bluuebunny/crossref_metadata_2025_split huggingface dataset:
P056 Rheumatology haematology interface: an unusual case of aortitis
Authors: Raghuvanshi Subhra , Tarar Bilal , Shaaban Asma 
Published: April 2022

Abstract

Background/Aims
In rheumatological practice it in not unusual to see patients with haematological involvement. We would like to present a very rare diagnosis of Erdheim-Chester disease presenting as retroperitoneal fibrosis and large vessel vasculitis who failed to respond to conventional treatments with steroids and methotrexate.

Methods
A 71-year-old man presented to haematology with retroperitoneal mass. This was investigated with CT thorax, abdomen and pelvis and a biopsy was performed which was negative for haematological malignancies. However, CT scan picked up thickening of aorta and a PET scan was performed subsequently confirming widespread aortitis and peri-renal mass thought to be consistent with retroperitoneal fibrosis. The patient was started on reducing course of oral steroids with a working diagnosis of retroperitoneal fibrosis with large vessel vasculitis.

Results
Subsequent staining for IGG-4 was negative and biopsy was not typical with IgG4 cells. The patient was started on high doses of oral steroids by haematologist with Methotrexate started subsequently by rheumatologist due to persistent changes on PET scan, high inflammatory markers and worsening of patient with generalised malaise, weight loss and fatigue. The patient failed to respond to uptitrated doses of methotrexate and was discussed with a specialist unit for consideration of anti-IL6 tocilizumab to control his large vessel vasculitis. On discussion of imaging in MDT, unusual appearance with sparing of ureters, splaying of peri-nephric fat, lack of IgG4 cells pointed towards an alternative diagnosis.

Conclusion
The patient was subsequently discussed in the national adult histiocytosis meeting with national and international haematologists. The clinical presentation, radiological appearance was thought to be classic of Erdheim-Chester disease, a rare form of adult onset histiocytosis. After further discussions with specialist centre the patient has been commenced on trametinib, a MEK inhibitor treatment (cell tissue negative for BRAF mutation). The patient has recently developed heart failure and has undergone right heart catheter which has found extremely rare pulmonary artery vasculitis too.

Disclosure
S. Raghuvanshi: None. B. Tarar: None. A. Shaaban: None.
P068 Monitoring of methotrexate blood toxicity during the COVID-19 pandemic for patients with rheumatoid arthritis: data from the Greater Manchester Care Record
Authors: Costello Ruth E , Williams Richard , Bruce Ian N , Hyrich Kimme , Dixon William G , Humphreys Jenny H 
Published: April 2022

Abstract

Background/Aims
Current British Society for Rheumatology guidance suggests 3-monthly blood monitoring for patients prescribed methotrexate whose disease, drug dosage and blood results are stable, although evidence for this recommendation is limited. Anecdotal reports suggest monitoring may have reduced during the pandemic. The study aims were, in patients with rheumatoid arthritis (RA) prescribed methotrexate, to determine: 1) interval length between blood tests during the pandemic, and 2) whether prolonged intervals were associated with abnormal blood test results.

Methods
Data came from the Greater Manchester Care Record, a database containing electronic health records from both primary and secondary care for people across Greater Manchester. Inclusion criteria were: a diagnosis of RA; regular blood monitoring ( &lt; =91 days between blood tests) and regular methotrexate prescriptions in the year prior to the pandemic (01/03/2019-01/03/2020). Blood test intervals during the pandemic were determined, a prolonged interval was defined as &gt; 91 days. Cytopenia and transaminitis events were identified between March-December 2020 and March-December 2019 (as a comparator). Proportions of events are presented for each time-period and stratified by whether the interval was prolonged.

Results
1011 patients met the inclusion criteria, with a median of 5 blood tests (interquartile range (IQR): 3-7) during the pandemic and a median interval of 57 days (IQR: 34-84). 612 (61%) patients had at least one prolonged interval, with 241 (23.8%) having multiple. Prolonged intervals had a median length of 112 days (IQR: 99-135). 115 (11.4%) people had a prolonged interval but no subsequent blood test before the study end date (median 120 days [IQR: 104-150]). The proportion of cytopenia and transaminitis events was low and similar across time-periods and when stratified by interval length (Table 1).

