bluuebunny/crossref_metadata_2025_split huggingface dataset:
P205 Patient preference for different devices for delivery of subcutaneous methotrexate when switching from oral therapy: findings from a pilot study comparing a button-free auto-injector pen and a button-activated auto-injector pen
Authors: Lartey Janet 
Published: April 2022

Abstract

Background/Aims
Subcutaneous (SC) injection of methotrexate (MTX) can offer advantages when compared to oral MTX in the management of rheumatic diseases such as rheumatoid arthritis (RA). Patient choice is an important factor to consider when initiating new treatments as it may lead to improved compliance. This pilot study evaluated patient preference between two MTX auto-injector pens and the important features that influenced the choice of device.

Methods
Rheumatology patients making the switch from oral MTX to SC MTX were invited to take part in structured consultation (using a 3-page questionnaire) to discuss their preferences regarding the use of a pre-filled, auto-injector pen. Patients were shown a button-free dummy pen and a button-activated dummy pen and asked to indicate their preference. Patients were asked to rate the relative importance of 7 features of their chosen auto-injector pen on a scale of 1 to 4 where 1 = “not important” and 4 = “very important”. The nurse leading the consultation alternated the order in which the auto-injector pens were presented to minimise bias.

Results
Thirty patients have switched to SC MTX to date. The majority of patients were female (80%) and aged over 40 years (73%). The majority (60%) had been prescribed MTX for the treatment of rheumatoid arthritis (RA) and been using oral MTX for more than 12 months (60%). The main reasons for switching to SC MTX were concerns about treatment side effects (50%) and/or effectiveness (50%). Twenty-five (83%) patients chose the button-free, auto-injector pen and 4 (13%) chose the button-activated, auto-injector pen. One patient had no preference but decided to use the button-free, auto-injector pen. Twenty-eight (93%) patients ranked “button/no button to press to activate the injection” as important (“important” or “very important”) when choosing. Of these, 22 (79%) indicated a preference for “no button” to activate the injection. Ninety percent of patients ranked a “system of recognition at the start and end of the injection process”, “easy to grip”, and “easy to uncap” as highly important; 84% ranked “visibility/invisibility of the needle” as highly important. Simplicity and ease-of-use were described as the main advantages by those patients choosing the button-free option (n = 25, 52% and 32% respectively).

Conclusion
The findings of this pilot patient preference study show that ease of use of the auto-injector pen is an important factor when patients are switching from oral MTX to SC MTX. Although multiple features contribute to ease of use, the absence of a button was identified as the most important feature and likely contributed to a greater preference for use of the button-free, auto-injector pen.

Disclosure
J. Lartey: None.
P207 NRAS Virtual Groups
Authors: Bwalya Naomie , Brewer Janet 
Published: April 2022

Abstract

Background/Aims
NRAS Groups have long provided an opportunity for those with RA to meet others in a similar situation for mutual benefit. Attendees have told us how they enjoy meeting in a non-clinical environment to learn more about the condition and receive encouragement from others. When COVID-19 hit and NRAS groups were unable to meet in person and most people living with RA had to shield this intensified the feelings of isolation. NRAS responded to this need by establishing online regional groups and JoinTogether virtual groups.

Methods
1. NRAS offered training and support to facilitate online group meetings to its regional groups’ leaders. Volunteers were provided with a dedicated NRAS email address, access to an Office 365 portal and Zoom account and GDPR training. NRAS colleagues attended introductory meetings to support the Group Leaders and continue to provide technical support, promotion via website and social media as well as general advice. 2. Recognising a need to reach a wider audience who were not accessing the regional groups - i.e. younger and perhaps “time poor” due to working etc. - NRAS took advantage of the move to online engagement and also initiated the exclusively online JoinTogether topic-based groups, using a Volunteer Lead model.

Results
Regional Groups: Almost half of the regional groups signed up to the online training. Many found that the online meetings brought very positive benefits e.g. they were able to reach a wider audience as attendees were not put off by having to travel and could still attend if they were feeling fatigued. Many reported it was easier to attract NHS rheumatology health professionals to give talks as they did not have to travel and could even join meetings from home in the evenings. Some groups in adjoining areas joined forces so they could expand their offerings. JoinTogether Groups: Volunteer Lead, with NRAS support, has now set up 5 topic-based groups, each led by two co-ordinators. Topics are: Exercise & Back to Sport; Parenting With Inflammatory Arthritis; 18-35 year olds with RA or JIA: Working with Inflammatory Arthritis and Parents with children with JIA. These groups are thriving and attracting new audiences. They are very much volunteer led and attendees play a key role in directing the development of the JoinTogether groups to suit their needs.

