bluuebunny/crossref_metadata_2025_split huggingface dataset:
P156 Multidisciplinary paediatric rheumatology clinics
Authors: Teoh Lisa 
Published: April 2022

Abstract

Background/Aims
Three years ago, long pending lists and poor engagement/accessibility were affecting JIA management. Physiotherapy was often not done within two weeks of joint injections. There were a few children with fixed flexion deformities.
Our aims were: timely and easy access to good multidisciplinary care; regular follow-up for children with JIA; timely physiotherapy after joint injections; holistic care through hospital and community.

Methods
1) Shared database to ensure all children received appropriate follow-up; 2) joint clinics with paediatrician, physiotherapy and occupational therapy; 3) therapy follow-up in the community; 4) handbook for families including team contact details.

Results
Improved service outcomes:
Improved clinical outcomes:

Conclusion
Working together in a joint approach has made us more efficient and effective. Winning the trust and engagement from our children and families over the last few years has made our work rewarding and led to improved clinical results.
We hope to be able to continue working in this way by gaining recognition from the trust of the value this adds for families.

Disclosure
L. Teoh: None.
P164 New JIA-at-NRAS resource Medicines in Juvenile Idiopathic Arthritis
Authors: Wilson Debbie L 
Published: April 2022

Abstract

Background/Aims
Biologics have been commissioned by the NHS for use to treat JIA since 2014. Many of the original biologics that were first developed have since lost exclusivity, allowing other manufacturers to produce highly similar versions (biosimilars). This difference between the originator and the biosimilar has caused confusion within the patient community, especially in how it has been communicated to them. Parents found the concept of biosimilars confusing and wanted more information about this, recommending that written material be provided. Previous conversations with healthcare professionals, parents and young people living with JIA had also found there was a lack of written information on all JIA medications so we looked into how this gap could be filled.

Methods
Knowing there was a need for this information, a focus group was convened with young people with JIA, parents of children with JIA and healthcare professionals. From this focus group and separate conversations with healthcare professionals it very quickly became apparent a resource not only covering medications for JIA but detailing the wider JIA journey was needed. This resource would need to cover each step from diagnosis to a young person taking control of their disease management. It would also cover how the complexity of the immune system means that some children/young people respond differently to medication; help them to learn about the unpredictability of the disease and to take control of managing their disease, particularly as they move onto adult rheumatology services. NRAS worked collaboratively with health writer and healthcare professionals to make sure this new resource covered all the topics that were discussed at the focus group and detailed all the medications used to treat JIA, including information on the issue of differentiating between biologics and biosimilars.

Results
The Medicines in JIA booklet is now freely available to all parents, young people and healthcare professionals from the jia.org.uk website. The addition of visuals makes the information easier to navigate, clearer to understand and helps to illustrate the JIA journey.

Conclusion
The feedback NRAS has received from both healthcare professionals and parents has been very positive: “We think that they’re absolutely fantastic, they cover everything, and I’m so pleased I’ve got these to give to parents and children.” Paediatric Rheumatology Nurse Haywood Hospital “This is brilliant and much needed. Great piece of work much appreciated by all of us”. Lead Nurse Nottingham Children and Young People’s Rheumatology Service “This has been my absolute saviour! It gives you support on administering the medicines and made me feel right at ease after reading it”. Parent of child with JIA

Disclosure
D.L. Wilson: None.
P167 COVID-19 perniosis, a differential diagnosis to consider in adolescent patients presenting with chilblain-like lesions
Authors: Gak Nataliya , Choida Varvara , Leandro Maria , Sen Debajit , Ciurtin Coziana , Fisher Corrine 
Published: April 2022

Abstract

Background/Aims
Chilblain-like lesions (perniosis) have been reported frequently during COVID-19 pandemic in children and adolescents with no history of exposure to cold temperatures or underlying autoimmune conditions. Patients with these skin changes reported mild COVID-19 symptoms or previous contact with confirmed COVID-19 cases before they became symptomatic. In the majority of cases, a causal relationship between SARS-CoV-2 infection and chilblain-like lesion has not been proven.

Methods
Retrospective review of patients with chilblain-like lesions, possibly secondary to SARS-CoV-2 infection, presenting to a tertiary Adolescent Rheumatology service between January and August 2021.

