bluuebunny/crossref_metadata_2025_split huggingface dataset:
OA39 Online Patient Reported Outcome Measure (PROM) engagement is dependent on demographics and locality: findings from an observational cohort
Authors: Bechman Katie , Yates Mark , Wright Hannah , Russell Mark , Nagra Deepak , Clarke Benjamin D , Ledingham Joanna , Norton Sam , Galloway James 
Published: April 2022

Abstract

Background/Aims
Online patient-reported outcome measures (PROMs) enable remote collection of perceptions of health status, function and wellbeing. Single-centre studies report that PROM completion is dependent on patient demographics. Here we use a large national prospective dataset to explore patterns of PROM completion.

Methods
Patients with a new diagnosis of early inflammatory arthritis (EIA) were recruited to the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and March 2020 and followed up for one year. PROMs capturing the impact of disease using the MSK-HQ, disability using HAQ, mental health using PHQ4ADS, and work using the WPAI were requested at baseline, 3 and 12 months. Multivariable logistic regression was constructed to examine patient level associations with PROM completion. Mean PROM completion by clinical commissioning groups (CCG) were mapped across England and spatial regression models used to identify regional patterns.

Results
A total of 34,856 patients with suspected EIA were recruited to NEIAA. Of these, 11,986 were diagnosed with EIA across England, recruited from 205 CCGs. The cohort was evenly distributed across the indices of multiple deprivation (IMD) deciles. Thirteen percent were Black, Asian, or minority ethnic (BAME). At least one PROM was completed by 5,331 (44.5%) patients. Of these, 3,846 (72.1%) had completed half of all the available PROMs whilst 412 (7.7%) had completed all available PROMs. BAME participants were less likely to return a PROM in adjusted regression modelling (adj OR 0.57, 95% CI 0.48-0.66). Deprivation quintile (adj OR 0.73, 95% CI 0.64-0.83), male gender (adj OR 0.86, 95% CI 0.78-0.94), comorbidity burden (adj OR 0.95, 95% CI 0.91-0.99) and current smoker status (adj OR 0.73, 95% CI 0.64-0.82) also reduced the odds of PROM completion. The proportion with PROM completion varied across CCGs. Spatial analysis identified two autocorrelated regions in England with a hotspot of high PROM completion in the North and a cold spot in the South East.

Conclusion
This study defines key participant characteristics that influence PROM engagement in a national clinical audit and identifies a novel association between locality and PROM completion. Integral to the utility of PROMs in NEIAA is that they are representative of the population with EIA. Our results suggest there are under-represented groups with the potential to bias in favour of those likely to experience better outcome.

Disclosure
K. Bechman: None. M. Yates: None. H. Wright: None. M. Russell: None. D. Nagra: None. B.D. Clarke: None. J. Ledingham: None. S. Norton: None. J. Galloway: Consultancies; Abbvie, Sanofi, Novartis, Pfizer, UCB, Janssen. Grants/research support; Eli Lilly.
P002 Advice line ... of duty
Authors: Knight Lucy , Miller Joanna , Dahiya Sandeep 
Published: April 2022

Abstract

Background/Aims
Advice lines in Rheumatology services are well established and supported by NICE to provide specialist support and advice to rheumatology patients. During COVID-19 the demand on this service greatly increased due to disruption in appointments, confusion regarding national advice, concerns and fears regarding condition and medication. Although patients were encouraged to refer to national guidance, many found it difficult to interpret therefore continued to access the advice line. Our advice line service largely follows the RCN 2006 guidance regarding service provision. Despite this during COVID-19 the volume of calls increased to up to 100 calls per day during the first lockdown. Support was required to effectively manage these calls with reduced clinical staff.

Methods
A retrospective review of calls to the advice line compared to the previous year was undertaken from the call log database. A further review of the nature of calls was undertaken for April 2020 and January 2021 where the numbers of calls were at their peak. Data is recorded including time of call, nature of call, advice given and time call returned.