Conclusion
NRAS virtual groups have allowed those living with RA or JIA to maintain contact with a community, with shared experiences, throughout the pandemic. They have also been instrumental in attracting attendees from audiences NRAS had traditionally found harder to access. The Volunteer Lead model that has been successfully implemented for the JoinTogether groups can now be expanded to other areas, enabling NRAS to increase capacity for delivering vital services.

Disclosure
N. Bwalya: None. J. Brewer: None.
P212 Understandings and responses to joint pain: preliminary findings from a rapid ethnographic assessment in Northern Tanzania
Authors: Msoka Elizabeth F , Bunn Christopher , Msoka Perry , Yongolo Nateiya M , Laurie Emma , Wyke Sally , McIntosh Emma , Mmbaga Blandina 
Published: April 2022

Abstract

Background/Aims
Musculoskeletal disorders (MSKD) are an important global health problem, but we know little about how it is understood and explained in Tanzanian communities. This understanding is crucial for developing culturally competent interventions and services for MSKD which avoid unintended impacts. This study aims to examine how joint pain is understood, explained, and responded to in rural and peri-urban communities in northern Tanzania.

Methods
We conducted rapid ethnographic assessment (REA) in two communities in Kilimanjaro region (one peri-urban, one rural) to document the language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts the pain has and how people respond to it. The REA included 60 short interviews with community leaders, traditional healers, community members, and pharmacists. The research team also wrote detailed field notes and, with written consent, took photographs which were used to develop ‘thick descriptions’ of the phenomena in each community. Thematic analysis of interview notes, thick descriptions and photographs was conducted using QDA Miner (v5.0) software.

Results
The dominant concepts of joint pain and its cause were named as Ugonjwa wa baridi - cold disease; Ugonjwa wa uzee - old age disease; rimatizim - disease of the joints and gauti - gout. Causes mentioned included exposure to the cold - walking bare foot, working in cold conditions - old age, alcohol and red meat consumption, witchcraft, demons, settling in one position, sex, injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. The impacts of joint pain included loss of mobility, economic and family problems, death, reduction in sexual functioning, and negative self-perceptions. Responses to joint pain blend biomedical treatments, exercise, herbal remedies, consultations with traditional healers and religious ritual.

Conclusion
Understandings of and responses to joint pain in the two communities are ‘syncretic’ - mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong ‘lay epidemiology’ in these communities. The impacts of joint pain are wide ranging, extending beyond the individual affected, and suggest that there are unmet needs which can be targeted by future interventions and services.

Disclosure
E.F. Msoka: None. C. Bunn: None. P. Msoka: None. N.M. Yongolo: None. E. Laurie: None. S. Wyke: None. E. McIntosh: None. B. Mmbaga: None.
P217 Describing the evolution of concordance/discordance between DAS28-ESR and ultrasound power Doppler synovitis in a treatment-naïve early RA cohort
Authors: Shukla Rudresh , Selby David A , Emery Paul , Plant Darren , Buch Maya H 
Published: April 2022

Abstract

Background/Aims
Discordance between DAS28-ESR and ultrasound (US)-detected power Doppler synovitis (PDUS) can lead to unnecessary DMARD cycling. Using DAS28-ESR and PDUS in an early RA trial cohort, we aimed to identify and describe concordance and discordance at diagnosis and evaluate their proportional change in response to treatment.

Methods
The ‘VEDERA’ trial randomised 120 treatment-naïve, new-onset RA patients to first-line etanercept + methotrexate (ETN+MTX) or methotrexate treat-to-target (MTX-TT) with escalation to ETN+MTX if not in DAS28-ESR remission at week 24. Clinical and US assessments were completed at baseline, weeks 12/24/48. Remission was DAS28-ESR ≤2.6 and active disease was DAS28-ESR &gt;2.6. PDUS presence was defined as total PDUS score ≥ 1. Active concordance was defined as active disease with PDUS while active discordance was defined as active disease without PDUS. Remission concordance was defined as remission without PDUS while remission discordance was defined as remission with PDUS. Descriptive analyses were undertaken to address the above aims.