Results
We identified five, male, adolescent patients (mean age, 16 years old) who presented with new onset of chilblain-like lesions affecting fingers, toes and heels in December 2020, which coincided with the peak of second wave of COVID-19 infection. One month prior to skin changes occurrence, 3 out of 5 patients experienced mild respiratory COVID-19-like symptoms and the rest of the patients were asymptomatic but were in contact with COVID-19 positive cases following outbreaks in schools. 1 of 3 symptomatic patients had a positive COVID-19 PCR test prior to skin manifestations. 2 out of 4 patients with heel lesions had deep, full thickness skin loss heel ulcers and 2 of 5 patients had superficially ulcerated lesions on a finger and toes, respectively, resulting in inability to attend school. None of the patients had any other symptoms or signs to suggest an underlying autoimmune connective tissue disorder. Demographics, clinical features and serological data are summarised in Table 1. One patient underwent a biopsy of heel ulcer which was histologically consistent with perniosis. In two patients (40%) chilblain like lesions resolved spontaneously within 2 months. Three patients (60%), with progressive ulcerated lesions, required various combinations of treatments with aspirin, calcium channel blockers (nifedipine), topical or oral steroids and hydroxychloroquine with complete resolution of symptoms within 6 months.

Conclusion
Chilblain-like lesions, including heel involvement associated with mildly symptomatic COVID-19 infection, have been reported before. Our mini-case series raises awareness of ulcerating chilblain like lesions possibly secondary to COVID-19 in adolescent patients, which require early recognition and instigation of treatment leading to better patient’s outcomes.

Disclosure
N. Gak: None. V. Choida: None. M. Leandro: None. D. Sen: None. C. Ciurtin: None. C. Fisher: None.
P168 An enriched population of tissue-resident CD8 memory T cells in young people with juvenile idiopathic arthritis recapitulate findings from mouse models of inflammatory arthritis flares
Authors: Bolton Chrissy , Rich-Griffin Charlotte , Dendrou Calliope , Brown Chrysothemis , Al-Mossawi Hussein , Croft Adam , Wedderburn Lucy 
Published: April 2022

Abstract

Background/Aims
Asymmetrical joint inflammation at presentation and during flares of juvenile idiopathic arthritis (JIA) implicates resident cell populations and the microenvironment in disease. Persistent CD8+ tissue-resident cell populations have been identified from murine models, capable of priming the joint towards an exaggerated inflammatory response, which resist systemic treatment. Clonally-expanded enriched populations of these tissue-resident CD8+ memory T cells (TRM) have been identified in synovial fluid of children with JIA.

Methods
We integrate and compare scRNA-seq findings from paired synovial fluid mononuclear cells and blood mononuclear cell (PBMC) samples from children with oligoarticular JIA (n = 2), adults with psoriatic arthritis (n = 3) and blood from healthy adult volunteers (n = 4).

Results
A number of T lymphocyte and myeloid cell populations demonstrated enrichment amongst synovial fluid mononuclear cells (compared to paired PBMCs) that corresponded across arthritic subtypes. A mean of 2.98% of T cells in synovial JIA samples had the CD69+ITGAE+CD8A+ tissue-resident signature compared to a mean of 0.37% in paired JIA PBMCs and 0.24% in other sample types (P &lt;.00001, vs synovial psoriatic samples). These cells recapitulated previously observed traits of tissue-resident CD8+ T cells, including high expression of transcription factor RUNX3, granzymes and the FABP5 fatty acid transporter. In mouse models the chemokine CCL5 was critical for leukocyte recruitment to mediate inflammatory flares and indeed, JIA synovial fluid samples exhibited stronger expression of CCL5 in TRM. Additionally, transcripts for cytokines involved in CD8+ tissue-resident T cell regulation and maintenance were specifically enriched in JIA synovial samples compared to peripheral blood, including IL-15, IL-12, IFN-γ; suggesting an environment conducive to the persistence of this population.

Conclusion
We confirm the existence of previously-described cell populations in synovial fluid from JIA patients and identify the enrichment of CD8 T cells with a tissue-resident signature. Further study is required to identify the significance or functional implications of these populations.

Disclosure
C. Bolton: None. C. Rich-Griffin: None. C. Dendrou: None. C. Brown: None. H. Al-Mossawi: None. A. Croft: None. L. Wedderburn: Consultancies; L.R.W. receieved a consultancy fee from Pfizer unrelated to this work. Grants/research support; L.R.W. declares support from AbbVie, GSK, Pfizer, Sobi, and UCB to the CLUSTER Consortium.
P174 HLA B27 status and disease phenotype: a cohort study of 223 patients with enthesitis-related arthritis
Authors: Bouraoui Aicha , Fisher Corinne , Glanville James , Sen Debajit 
Published: April 2022

Abstract

Background/Aims
Enthesitis-related arthritis (ERA) is a subtype of juvenile idiopathic arthritis (JIA) accounting for 10-20% of patients with JIA. ERA is associated with a poor prognosis compared to other JIA subtypes. Whilst a high proportion of patients with ERA are HLA-B27 positive, the correlation between HLA-B27 status and disease phenotype is not well described. The aim of our study was to investigate the influence of HLA-B27 status on ERA phenotype.