Results
There was a 130% increase in calls during the first lockdown. This reduced by the early 2021 lockdown to 72%. The majority of calls in April 2020 were related to shielding and risk status (53%). A further 19% of calls were related to medication, these included queries regarding homecare deliveries and delays. 6% were appointment enquiries and they were passed to the administrative team. In January 2021 the majority of calls were related to medication (30%). 19% of calls were regarding the COVID-19 vaccine. There were still 8% of calls regarding shielding. 9% of calls were related to appointments. Pressure on the nursing team was increased due to staff redeployment.

Conclusion
The analysis of calls during the COVID-19 pandemic highlighted that although there was extensive national guidance produced, many patients still required the support and guidance of their specialist teams to interpret these according to their condition. We believe there is a duty of care for the specialist teams to maintain this level of service during any future events and this should be factored into any decisions regarding redeployment of staff. Appointments and homecare delivery enquiries continued despite directions to alternate numbers, therefore impacted on workload for the clinical nursing team. In order to streamline the service we introduced ‘options’ to select: option 1 for appointments, option 2 for homecare and option 3 for advice line queries. Option 1 and 2 then directed to the relevant team. Future developments include audit to assess the impact of introducing telephone options; reviewing the funding and scope of the service, which has extended beyond medication and flare advice; and further exploration of text and email platforms.

Disclosure
L. Knight: None. J. Miller: None. S. Dahiya: None.
P006 Rituximab biosimilar switching shows non-inferior outcomes in routine clinical practice
Authors: Bilan Jimmy , Chew Xin , Perry Martin E 
Published: April 2022

Abstract

Background/Aims
Biosimilar biologic therapy has been widely implemented in recent years. However, little data exists outwith clinical trials to confirm patient response to therapy and any safety signal following switch from originator products or between biosimilars. This study reviewed all rheumatoid arthritis patients prescribed biosimilar rituximab in a ‘real world' clinical practice setting to a certain clinical response following switching.

Methods
Retrospective review of clinical data from medical record was undertaken across three hospital sites in the UK. Patients were identified from biologic database and infusion facility records. Basic demographics were collected. The current biosimilar brand of rituximab, previous brands including originator were also collected and previous record of biologic and steroid therapy. The DAS-28 ESR was recorded pre- and post-biosimilar switch along with any note of infusion reactions.

Results
The database screening of 925 patients on biologic therapy identified 64 patients with rheumatoid arthritis taking rituximab biosimilar therapy. 48 female and 16 male patients with mean disease duration of 7.7 years were identified. 78% of patients were seropositive and all were on 6-monthly pulse infusions of 1g rituximab, 2 weeks apart. 34 (52%) patients were also taking methotrexate, (mean dose of 15mg/wk). Nine patients (14%) were taking concurrent oral prednisolone. Mean current DAS-28 ESR was 3.23. At biosimilar initiation DAS-28 was 4.00 (19% fall, non-significant). There were 14 adverse events, of which 11 were infusion-related reactions, six of which were for truxima, the remainder were with mabthera and rixathon. No anaphylaxis was recorded, although one patient had a hypersensitivity reaction. 38 (59%) patients had rituximab as first biologic.

Conclusion
This ‘real-life’ clinical review found similar clinical efficacy of rituximab biosimilar to originator product based on the DAS-28 ESR score. There were no notable safety or infusion differences.

Disclosure
J. Bilan: None. X. Chew: None. M.E. Perry: Honoraria; Lilly, Celltrion, Gilead, Abbvie, Biogen, Jaansen.
P010 Designing a fast-track pathway for the diagnosis of giant cell arteritis in a busy Ambulatory Emergency Care Unit based on British Society of Rheumatology guidelines
Authors: Lakhani Priyanka M , Ali Sabreen , Sames Edward , Agarwal Paras , Lisk Radcliffe 
Published: April 2022