Results
At baseline all patients had active disease - 67% (81/120) were concordant and 33% (39/120) were discordant. Baseline DAS28-ESR and individual components were higher in the concordant compared to discordant group.
In the active concordant group, from baseline to weeks 24 and 48 respectively, 30% (24/81) and 20% (16/81) persisted, and 26% (22/81) and 38% (31/81) became remission concordant; while 30% (24/81) and 35% (28/81) shifted to active discordance at weeks 24 and 48 respectively and 14% (11/81) and 7% (6/81) became remission discordant.
In the active discordant group, from baseline to weeks 24 and 48 respectively, 72% (28/39) and 49% (19/39) persisted and only one and two patients were remission discordant; while 8% (3/39) and 15% (6/39) shifted to active concordance at weeks 24 and 48 respectively and 18% (7/39) and 31% (12/39) became remission concordant.

Conclusion
Discordance of DAS28 is typically associated with later RA. In this report, a third of patients shifted from active concordance to discordance following DMARD treatment early in the RA pathway. Further study is needed to understand how these patients compare to those that started and persisted with active discordance, and also later discordant RA patients.

Disclosure
R. Shukla: None. D.A. Selby: None. P. Emery: None. D. Plant: None. M.H. Buch: None.
P224 Anti-PARP1 as a novel autoantibody in myositis
Authors: Riddell Victoria , Betteridge Zoe , Bowler Elizabeth , Chinoy Hector , Gordon Patrick , Wedderburn Lucy , Bagby Stefan , Mchugh Neil , Tansley Sarah 
Published: April 2022

Abstract

Background/Aims
Idiopathic inflammatory myopathies (IIM) are multisystem diseases characterised by muscle inflammation. Over 60% of patients with IIM have a myositis-related autoantibody. Our laboratory specialises in autoantibody testing. We offer an extended spectrum autoantibody testing diagnostic service and have also screened over 3000 myositis patients enrolled in research studies for the presence of autoantibodies. We noticed a recurring pattern following K562 cell radio-immunoprecipitation that was present in several myositis patient sera and in a handful of samples that came to us via the diagnostic service. We set out to determine the antigenic target of this novel autoantibody.

Methods
We have previously screened 1319 serum/plasma samples from IIM patients enrolled in the UKMyoNet and 380 from patients with juvenile onset IIM enrolled in the JDCBS for autoantibodies by immunoprecipitation. Additional cohorts similarly investigated include &gt;150 healthy control sera and &gt;400 SLE patient sera. Patients with the novel autoantibody of interest were identified by a distinctive 120kDa band associated with a ‘smear’ on autoradiography following K562 cell immunoprecipitation and separation of autoantigens by SDS PAGE. ESI-QTOF mass spectrometry was used to identify the antigenic target in an example serum. Using a commercial anti-PARP1 antibody as a control, western blotting of K562 and PARP1 overexpressed cell lysate was used to confirm the antigenic target in remaining samples of interest. Indirect immunofluorescence was performed on HEp-2 cells according to manufacturers’ instructions.

Results
11 patient samples were identified as having the 120 complex ‘smear’ pattern of interest: six had been received via the diagnostic service and five were enrolled in UKMyoNet. Prevalence in the UKMyoNet cohort was 0.4%. Mass spectrometry identified PARP1 as the antigenic target. This was confirmed in all remaining samples by western blot. Table 1 shows available clinical data.

Conclusion
PARP1 is an autoantigen target in myositis patients in addition to those with other rheumatic diseases. Where data was available, patients with anti-PARP1 had features suggesting an anti-synthetase syndrome phenotype, but this may primarily relate to the other autoantibodies present. Further work is needed to determine the prevalence of anti-PARP1 in other cohorts and its clinical associations.