Methods
Demographic and clinical data were collected and HLA-B27 positive and negative patients were compared. All subjects included met ILAR classification criteria. The data were analysed using R software (R version 4.0.4). Median and interquartile range (IQR) were calculated for continuous variables and frequency and percentage for categorical variables. Subgroup comparison was performed using the chi-squared test for qualitative variables, and Wilcoxon rank-sum for quantitative variables. P values less than 0.05 were considered significant.

Results
223 patients were included in this study. The median age of symptom onset was 12 years (IQR: 9-14). The median disease duration was 11 years (IQR: 7-14). 18% of patients had family history of HLA-B27-related disease and 67% had positive HLA-B27. 54% of patients were on conventional disease modifying anti-rheumatic drugs (cDMARDs). 80% were on biologic DMARDs (bDMARD). HLA-B27 positive patients (n = 148) and negative patients (n = 68) were compared. Our analysis revealed a higher proportion of male patients in the HLA-B27 positive cohort (74% [n = 111] versus 59% [n = 39], p = 0.02). HLA-B27 positive subjects developed ERA at an older age compared to the HLA-B27 negative group at 12 versus 11 years, respectively (p = 0.02). HLA-B27 positive patients also had a higher probability of an axial phenotype within 12 months of disease onset 51% (n = 75) in the HLA-B27 positive group versus 32% (n = 22) in the HLA-B27 negative group (p = 0.01). At any point of disease course, sacroiliitis was also more common in the HLA-B27 positive group (78% [n = 116] versus 63% [n = 43], p = 0.01), who also had a higher usage of bDMARDS (74% [n = 110] versus 56% [n = 38], p = 0.006). There was no significant difference between the two groups in terms of ethnicity, family history of HLA-B27 disease or the prevalence of extra-articular manifestations, including uveitis.

Conclusion
Our study revealed that patients with ERA who were HLA-B27 positive, were more likely to be male, developed disease at an older age and had a higher probability of axial phenotype at onset and later in disease. They also had an increased bDMARD requirement. These data suggest that HLA-B27 confers a worse prognosis clinically which is consistent with findings from other studies.

Disclosure
A. Bouraoui: None. C. Fisher: None. J. Glanville: None. D. Sen: None.
P185 Patients' and clinicians' perspectives on the clinical utility of the Rheumatoid Arthritis Foot Disease Activity Index
Authors: Hoque Anika 
Published: April 2022

Abstract

Background/Aims
Although patient-reported outcome measures (PROMs) are recommended in clinical practice, their application in primary care is limited. The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) is a validated PROM for assessing foot disease activity in rheumatoid arthritis (RA). This qualitative study aims to understand the clinical utility of the RADAI-F5 as a management tool for foot disease in RA.

Methods
Adult RA patients and rheumatologists, physiotherapists and podiatrists routinely involved in treating RA patients were recruited through convenience sampling. Recruitment continued until data saturation had been achieved. A 60-minute, semi-structured, one-on-one Microsoft Teams interview with participants was conducted. Interviews involved open-ended questions to explore barriers and facilitators to the clinical application of the RADAI-F5. These interviews were audio-recorded and transcribed verbatim, with each participant verifying the transcript to establish rigour and credibility. The transcripts were coded using Nvivo12, and inductive thematic data analysis was conducted to identify emerging themes.

Results
Eight RA participants: 7 females; mean [standard deviation, SD] age 52.4 [9.5], mean [SD] disease duration 16.1 [16.4] and eight clinicians; mean [SD] age 46.75 [5.3], mean [SD] years of clinical experience of 19.5 [2.21] participated. The RADAI-F5 has four key themes that support its clinical utility. These were as follows: ‘need for the RADAI-F5' because patients felt that feet were ignored during routine consultations and clinicians felt the need for a foot PROM that is accurate, short and quick to complete in clinical practice; ‘promoting patient-clinician communication' because it can identify areas of concern that may be under-recognized by clinicians; ‘guiding management' as implementing the RADAI-F5 could assist in the screening, monitoring foot disease status, and guiding future interventions; and ‘patient involvement,' since the tool may trigger patients to be more involved in their foot health self-management. Three themes were identified as potential barriers to implementation; ‘practical difficulties, including lack of time during appointments; ‘lack of validity', as clinicians were hesitant to use the RADAI-F5 until its validity is established further with the use of ultrasound imaging and clinical examination; and, ‘lack of an electronic database', since there is currently no electronic system for reporting RADAI-F5 results.

Conclusion
The results of this study suggest that the RADAI-F5 has significant potential as a clinical tool to aid foot disease management in RA. However, some barriers to implementation may need to be overcome to enable widespread uptake in rheumatology clinics.