Abstract

Background/Aims
BSR states: “GCA is a medical emergency. Patients should be evaluated by a specialist ideally on the same working day if possible and in all cases within 3 working days.” Currently in this DGH there is no pathway for diagnosis and management of GCA. Patients are referred from their GP and A&E directly to the Ambulatory emergency care unit (AECU), but it is not guaranteed they will be seen by a specialist within 3 days. We were also receiving inappropriate referrals for possible GCA such as patients under the age of 50 or chronic headache. We have 7-day access to acute ultrasonography in this DGH. We aimed to utilise this service in our fast-track GCA pathway. Aims: 1. All patients with suspected GCA to be seen within 3 working days by specialist. 2. Reduce the number of inappropriate referrals. 3. Reduce irreversible sequelae (visual loss, scalp tissue necrosis and stroke)

Methods
We developed a fast-track pathway containing referral criteria, directions for obtaining urgent ultrasonography and management advice. This was uploaded onto the intranet and was put up as posters in the AECU (see pathway). Baseline measurement: data were collected from ambulatory care referrals over a 5-month period. 29 patients were referred as possible GCA. After introduction of the pathway, data were re-collected over a 3-month period, with nine patients referred as possible GCA.

Results
Outcomes measured:
The percentage of inappropriate referrals decreased by 16% . The percentage of patients reviewed by rheumatology within 3 days increased from 44% to 78%. The percentage of sequelae did not change. Visual loss occurred in both groups at presentation (transient in one patient).
Prior to pathway implementation, 31% of patients referred had raised CRP/ESR. ESR/CRP was not tested in 34% of referrals. Following implementation, 100% of patients had CRP and ESR tested; of these 66% had raised CRP/ESR.

Conclusion
We have shown that having a fast-track pathway in place results in higher likelihood of a specialist evaluation within 3 days, as per BSR guidelines. To improve we suggest implementation of dedicated same-day AECU appointments for Rheumatology Specialists.

Disclosure
P.M. Lakhani: None. S. Ali: None. E. Sames: None. P. Agarwal: None. R. Lisk: None.
P013 Diagnosis and Management of Giant Cell Arteritis Patients in Cardiff and Vale University Health Board (January 2017-February 2020)
Authors: Yau Jessica , Saleh Mohammed , Negi Anurag 
Published: April 2022

Abstract

Background/Aims
Giant cell arteritis (GCA) is a medical emergency presenting with a new-onset headache. Delay in treatment can cause permanent vision loss and other complications. It responds quickly to oral and parenteral steroids. Temporal artery biopsy (TAB) is the gold standard. However, it is not easily available in a timely manner and can produce normal results due to skip lesions and if done after starting steroids. In contrast, ultrasound (USS) is a useful non-invasive alternative. The aims of this audit were to study our current practice against the NICE guidelines/BSR pathway on GCA management, to evaluate the impact of USS on diagnosis and management of GCA and the use of tocilizumab and steroid-sparing synthetic DMARDs.

Methods
This is a retrospective, audit study on patients with a new diagnosis of suspected GCA referred to the Cardiff and Vale Health Board from January 2017 to February 2020. 105 patients who had a USS doppler test were identified, 51 were excluded due to various reasons, ultimately data on 54 patients were analysed.

Results
50 patients (93%) were &gt;50 years old; female: male was 4:1.5. 44 (81%) were primary care referrals. 50 (93%) were seen by a rheumatologist within 48 hours. 11 had visual symptoms, all had an ophthalmology review, two had ischemic changes suggestive of GCA. Pre-USS, 21/54 (39%) were classed as likely GCA. Post-USS, 19/54 (35%) were confirmed GCA, two were refuted. Only 3/54 showed signs of GCA on USS (sensitivity: 15.79%). TAB was done in five patients (sensitivity: 20%), 1/5 showed GCA, all had negative USS. The low sensitivity of USS and TAB is likely to be due to steroid exposure, as all patients were on steroids at time of USS and three had the biopsy 2 weeks post-steroid use. 19 patients continued on steroids for GCA. At 12 months follow-up, 2/19 had discontinued steroids, only 4/17 were on prednisolone &gt;10mg. None of the patients in our cohort required tocilizumab or other steroid-sparing agents.

