bluuebunny/crossref_metadata_2025_split huggingface dataset:
P134 Mortality rates in individuals with a history of fracture: does sex matter? Findings from the Hertfordshire Cohort Study UK
Authors: Laskou Faidra , Westbury Leo , Patel Harnish , Cooper Cyrus , Dennison Elaine 
Published: April 2022

Abstract

Background/Aims
The occurrence of hip and vertebral fragility fractures has been linked to increased mortality; possible explanations including fracture complications and multi-morbidity. Given the advances in osteoporosis management in recent years, and the time since this subject was last studied, we aimed to examine associations between previous fracture and mortality, and specifically to consider whether sexual dimorphism in relationships existed, using a UK community dwelling cohort of older adults (Hertfordshire Cohort Study), linked to death registers.

Methods
2997 (1579 men and 1418 women) participants were included in the study. At baseline, participants self-reported history of fractures and a subset (n = 992) underwent hip bone mineral density (BMD) assessment. Median follow-up time for mortality was 16.2 years. Previous fracture since age 45 years (any and minor trauma) and femoral neck BMD in relation to all-cause and cause-specific mortality (cancer, cardiovascular and other) were examined separately, using sex-specific Cox proportional hazards models, with and without adjustment for age.

Results
The mean (SD) age of participants at baseline was 65.7 (2.9) years for men and 66.6 (2.7) for women. 575 (36.4%) men and 365 (25.7%) women died over the follow up study period. 230 (14.6%) men and 155 (10.9%) women died from cancer and, 169 (10.7%) men and 70 (4.9%) women from cardiovascular diseases. 174 (11.0%) men and 138 (9.7%) women died from other causes. Among men who died from other causes, the most common conditions leading to death were dementia (9.2%), bronchopneumonia (8.1%) and Parkinson’s disease (7.5%); corresponding conditions for women were Alzheimer's disease (11.6%), pneumonia (9.4%) and dementia (8.0%). In women, mortality associated with diseases other than cardiovascular disease or cancer was increased significantly in the presence of a previous fracture since the age of 45 (unadjusted hazard ratio: 1.47, 95% CI: 1.01,2.15, p = 0.04) and minor trauma fracture (1.67, 95% CI: 1.14,2.46, P = 0.01); association regarding minor trauma fracture was robust to adjustment for age (p = 0.04). In men, a history of fracture since the age of 45 was associated with increased cancer-related mortality with and without adjustment for age (1.42, 95% CI: 1.01, 1.99, P = 0.04 without age-adjustment). Baseline BMD was not associated with increased mortality from any cause in either sex.

Conclusion
Our study has highlighted different associations between fracture and mortality in men and women, possibly suggesting different pathogenesis of fracture in the two sexes. Work in other large cohorts with linked mortality data might seek to replicate and further explore these associations.

Disclosure
F. Laskou: None. L. Westbury: None. H. Patel: None. C. Cooper: None. E. Dennison: None.
P144 Phalangeal microgeodic syndrome: is this very rare condition becoming more common?
Authors: Parker Lucy , Ahmad Moneeb , Mukherjee Sandeep , McAlinden Paula 
Published: April 2022

Abstract

Background/Aims
Phalangeal microgeodic syndrome (PMS) is a rare condition with only a handful of published case reports. Most of these cases are recognised in childhood, typically in Japan. It presents with pain and dusky discolouration in the digits, distinct from Raynaud’s phenomenon in that the colour change is fixed and pain constant. Symptom onset is related to cold exposure with first presentation usually occurring in winter. Features on magnetic resonance imaging (MRI) are striking and characteristic, with a distinct pattern of bone marrow oedema.

Methods
We report five cases of MRI-proven PMS all identified in the last 12 months, with symptom onset during the winter. The patients were all female, aged between 25 and 79. One patient was already under the care of rheumatology with an established diagnosis of systemic lupus erythematosus (SLE), but the remainder were de novo referrals presenting specifically with pain and discolouration of the digits. One patient developed symptoms 2 days after receiving the first dose of Pfizer/Biontech RNA vaccine against COVID-19. One patient had to self-isolate following a COVID-19 contact and developed symptoms shortly thereafter, although there was no proven infection in the affected individual.