Conclusion
Nearly two-thirds of patients on stable methotrexate had at least one prolonged interval and 1 in 10 had a prolonged interval with no subsequent blood test. Initial analyses of test results do not indicate increased occurrence of methotrexate blood toxicity in those with prolonged blood test intervals during the pandemic. Further work is required to determine whether those with prolonged intervals represent a group at lower risk where less frequent blood tests would be appropriate.

Disclosure
R.E. Costello: None. R. Williams: None. I.N. Bruce: None. K. Hyrich: None. W.G. Dixon: Consultancies; Consultancy fees from Abbvie and Google unrelated to this work. J.H. Humphreys: None.
P070 Patients with idiopathic inflammatory myopathies suffer from poor self-reported PROMIS physical function after COVID-19 infection: an interview-based study from the MyoCite cohort
Authors: Kharbanda Rajat , Ganatra Keya , Agarwal Vikas , Gupta Latika 
Published: April 2022

Abstract

Background/Aims
Patients with rheumatic diseases are known to exhibit worse outcomes with COVID-19. However, the effect on individual diseases such as idiopathic inflammatory myopathies (IIM) remain unexplored.

Methods
A self-report e-survey with 36 questions was pilot tested and validated to cover demographics, history of COVID-19 contact, course and severity of COVID-19 infection, influence of COVID-19 infection on physical state one-month after the infection and vaccination status. Baseline characteristics were retrieved from the MyoCite registry and biobank archive. PROMIS-10a, a validated self-report tool was used to quantify physical function. Age and gender similar healthy controls (HC) were included for comparison.

Results
10 patients of IIM were compared with 40 controls. Fever was the most common symptom reported by both the groups however, fatigue, chest pain, and breathlessness were experienced more by patients of IIM compared to HC. However, severity of COVID-19 infection as substantiated by pneumonia, hospitalization, and oxygen requirement was comparable in IIM and HC, possibly due to small numbers PROMIS physical function was comparable before COVID-19 in both groups, and in HC physical function remained the same a month before and after COVID-19. On the other hand, the physical function deteriorated at 30-days after COVID-19 in the IIM group as compared with their baseline function as well as HC. Specific tasks were more challenging for IIM, including climbing stairs, bending or kneeling and shampooing hair, although the limitation was mild (Table 1). IIM patients were also less likely to be vaccinated, suggesting prevalent hesitancy in this group (50% vs 90%, p: 0.007) (Table 1).

Conclusion
Patients with IIM exhibit increase in fatigue, and dyspnoea during COVID-19 although there is no increase in hospitalisation and had similar disease severity compared to HC. Short term physical function is impacted at 30-days post COVID-19, suggesting the need for closer long-term follow-up. Vaccine hesitancy is prevalent and merits addressing in patients with IIM.

Disclosure
R. Kharbanda: None. K. Ganatra: None. V. Agarwal: None. L. Gupta: None.
P111 Patient-related factors influencing remote consultations in rheumatology - lessons from a COVID-19 initiative
Authors: Hannides Michael , Wig Surabhi , Vasireddy Sreekanth 
Published: April 2022

Abstract

Background/Aims
The COVID19 pandemic significantly altered healthcare provision. Our department switched immediately to remote consultations without suspending service, including telephone and video consultations. In this analysis we aimed to explore the role of patient-related factors in influencing the process and outcome of remote consultations with a view to improving the quality of service provision.

Methods
A data collection form was developed and offered to all clinicians to complete after each remote consultation. Information on age, gender, new or follow up status and interpreter use were collected. Clinicians were asked to rate the effectiveness of specific components of the consultation process (time adequate, relevant history, physical examination, management plan and communication quality) as compared to the usual face to face appointments on Numerical Rating Scales (NRS, 0–0). Data were collated in a Microsoft Access database. Statistical analysis was performed using SPSS version 25.