Conclusion
Temporal artery USS is useful in aiding the GCA diagnosis and reduces the need for TAB, especially in patients with low clinical probability of GCA. Clinical assessment, USS and ophthalmology review together can avoid unnecessary exposure to long-term steroids. It is reassuring that the majority of patients with a low GCA probability had a normal USS. This helped in avoiding steroid use and/or to stop steroids quickly in those who had already started steroids. A local pathway for management of patients referred as suspected GCA is being established in the department. Teaching sessions for non-rheumatologists involving BSR Guidelines on GCA might help reduce unnecessary referrals and improve standard of care. We aim to study the reasons for the low utilisation of tocilizumab and other steroid-sparing agents.

Disclosure
J. Yau: None. M. Saleh: None. A. Negi: None.
P024 Real-world experience of Tocilizumab withdrawal in GCA
Authors: Khalid Salema , Davidson Brian , Hopkinson Neil , Mason Alice , Malik Mariam , Laskou Faidra , Parker Lucy 
Published: April 2022

Abstract

Background/Aims
Part 2 of the GIACTA trial explored the maintenance of efficacy in giant cell arteritis (GCA) patients. It showed that nearly half the patients treated with weekly tocilizumab (TCZ) maintained remission, though flares did still occur in the remaining half when TCZ was discontinued. Currently, NHS England has approved the use of TCZ in GCA for only 1 year as this duration was agreed upon by clinical experts to be sufficient to sustain remission. However, this remains a point of concern amongst clinicians as to whether data from real-life patients confirms that 1 year of TCZ can achieve sustainable remission.

Methods
Our objective is to assess the real-world experience of TCZ withdrawal in GCA patients and how different centres are trying to mitigate risk of relapse after its cessation. We are conducting a patient survey across six hospitals in Wessex, United Kingdom. Our aim is to assess the change in clinical features, acute phase reactants and the rate of sustained remission and relapse.

Results
53 patients with GCA were included in the survey. Average age of patients was 73.5 years. 36 patients had cranial GCA, five had large vessel vasculitis and no sub-type was mentioned for the 12 remaining patients. Temporal artery biopsy was the most common diagnostic tool used for 21 patients, followed by PET scan for 14 patients. Eight patients had a clinical diagnosis only, while seven were diagnosed with GCA based on findings of Anterior Ischaemic Optic Neuropathy. Only three patients had their diagnosis confirmed via ultrasound temporal arteries. Out of these 53 patients, 45 started Tocilizumab. 15 patients stopped treatment due to side effects. Of the remaining 30 patients, only 17 have completed their 1 year of TCZ so far. Two patients relapsed 6 months after stopping TCZ. One of them was on methotrexate (MTX) and low dose prednisolone, while other was on mycophenolate mofetil only. Of those who are currently stable since completing TCZ, five patients are on MTX with prednisolone, one patient on leflunomide and prednisolone, four patients on prednisolone only and three patients on MTX only. Two patients are on no treatment currently.

Conclusion
This is an ongoing study. Our figures so far show that most patients are still on treatment with steroids and MTX, either alone or in combination, after completing 1 year of TCZ. This could be due to clinicians trying to mitigate against relapse once TCZ is withdrawn. This study highlights that real-world data on relapse/remission rates following TCZ withdrawal is essential as it will help shape future GCA treatment and guidelines.

Disclosure
S. Khalid: None. B. Davidson: None. N. Hopkinson: None. A. Mason: None. M. Malik: None. F. Laskou: None. L. Parker: None.
P044 Giant cell arteritis in an immunocompromised patient with rheumatoid arthritis
Authors: Chauhan Neal , Kinder Alison 
Published: April 2022

Abstract

Background/Aims
Giant cell arteritis (GCA) is a common medium-large vessel vasculitis with an approximate incidence of 10 cases per 100,000 people over 50 years old. First line management of GCA is with high dose glucocorticoids followed by steroid sparing agents, namely methotrexate with tocilizumab for resistant cases. Here we describe a patient established on methotrexate for rheumatoid arthritis, receiving rituximab with intravenous methylprednisolone (IVMP) who went on to develop GCA.