Results
Four out of five cases were managed conservatively, with advice on maintaining core and peripheral temperature and skin integrity. Without any specific therapy, these four cases improved spontaneously to coincide with increasing seasonal temperatures. The fifth case with existing SLE was treated with intravenous pamidronate and subsequently with a calcium channel blocker, with some improvement in symptoms.

Conclusion
In these authors’ experience, it would seem PMS is increasing in incidence. It is unclear if this relates to wider availability and image quality of MRI, clinician bias due to personal experience of more cases or a genuine increase. The winter 2020/21 was particularly cold with sub-zero conditions lasting well into May, which may have impacted on this flurry of new cases. We have identified one prior case report which describes PMS in a patient with existing connective tissue disease. Our patient with SLE appeared to have a more severe clinical presentation requiring additional medical therapy to control the symptoms compared with the four cases where PMS was a stand-alone condition. Dermatological manifestations of acute COVID-19 infection are well documented in children and include chilblain-like lesions and acrocyanosis. Any association between COVID-19 and PMS is purely hypothetical and would require more study to identify any true relationship.

Disclosure
L. Parker: None. M. Ahmad: None. S. Mukherjee: None. P. McAlinden: None.
P145 Safety of colchicine or NSAID prophylaxis when initiating allopurinol for gout: propensity score-matched cohort studies
Authors: Roddy Edward , Bajpai Ram , Forrester Harry , Partington Richard , Mallen Christian D , Clarson Lorna , Padmanabhan Nishita , Whittle Rebecca , Muller Sara 
Published: April 2022

Abstract

Background/Aims
Initiating urate-lowering therapy for gout commonly triggers a gout flare and hence co-prescription of colchicine or non-steroidal anti-inflammatory drug (NSAID) prophylaxis is recommended. However, little is known about the incidence of adverse events associated with prophylaxis. We aimed to determine the risk of adverse events severe enough to warrant seeking healthcare associated with colchicine or NSAID prophylaxis when initiating allopurinol for gout.

Methods
We conducted two matched retrospective cohort studies, using linked data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) datasets. Adults aged ≥18 years with a Read code for gout and a new allopurinol prescription between 1997 and 2016 were identified. We compared those prescribed (1) colchicine or (2) NSAID prophylaxis with those prescribed no prophylaxis, individually matched by age, sex and propensity to receive prophylaxis, to reduce the impact of confounding by indication. Adverse events were identified in CPRD and HES using Read and ICD10 codes respectively. Associations between colchicine or NSAID prophylaxis and the first occurrence of each outcome were investigated using weighted Cox proportional hazards models. CPRD Gold and Aurum datasets were analysed separately and then combined using 2-stage individual patient data meta-analysis.

Results
13,945 individuals who initiated allopurinol with colchicine prophylaxis were matched to 13,945 who initiated without prophylaxis (mean age 63.62 years [95%CI 63.54, 63.70]; 78% male). Diarrhoea was the most common adverse event in the colchicine group, followed by nausea/vomiting, myocardial infarction (MI), neuropathy, myalgia, and bone marrow suppression (Table). Diarrhoea, MI, neuropathy, myalgia, and bone marrow suppression were significantly more common with colchicine prophylaxis compared with no prophylaxis. 22,880 individuals who initiated allopurinol with NSAID prophylaxis were matched to 22,880 who initiated without prophylaxis (mean age 63.34 years [95%CI 63.26, 63.42]; 78% male). Angina, acute kidney injury, MI, and peptic ulcer disease were significantly more common with NSAID prophylaxis than without (Table).

Conclusion
Gastrointestinal, cardiorenal, myoneuropathic, and haematological adverse events were associated with prophylaxis, although absolute event rates were low. This information can inform treatment decisions and choice of colchicine or NSAID for prophylaxis when initiating allopurinol.