Results
In total, 285 valid forms were evaluated. 193 (67.7%) were women. Patients registered for new appointments (n = 51, 18%) were significantly younger (mean±SD 52.9 ± 19.7 vs 60.6 ± 17.2 years, P = 0.012). There were no significant correlations with age or any significant differences with gender in mean scores of NRS. New patients scored lower on NRS for relevant history (8.0 ± 1.1 vs 8.9 ± 1.2, P&lt;0.001), management plan (4.8 ± 2.5 vs 7.8 ± 2.0, P&lt;0.001) and communication quality (6.6 ± 2.0 vs 8.4 ± 1.6, P&lt;0.001). Interpreter usage (n = 9, 3.4%) had lower scores for relevant history (7.1 ± 2.4 vs 8.8 ± 1.1, P = 0.012) and communication quality (5.4 ± 2.6 vs 8.1 ± 1.8, P = 0.002). There was no significant association of age or gender with subsequent follow up appointment requested as face-to-face or remote. New patients were significantly more likely than follow-up patients to be offered a face-to-face follow up appointment (univariate regression, odds ratio (OR) 5.49, 95% CI 2.7-11.1, P &lt; 0.001). However, once adjusted for management plan in multivariate regression, new patients were no longer significantly associated with subsequent follow up face-to-face appointment (adjusted OR 1.19, 0.48-2.92, P = 0.71).

Conclusion
Our study is one of the first in the UK to explore patient-specific factors influencing remote consultations in rheumatology. In our cohort, patient age or gender was not a limiting factor in utilising remote consultation. New consultations and interpreter use pose challenges for remote consultations, and further studies are needed to address these to see if any measures such as appropriate selection at triaging new appointments may be possible, to improve outcomes.

Disclosure
M. Hannides: None. S. Wig: None. S. Vasireddy: None.
P123 Switching to biosimilars: what do patients think?
Authors: Coady David , Parkin Lindsay , Fairle Louise , Smith Andy 
Published: April 2022

Abstract

Background/Aims
Newer ‘biosmilars’ come with a potential cost saving to the NHS. Switching of generic medicines has been studied (1) but not in the context of biologic drugs. We are interested in patients’ views on switching to biosimilars. Will they have concerns and what can we do as Professionals to support them?

Methods
A sample of 20 patients previously switched to a biosimilar were invited to a semi-structured face to face or telephone interview, lasting approximately 45mins. Interviews were recorded, anonymized and transcribed. Thematic analysis was undertaken by the research team using grounded theory (2).

Results
15 interviews took place until ‘saturation’. Themes to emerge included: Trust: several patients mentioned ‘trusting’ someone they had an established relationship with, such as their consultant or specialist nurse. This would influence their decision to switch. Cost for NHS: awareness of costs to the NHS was discussed with a realisation that these are expensive drugs and there is a wider ‘altruistic’ need to switch to cheaper drugs when asked. But not all patients were happy. One patient felt ‘pushed’ into switching ‘Cross, you know I have worked, my husband has worked, we’ve paid out National Insurances all out lives ⋯⋯ I was being pushed towards this cheaper version ⋯’ Quality of delivery device: many comments were made on the quality of the delivery devices. ‘It’s just a bit more flimsy⋯’. Pre Switch training: some patients felt ‘information’ overload. Others did not read any extra information given. Others felt there was not enough support for the new device or training to use it. Preconceptions: several patients had preconceptions, that switching may create issues and described pre-switch anxiety: ‘I was quite nervous about changing from one to another because I’d been perfectly fine with the one I was on ⋯⋯’

Conclusion
Patients fell into two groups: 1) no particular anxiety about switching and 2) those with pre-switch anxiety. Pre switch anxiety seemed to be driven by prior experiences (reactions or ineffectiveness of prior medications). As the number of biosimilars increase it is likely that patients may be asked to switch multiple times. Confidence in the product and clinical support appear key to successful switching. We suggest a need for further research into this issue and intend to use the above themes in developing a questionnaire for wider sampling.