Methods
A 65-year-old Caucasian female with seropositive rheumatoid arthritis (RA) established on 20mg weekly subcutaneous methotrexate and low dose 5mg prednisolone was escalated to her tenth cycle of rituximab with 100mg IVMP for an arthritic flare. The day after her second infusion, two weeks apart, the patient presented with headaches. These were severe temporal pains with scalp tenderness for the past four weeks. She denied visual changes, jaw claudication or polymyalgia rheumatica features. Examination identified bilateral thickened and tender temporal arteries. Ultrasound confirmed bilateral frontal temporal artery halo signs, with intimal thickening of 0.9mm and 0.4mm of the left and right respectively. Blood tests showed a rise in C-reactive protein to 46mg/L from 13mg/L. In view of these findings, procedural risks and recent immunosuppression biopsy was not sought. The patient was commenced on 40mg prednisolone before weaning by 5 mg 2-3 weekly. Her headache improved, without relapse and her CRP normalised within 2 weeks. Given tocilizumab had previously been ineffective in the patient’s RA management, she declined transition to this biologic and her methotrexate was increased to 25mg.

Results
Development of GCA in a patient with pre-established immunotherapy is rare. This report represents only the second case noted in the literature of the vasculitis occurring in a patient whilst on rituximab. Excluding tocilizumab (anti-IL6), a meta-analysis of other biological agents including infliximab, adalimumab, etanercept (anti-TNF) and abatacept (anti-CTLA4) have not been proven to have clinical significance over placebo in GCA. However, evidence of rituximab and its role in GCA is limited with no clinical trials. Contrary to this case of GCA, rituximab (anti-CD20) therapy has a well-recognised role in ANCA associated vasculitis and there are growing calls for trials in large vessel vasculitides. Recent case series of rituximab in Takayasu’s arteritis have presented contrasting outcomes of persistent disease activity versus clinical and laboratory remission. Robust clinical trials are therefore required to evaluate the long-term impact of rituximab on large vessel vasculitis.

Conclusion
Although rare, clinicians should be vigilant for the development of GCA despite established immunosuppression.

Disclosure
N. Chauhan: None. A. Kinder: None.
P053 Heterotopic ossification after COVID-19 infection - case report
Authors: Chang Yvonne , Stathopoulou Eleni 
Published: April 2022

Abstract

Background/Aims
Heterotopic ossification (HO) is the abnormal formation and deposition of mature lamellar bone within soft tissue, associated with trauma, surgery, neurologic injury and prolonged immobilisation. Several recent case reports have demonstrated this condition in COVID-19 patients requiring mechanical ventilation.

Methods
We present a case of heterotopic ossification in the shoulder after a long stay in intensive care unit (ICU) due to COVID-19 infection.

Results
A 55-year-old man with stable psoriatic arthritis on sulfasalazine was admitted to ICU for mechanical ventilation after contracting COVID-19 infection. After discharge from ICU, he began noticing increasing right shoulder pain with restricted movements of abduction, internal and external rotation. His serum alkaline phosphatase was moderately elevated. Despite physiotherapy and NSAIDs, there was slow improvement. Shoulder x-ray showed significant bony overgrowth around proximal humerus which was initially thought to be part of his psoriatic arthritis. It was confirmed at Rheumatology/Radiology MDT to be heterotopic ossification. A computed tomography of the right shoulder was requested to evaluate the extent of the condition and orthopaedic advice was sought.

Conclusion
There are many factors contributing to the development of heterotopic ossification including trauma, spinal cord injury, brain injury, hypoxia, prolonged immobilisation with limitation of joint movement and prolonged bed rest which cause alterations in calcium homeostasis, male sex and over 60 years of age.
New onset joint pain and stiffness in patients who have recovered from COVID-19 especially those who had long ICU stay should be further investigated for this condition.
Treatment includes analgesia and physiotherapy with potential surgical intervention.

Disclosure
Y. Chang: None. E. Stathopoulou: None.