients referred to the clinic with suspected axSpA from May 2019 to December 2020. The performance analysis looked at time from GP referral to outpatient appointment (OPA), time from OPA to MRI examination, time from MRI scan to follow-up appointment and time to biologic disease-modifying anti-rheumatic drug (bDMARD) therapy. Statistical analysis was performed using unpaired t-tests.

Results
From December 2013 to April 2019, 31 patients were identified with an axSpA diagnosis (comparator group), and 65 patients were identified post-audit (active group). The mean time from referral to initial OPA was unchanged between the two groups, at 37 days. While the time from OPA to MRI scan was significantly shorter prior to set-up of the axSpA clinic (34.9 vs. 76.7 days; p = 0.0014), at least nine patients had delayed MRI owing to COVID-19. Excluding these patients from the analysis, the mean wait time from MRI scan in the active group reduced to 35.2 days, which was not statistically different from the comparator group (p = 0.9600). Time from MRI to follow-up OPA and time from a patient meeting the criteria for bDMARD therapy to first prescription of bDMARD reduced following set-up of the axSpA clinic, although differences were not significant (93.1 vs. 50.0 days; p = 0.1400 and 35.3 vs. 21.0 days; p = 0.0510, respectively). Time from first OPA to bDMARD therapy prescription reduced significantly (288.4 vs. 116.7 days; p &lt; 0.0500).

Conclusion
The set-up of the axSpA clinic did not make any difference to the early part of the axSpA pathway (the diagnostic phase); however, there was a notable difference for follow-up times and starting treatment after the diagnosis had been made, which most likely reflects the importance of the role of a nurse specialist in the clinic.

Disclosure
L.A. Newdick: None. M.P. Sykes: None.