Disclosure
V. Riddell: Grants/research support; Bath Institute of Rheumatic Disease. Z. Betteridge: None. E. Bowler: None. H. Chinoy: None. P. Gordon: None. L. Wedderburn: None. S. Bagby: None. N. Mchugh: None. S. Tansley: None.
P248 Tuberculosis is still a major contributor to serious infection in juvenile SLE
Authors: Chatterjee Rudrarpan , Pattanaik Sarit Sekhar , Gupta Latika , Misra Durga P , Agarwal Vikas , Lawrence Able , Aggarwal Amita 
Published: April 2022

Abstract

Background/Aims
Infections are a major cause of morbidity and mortality in juvenile systemic lupus erythematosus (SLE). We assessed the incidence and risk factors for major infections in juvenile SLE.

Methods
We carried out a retrospective review of 175 patients of juvenile SLE (ACR 1997 criteria) with age &lt;18 years visiting the rheumatology clinic at a single centre between 2010 and 2020. Clinical details were retrieved from clinical case records and supplemented with data from the hospital's electronic health records. Major infections (defined as need for hospitalization, prolonged antibacterial therapy &gt;1 week, resulting in disability or death) were recorded. Predictors of infection and their outcomes were determined using multivariate logistic regression and Kaplan Meier survival analysis.

Results
Among 175 patients (154 were girls) with a mean age of 14.79±3.1 years, there were a total of 52 major infections in 43 patients with an incidence rate of 8.83 per 100 person-years. The respiratory tract (19) was the most commonly involved site followed by skin and soft tissue (10), gastrointestinal tract (6), systemic bacteremia (5), ear nose and throat (4), disseminated infection (3), urinary tract (2), central nervous system (1), joint (1) and dengue shock syndrome (1). Organisms isolated were Mycobacterium tuberculosis (11) which was the most common and predominantly extrapulmonary, followed by enterobacteria (12), Staphylococcus aureus (5), cytomegalovirus (3), Herpes zoster (2), Herpes simplex (1), MRSA (1), and Candida (1).
Gastrointestinal involvement (OR 4.21), major organ involvement (OR 2.5), use of cyclophosphamide (OR 7.63), higher baseline SLEDAI (16[11.5-21] vs 12[8.75-16.25]) and a higher daily dose of prednisolone (16.1±15.1mg vs 6.1±5.8mg) at the time of the infection were predictors of a major infection. On multivariate analysis, only higher daily doses of corticosteroids (OR1.09, 95% CI 1.05-1.14) and gastrointestinal involvement (OR 4.98, 1.05-23.65) were significant predictors.
Major infection-free survival at 1 year and 5 years was 82.5% (95% CI 76.8-88.7) and 72.5% (95% CI 65-80.9) respectively. There were eight deaths with five directly attributable to infection. Overall survival was worse in those who had an episode of major infection.

Conclusion
The risk of major infections in juvenile SLE is significant and associated with higher daily corticosteroid use and gastrointestinal involvement at baseline.

Disclosure
R. Chatterjee: None. S. Pattanaik: None. L. Gupta: None. D.P. Misra: None. V. Agarwal: None. A. Lawrence: None. A. Aggarwal: None.
P257 Are there regional variations in access to biological disease modifying anti-rheumatic drugs for the treatment of psoriatic arthritis in England?
Authors: Vivekanantham Arani , Coates Laura , Tillett William 
Published: April 2022

Abstract

Background/Aims
There are regional variations in access to biologic disease modifying anti-rheumatic drugs (bDMARDs) for patients with rheumatoid arthritis in the UK, with relative under-treatment according to established best practice. Similar concerns exist for access to biologic therapies for patients with psoriatic arthritis (PsA). In this study we set out to understand regional variations in access to bDMARDS for the treatment of PsA in England.

Methods
Formularies are mandated to be published by the National Institute for Health and Care Excellence (NICE). ValueBase, a personalised business intelligence company specialising in healthcare, tracks every change for every drug on every published formulary every day with data from January 2017 in 184 formularies. The Availability Index (AI) is used to standardise individual formulary listing differences. It is scored from 0-100 and calculated by dividing the ‘base score’ for prescribing initiators by the ‘prescribing position’. The ‘base score’ values included 0 (not recommended), 5 (unlisted/under review), 30 (restricted availability), 45 (specialist/hospital only), 65 (initiated by specialist, continued in primary care) and 100 (all prescribers). We would expect the optimal score to be &gt; 45 as these are specialist medications. The ‘prescribing position’ included where the drug is ranked on the formulary (e.g., first line).