Disclosure
E. Roddy: None. R. Bajpai: None. H. Forrester: None. R. Partington: None. C.D. Mallen: Grants/research support; Keele University School Of Medicine has received funding from BMS to support a non-pharmacological atrial fibrillation screening study. L. Clarson: None. N. Padmanabhan: None. R. Whittle: None. S. Muller: None.
P153 A patient-led survey into the benefits and limitations of telemedicine appointments for assessing children and young people with rheumatic conditions in Canada
Authors: Wilson Jennifer , Costello Wendy , Angevare Saskya , Beesley Richard P 
Published: April 2022

Abstract

Background/Aims
During the COVID-19 (coronavirus) pandemic, some healthcare provision shifted to remote, technology-assisted appointments (telemedicine). This study sought the views of parents/carers about telemedicine, identifying the benefits and limitations, to assist in improvement to future service provision.

Methods
An online survey was developed and shared via social media and direct contacts, targeted at parents of children with rheumatic and autoinflammatory conditions in Canada. Fieldwork took place during May 2021. Consent was provided during enrolment.

Results
A total of 157 responses were received (78% female, median age 12). The primary diagnosis for the majority was juvenile idiopathic arthritis (JIA; 39% polyarticular, 15% oligoarticular, 8% enthesitis-related JIA, 6% psoriatic, and 9% systemic). Respondents reported in-person appointments represent a considerable time burden (87% travel more than an hour to attend; 40% take a full day [or more] out of school to attend; 38% of parents take a full day off work). During the pandemic, the proportion having a telemedicine appointment increased from 5% to 82%. Table 1 shows the scores (1 worst, 5 best) given by parents about their telemedicine experience. Overall, most aspects scored positively (p&lt;.05). However, parents felt telemedicine was not as good as in-person appointments (mean 2.66, 95% CI 2.42-2.90).
The majority of respondents reported telemedicine appointments had saved them time (68%), and many said it enabled them to have an appointment (63%) and made the appointment safer (59%), and many said it saved money (44%). However, 78% felt that their consultant could not properly assess their child, 22% were concerned that the doctor could not identify changes in their child’s condition, 14% said it was hard to explain their child’s condition, and 18% of parents and 22% of CYP disliked telemedicine. Overall, 61% said they would prefer the next appointment to be in-person, while 31% were amenable to some combination of in-person and virtual care.

Conclusion
There are advantages to telemedicine, notably saving time and making appointments accessible, and overall parents reported satisfaction with remote appointments. However, parents continue to report the value of in-person appointments.

Disclosure
J. Wilson: None. W. Costello: None. S. Angevare: None. R.P. Beesley: None.
P169 The impact of online art therapy groups for paediatric rheumatology patients
Authors: Keane Megan H 
Published: April 2022

Abstract

Background/Aims
In January 2020 art therapy was offered to rheumatology patients at the Great North Children’s Hospital supported by the Teapot Trust, as open groups and 1:1 ward-based interventions. However, this service was suspended due to Covid 19 restrictions. In response to these restrictions and to the needs of the patients we offered weekly online art therapy groups.

Methods
The rheumatology team referred patients directly to the art therapist and groups were allocated. The aim was to provide a safe space for the exploration of difficult thoughts and feelings and to give opportunities for peer support and interaction. Group members defined their own goals, including: ‘to feel less worried about medical procedures’ or ‘to feel less lonely’. Parents also identified goals, including: ‘to provide something different for their child to associate with rheumatology treatment.’ Themes brought to sessions included medical anxiety, isolation, coping with loss, feeling different, resilience, control, independence and identity. Progress in therapy was measured using Goal Based Outcomes and online surveys, allowing children to report on their own progress.