Disclosure
D. Coady: Grants/research support; Biogen grant, N/A. L. Parkin: None. L. Fairle: None. A. Smith: None.
P129 Quantification of longitudinal joint and cartilaginous changes within ankles with haemophilia joint degeneration using MRI imaging
Authors: Schaper Madeleine , Sharrock Megan , Wilkins Richard A , Redmond Anthony C 
Published: April 2022

Abstract

Background/Aims
Haemophilia is an X-linked recessive genetic disorder characterised by episodes of spontaneous and traumatic intra-articular bleeding. 90% of bleeds are of musculoskeletal origin, with the ankle being most affected joint. Recurrent bleeding results in haemosiderin accumulation, linked to progressive, end-stage ankle haemarthropathy in adolescent and adult patients. Magnetic Resonance Imaging (MRI) is gold-standard for the evaluation of early soft tissue and cartilage changes in ankles with haemarthropathy. This study utilised MRI sequences to quantify longitudinal changes within the ankle joint, via changes in cartilage thickness (CT), subchondral thickness (ST) and joint space width (JS) over time.

Methods
Clinical T1 Sagittal MRI scans of HJD ankles were selected (N = 5). Each patient had a minimum of two MRI scans available, at least one year apart, to allow for comparison of longitudinal changes. All images were identity coded but fully anonymised. The earliest available and most recent MRI scan were measured in three slices (medial, lateral and middle slice) and at different points along the joint space (anterior, middle and posterior). Measurements taken were cartilage thickness on the talar dome (CT) and the distance between the subchondral bone of the tibial plafond and talar dome (ST). The joint space width (JS) was then determined by subtracting CT from ST.

Results
Chondral thickness measurements showed most reduction, particularly at the antero-lateral aspect (-0.4mm) compared to the antero-medial and middle sections, with -0.24mm and -0.34mm (Table 1). ST and JS reduction was predominantly seen in the anterior joint, with most reduction in antero-lateral joint (-1.13mm). The posterior joint showed minimal reduction in the postero-medial and middle sections, with the posterior-lateral joint space width increasing (0.2mm). Subchondral thickness and joint space measurements were variable and did not demonstrate linear change over time.

Conclusion
A systematic longitudinal decrease in cartilage thickness was seen in the antero-lateral and antero-medial aspect of the ankle joint. The antero-lateral aspect of the ankle showed the greatest reduction in joint space and cartilage thickness. This suggests that this area of the joint is likely to provide the best early indications of haemarthropathy when using MRI as a diagnostic tool.

Disclosure
M. Schaper: None. M. Sharrock: None. R.A. Wilkins: None. A.C. Redmond: None.
P136 Methotrexate osteopathy - clinical and radiological characteristics in a case series of twenty-one patients
Authors: Merriman Andrew T , Foley Jon , Golla Janardhana , McRorie Euan , Hauser Barbara 
Published: April 2022

Abstract

Background/Aims
Methotrexate osteopathy was originally described in the 1980s as a combination of bone pain, osteoporosis and insufficiency fractures in paediatric patients receiving high-dose methotrexate for leukaemia. Since then, cases of insufficiency fractures in patients on long-term, low-dose methotrexate for rheumatic disease have been sporadically reported as methotrexate osteopathy. This case series aims to characterise the clinical and radiological features of this poorly defined condition.

Methods
Patients were identified by searching the MRI reports of rheumatology patients in NHS Lothian for the term ‘insufficiency fracture’ and asking consultant rheumatologists to submit cases where methotrexate osteopathy was suspected. Patient demographics, clinical and radiological features were analysed.