Results
For anti-TNFa, the mean AI was 45 ([standard deviation] SD 16, minimum 0, maximum 100). For the IL-17 inhibitors, the mean AI was 48 (SD 17, the minimum 0, maximum 100). For the IL-23 inhibitors, the mean AI was 48 (SD 18, minimum 30, maximum 100). For the JAK inhibitors, the mean AI was 24 (SD 22, minimum 0, maximum AI 50). For the other monoclonal antibodies, the mean AI was 45 (SD 14, minimum 0, maximum 100). The rate of formulary adoption for new drugs approved since 2016 varied considerably (Table 1).

Conclusion
There are regional variations in access to bDMARDs for treatment of PsA in England. Such differences have also been demonstrated in other countries (e.g., Sweden) and call for further improvement towards delivering equitable PsA care, both nationally and internationally.

Disclosure
A. Vivekanantham: None. L. Coates: None. W. Tillett: Consultancies; WRT has received research funding, consulting, or speaker fees from Abbvie, Amgen, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer and UCB.
P278 Baseline characteristics and treatment response to ixekizumab categorised by sex in radiographic and non-radiographic axial spondylarthritis patients through 52 weeks: data from three phase III, randomized, controlled trials
Authors: Kiprianos Allan , van der Horst-Bruinsma Irene E , Bolce Rebecca , Hunter Theresa , Calderon David Marcelino Sandoval , Zhu Danting , Geneus Vladimir , Lisse Jeffrey R , Liu-Leage Soyi , Magrey Marina 
Published: April 2022

Abstract

Background/Aims
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease of the axial skeleton comprising two subtypes within the same spectrum: radiographic (r-axSpA) and non-radiographic (nr-axSpA). Previous studies have shown that clinical presentation and treatment response of males and females may differ despite similar disease burden. Ixekizumab (IXE), a high-affinity monoclonal antibody that selectively targets interleukin-17A, has demonstrated superior efficacy to placebo in the treatment of patients with r-axSpA (COAST-V/W [bDMARD-naïve/TNFi-experienced]) and nr-axSpA (COAST-X [bDMARD-naïve]). Here we report baseline characteristics and treatment response to IXE categorised by sex in patients with r-axSpA and nr-axSpA for up to 52 weeks.

Methods
Patients fulfilled the ASAS classification criteria for r-axSpA or nr-axSpA. Patients were randomized to receive 80 mg subcutaneous IXE every two weeks (Q2W) or four weeks (Q4W), or to placebo (PBO; 16 weeks COAST-V/W; 52 weeks COAST-X). Baseline characteristics and treatment outcomes were assessed. Patients were categorised by sex; missing data were controlled for using non-responder imputation (NRI) and modified baseline observation carried forward (mBOCF) analysis was conducted on continuous efficacy variables.

Results
At baseline, females were older, with significantly higher pain and fatigue scores and peripheral joint symptoms. ASAS40 response rate with IXEQ4W was achieved in 39% of males with r-axSpA by week 16, and 44% by week 52. Females achieved 16.7% at week 16, and 33.3% at week 52. In nr-axSpA, 46% of IXEQ4W males achieved ASAS40 at week 16 and 30% at week 52. 23.9% of females achieved ASAS40 at week 16, increasing to 30.4% at week 52.

Conclusion
This analysis demonstrates that, for the axSpA disease spectrum, females present with higher disease burden as reflected by higher scores in fatigue/tiredness, and spinal pain at night. Our findings indicate that males and females respond to IXE; however, females experience this benefit later in their treatment course, with a more prolonged attainment of peak response.

Disclosure
A. Kiprianos: None. I.E. van der Horst-Bruinsma: None. R. Bolce: Shareholder/stock ownership; Eli Lilly and Company. T. Hunter: Shareholder/stock ownership; Eli Lilly and Company. D. Marcelino Sandoval Calderon: Shareholder/stock ownership; Eli Lilly and Company. D. Zhu: Shareholder/stock ownership; Eli Lilly and Company. V. Geneus: Shareholder/stock ownership; Eli Lilly and Company. J.R. Lisse: Shareholder/stock ownership; Eli Lilly and Company. S. Liu-Leage: Shareholder/stock ownership; Eli Lilly and Company. M. Magrey: None.