Results
After six sessions all group participants reported progress towards meeting their individual goals. Clinical staff shared: “the last 18 months has been challenging for our patients and the need for additional therapy cannot be underestimated”, “we have had to adapt to provide art therapy and the ease of referral has made my job easier”, “our patients have valued and enjoyed their sessions, they can connect with each other so don’t feel so isolated with their diagnosis or treatment.” Parent feedback included: my daughter “was not in a very good place, she was very down and also grieving, these sessions have been invaluable to her, she has gained a lot of confidence in talking about her feelings and expressing them through art has been a great help.” My child “has been able to speak to other children like herself. To make friends and to open up a bit more.” “I have been surprised by how much of what they put down on paper was about the hospital. These are things that they don’t talk about and it has been an eye opener for me.” Patient's feedback included: it was important “to discuss my feelings in a safe environment without anyone thinking they were silly”, “Thank you for helping me express my feelings and have confidence to speak out”.

Conclusion
Offering art therapy online creates a forum for sharing experiences and developing a community. It has shown a positive impact on the wellbeing of the patients and their carers. In response to the positive feedback, the service will continue on a rolling basis.

Disclosure
M.H. Keane: None.
P194 Flares of rheumatoid arthritis following coronavirus vaccination
Authors: Hayward Rhys J , Farah Ziad 
Published: April 2022

Abstract

Background/Aims
With the emergence of the coronavirus vaccine and the clear and important role it provides in maintaining the health of individuals and the population, it is important that our patients receive or are recommended the vaccine. We here document a case series of patients who have long-term quiescent rheumatoid arthritis who then experienced a flare of disease activity after receiving a vaccine. This information is important to understand as it allows informed discussions regarding the side effect profile of the vaccine and also the influence this may have on the patient’s disease control and future management options.

Methods
Patients were reviewed in clinic as part of standard care. Individuals with rheumatoid arthritis who had experienced a flare defined as a self-reported disease activity score of &gt; 5.1 in otherwise stable disease were noted and their response to treatment reviewed. This was a review of usual clinical practice and did not alter the treatment undertaken or monitoring of the patent. Information obtained was through the consultation with a rheumatologist and the data was collected retrospectively through review of clinical notes and clinic letters.

Results
Table 1 outlines the patient details and treatment responses.
All flares occurred within two weeks of receiving the vaccine. Of the patients who flared, two required short-term steroid treatment; three an increase in the usual medications and one who had been in disease remission to re-start previous therapy. More patients in the Pfizer vaccine group required an escalation of usual care compared to the AstraZeneca vaccine group.

Conclusion
We report six cases of rheumatoid arthritis flare soon after receipt of the coronavirus vaccine. In all, disease control was returned with minimal changes to treatment, 33% of those requiring either no treatment or an intramuscular steroid injection alone. Therefore, we recommend that clinicians should counsel patients of this potential effect, but continue to advocate the vaccine, as the risk of complications to their underlying arthritis is very low and seemingly easily treatable.

Disclosure
R.J. Hayward: None. Z. Farah: None.
P195 Defining the relationship between pain intensity and disease activity in patients with rheumatoid arthritis: a secondary analysis of six studies
Authors: Ibrahim Fowzia , Ma Margaret , Scott David L , Scott Ian 
Published: April 2022

Abstract

Background/Aims
Pain is the main concern of patients with rheumatoid arthritis (RA). Whilst rheumatologists often focus on reducing disease activity to improve pain the relationship between disease activity and pain in RA is incompletely characterised. Our aim was to better understand this, by defining the associations, discordance, and temporal relationships between pain intensity and disease activity in RA.