Results
We identified 21 patients with insufficiency fractures taking long-term methotrexate. The mean age at presentation with methotrexate osteopathy was 66.9± 9.5 years. 20 of the patients (95%) were women. 18 of the patients (86%) had rheumatoid arthritis. The average BMI of the cohort was 25.7± 5.4. The average duration of methotrexate use was 7.5± 4.5 years. The most common sites of fracture were the calcaneus (12 patients, 57%) and the metaphysis of the distal tibia (13 patients, 62%). Other frequent fracture sites included the proximal tibia, talus, and distal femur. 13 of the patients (62%) had more than one fracture and 12 (57%) had bilateral fractures. 12 of the patients (57%) required an MRI to identify the fracture and there was an average delay of 4.8± 4.0 months between the initial presenting symptoms and imaging confirming a fracture. Osteoporosis was found in 12 of the 15 patients (80%) who had a DEXA scan, with an average T-score of -2.23± 1.14 for the spine and -2.64± 0.78 for the femoral neck. 14 of the 21 (66.6%) patients received antiresorptive osteoporosis treatment. Only 2 of the patients (9.5%) were on long-term steroids at the time of diagnosis.

Conclusion
Methotrexate osteopathy should be suspected in patients on long-term methotrexate with unexplained pain in the lower limbs. There are often multiple, bilateral fractures which most commonly affect the distal tibia and calcaneus. Fractures may not be visible on X-ray, and pain from the fractures may mimic synovitis, causing a delay in diagnosis. A high index of suspicion and detailed imaging with MRI is often required to identify insufficiency fractures associated with methotrexate osteopathy. If the condition is suspected, a detailed fracture risk assessment should be organised, and the cessation of methotrexate considered.

Disclosure
A.T. Merriman: None. J. Foley: None. J. Golla: None. E. McRorie: None. B. Hauser: None.
P170 I think the mental aspect is just awful: experiences of young men living with inflammatory arthritis
Authors: McNeil-Walsh Ruben J , Flurey Caroline A , Cramp Fiona , Robson Jo , Eccleston Christopher , Galdas Paul M , Cushnie Lewis 
Published: April 2022

Abstract

Background/Aims
Health-related quality of life (HRQoL) is consistently reported to be reduced in people with inflammatory arthritis (IA), but little is known about the specific experiences of young men living with these conditions. This study seeks to address this knowledge gap and identify key aspects of the patient perspective.

Methods
Online semi-structured interviews with male IA patients age 16-30. Participants were recruited via online platforms and participating NHS Trusts. Data were analysed using reflective thematic analysis.

Results
17 male patients (RA, JIA, PsA, AS); mean age 23 years (SD: 3.87); disease duration 7 years (SD 6.41); medication (100% on DMARDs/ biologic). Five themes are proposed: “it had a massive mental impact on me”: Psychosocial burden. Participants explicitly described the burden of IA on mental health and wellbeing (“From the diagnosis afterwards is when my mental health was really impacted”). Participants highlighted difficulties in discussing these challenges with healthcare professionals, despite a desire to do so. “I’m still quite candid about who I disclose it to”: Selective disclosure. Participants reported using caution in discussing their condition, which may be a protective mechanism for young men giving them a sense of control (“I think just as a bit of a control thing [...] I didn't want people to know everything”).“I view my arthritis as emasculating”: Disrupted and disruptive masculinity. For some, IA interfered with how they wanted to be as a man (“That kind of sums it up, just not being able to fulfil that role of sort of being the man”). Societal expectations seemed to shape their view on how they as young men should manage (“I think you're expected to manage your own feelings and your own everything and go through it [⋯] like, just man up and take it”). “You have to keep going, you have to keep the ball rolling”: Remarkable resilience. Participants expressed resilience in response to setbacks and ongoing challenges. (“I can't just sit back and cry, I need to get on with it and move on”). “It is a roller coaster, you know, you're okay one minute then you're not”: Sense of uncertainty. Participants explained IA brought uncertainty and instability into their lives, adding a layer of difficulty to planning next steps as a young adult (“It makes planning very difficult. I feel like I'm always waiting for something to happen”).

Conclusion
IA can influence young men’s sense of self and may interfere with their ability to navigate emerging adulthood. Some young men report IA having considerable impact on their mental health and wellbeing. Next steps will explore clinician’s perspectives on caring for this patient group to help understand how young men might be better supported

Disclosure
R.J. McNeil-Walsh: None. C.A. Flurey: None. F. Cramp: None. J. Robson: None. C. Eccleston: None. P.M. Galdas: None. L. Cushnie: None.