Methods
We undertook a secondary analysis of 1,132 patients with RA followed-up over 12 months in five trials and one observational study. Pain intensity was measured using a 100mm visual analogue scale (VAS), and disease activity using the DAS28-ESR. Relationships between 12-month pain VAS and DAS28-ESR (overall score and its components) were evaluated using Spearman correlations, linear regression models, Bland-Altman plots, and Kappa statistics. Temporal relationships were evaluated by describing mean pain intensity scores in patients over time stratified by disease activity status.
Results: Associations: Linear regression models showed significant associations between pain intensity VAS and DAS28-ESR (Table). Patient global assessment (PtGA) scores explained 79.3% of the variance in pain VAS, and ESR only 19.7%. Correlations between pain intensity VAS and DAS28-ESR components were highest with PtGA (R = 0.88) and least with ESR (R = 0.10).
Discordance: “fair” agreement was seen between categories of pain intensity scores (categorised as low=VAS ≤34, moderate=VAS 35-74, high=VAS &gt;74 based on previous studies) and DAS28-ESR categories (Kappa statistic 0.287). 14% of patients in remission/low disease activity (LDA) had moderate/high pain scores; 18% of patients in high disease activity (HDA) had low pain scores. Bland-Altman plots showed many patients scored pain VAS and PtGA similarly.
Temporal relationships: changes in disease activity and pain intensity scores over time mirrored each other. When patients with baseline active RA achieved 12-month remission/LDA mean pain VAS scores fell by &gt; 60% from baseline. When patients in baseline remission/LDA had active RA at 12-months mean pain VAS scores increased by &gt; 60% from baseline.

Conclusion
Whilst pain intensity is closely related to DAS28-ESR, discordance occurs in a substantial minority of patients. The relationship between DAS28-ESR and pain intensity VAS scores is largely attributable to its significant association and strong correlation with PtGA scores.

Disclosure
F. Ibrahim: None. M. Ma: None. D.L. Scott: None. I. Scott: None.
P200 Combining protein quantitative trait and genetic risk score analysis to identify biomarkers of treatment response to TNFi in patients with rheumatoid arthritis
Authors: Li Zhaoxun , Ling Stephanie F , Nair Nisha , Isaacs John D , Hyrich Kimme L , Morgan Ann W , Wilson Anthony G , Barton Anne , Plant Darren 
Published: April 2022

Abstract

Background/Aims
Rheumatoid arthritis (RA) is an inflammatory joint disease that can lead to disability if inflammation is not controlled. Biologic disease modifying anti-rheumatic drugs (bDMARDs), including tumour necrosis factor inhibitors (TNFi), are an effective line of therapy for moderate to severe RA. However, treatment response to TNFi is not universal and cannot be predicted from clinical factors. In this study, a protein quantitative trait loci (pQTL) study and genetic risk score (GRS) analysis were combined to identify protein-based biomarkers that are predictive of TNFi treatment response.

Methods
Protein expression data were generated using Sequential Window Acquisition of All Theoretical Mass Spectra (SWATH-MS) in serum samples taken from 80 RA patients about to commence therapy with etanercept. Protein expression was log2 transformed and the k-nearest neighbour model was used to impute missing values. A pQTL study was performed in patients with available imputed genome-wide genetic variation data to detect cis-acting genetic markers (p &lt; 1E-05). GRS for pQTLs were subsequently tested in 1,430 RA patients with available genome-wide genetic and TNFi treatment response data (improvement in DAS28 between pre-treatment and 3/6 months on drug). The GRS analysis was adjusted for baseline disease activity, sex, conventional synthetic DMARD co-therapy and the first 10 principal components, calculated from the genetic datasets.

Results
Following imputation, expression levels for 271 proteins were analysed in 69 RA patients with available genotype data. 514 cis-pQTLs were found for 16 proteins. GRS for the proteins Apolipoprotein(a) (UniProt ID P08519, p = 0.017) and Carboxypeptidase N subunit 2 (P22792, p = 0.027) were found to be modestly associated with treatment response; however, scores for both proteins explained less than 1% of the variance in DAS28 difference between time-points.

Conclusion
This study identified two protein-based genetic biomarkers of treatment response to TNFi. However, genetic scores based on these proteins are unlikely to be useful predictors, explaining little variance in on-treatment disease activity.

Disclosure
Z. Li: None. S.F. Ling: None. N. Nair: None. J.D. Isaacs: None. K.L. Hyrich: Honoraria; Abbvie. A.W. Morgan: None. A.G. Wilson: None. A. Barton: None. D. Plant: None.