Disclosure
A. Hoque: None.
P201 Sleep disturbance in early rheumatoid arthritis and fibromyalgia and its association with mood and quality of life
Authors: Wall Amanda J. W , Delmestri Antonella , Silva Naiduwa W. I. L , Soni Anushka 
Published: April 2022

Abstract

Background/Aims
Rheumatoid arthritis (RA) and fibromyalgia (FM) are common musculoskeletal conditions associated with pain, mood and sleep disturbance, functional limitations and poor health-related quality of life (QOL). Studies report sleep problems in 50-75% established RA and 70-90% FM. The aim of this study is to quantify the presence of sleep disturbance amongst patients with newly diagnosed RA or FM, to describe any association with measures of anxiety or depression, and to investigate the impact of sleep disturbance on QOL in this patient group.

Methods
Patients with a clinical diagnosis of early RA or FM were recruited from Rheumatology clinics over 12 months (ethics reference: IRAS Project 252762). Patients completed baseline patient reported outcome measures prior to commencing treatment: Insomnia Severity Scale (ISS), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Physical Activity Calculator (PAC) and the Short Form-36 Health Survey (SF-36). Students t-test, Mann-Whitney and Chi-squared test were used to compare normal, non-normal and binary data respectively. Regression modelling was used to investigate the association between sleep disturbance and the general health subscale of SF-36 (GHSF-36), adjusting for age, sex and rheumatic condition.

Results
161 participants were recruited: 84 had a diagnosis of early RA and 77 had FM, mean age 50 (16) years, 118 (73%) females. Moderate-to-severe insomnia was present in 34/84 (41%) of early RA patients and 56/77 (72%) of FM patients. Table 1 shows further baseline characteristics according to rheumatological diagnosis. Overall, there was a significant relationship between insomnia severity and general health (r=-0.39, p &lt; 0.001), anxiety (r = 0.49, p &lt; 0.001) and depression (r = 0.64, p &lt; 0.001). Regression analysis confirmed an association between baseline sleep disturbance and general health after adjusting for age, sex and diagnosis (ß=-0.79, 95% CI -1.22 to -0.36, p &lt; 0.001).

Conclusion
Although there is greater sleep and mood disturbance in patients with FM, 41% of patients with early RA also reported moderate-to-severe insomnia at the time of diagnosis. Activity levels remain similar between the two groups and insomnia severity was significantly associated with reduced health related QOL. This highlights the importance of addressing sleep, and mood, in Rheumatology clinics to help improve health related QOL.

Disclosure
A.J.W. Wall: None. A. Delmestri: None. N.W.I.L. Silva: None. A. Soni: None.
P203 Prevalence of lower limb disease activity and walking disability in the first two years of rheumatoid arthritis: results from the Scottish Early Rheumatoid Arthritis inception cohort
Authors: Kelleher Nancy , Hendry Gordon J 
Published: April 2022

Abstract

Background/Aims
Lower limb synovitis and walking disability are reported as common in rheumatoid arthritis (RA), however there is a paucity of contemporary longitudinal studies reporting prevalence rates from disease onset. The aims of this study were to determine i) the prevalence of lower limb synovitis and walking disability from first presentation to 2 years, and ii) the prevalence of active foot/ankle disease amongst participants in Disease Activity Score-28 (DAS28)-remission.

Methods
The Scottish Early Rheumatoid Arthritis (SERA) study is an inception cohort of newly diagnosed inflammatory arthritis patients attending rheumatology units across Scotland. SERA data included demographics and 6-monthly clinical outcome data. Data from participants diagnosed with RA were included. Synovitis was determined using tender and swollen joint counts recorded at hips, knees, ankles and metatarsophalangeal (MTP) joints 2-5, and dichotomised as present (≥1) or absent (0). Walking disability was measured using the Health Assessment Questionnaire (HAQ) walking subscale (range 0-3) and dichotomised at present (≥1) or absent (0). Prevalence rates are expressed as percentages of participants. Subgroup analysis was performed to estimate the prevalence of foot/ankle joint swelling in participants who were in DAS28-remission (&lt;2.6).

Results
A total of 932 participants (65.9% female) with a median (interquartile range [IQR]) age 59.5 years (49.5-68.1) were included, dropping to 391 at 2 years. Prevalence rates for lower limb synovitis and walking disability are reported in table 1. At 6 months, 138/816 (28.6%) participants met DAS28-remission criteria, followed by 124/691 (31.9%) at 1 year, 118/522 (39.2%) at 18 months, and 88/391 (39.5%) at 2 years. For those in DAS28-remission the prevalence of foot/ankle joint swelling was 10.3% at 6 months, 13.5% at 1 year, 17.6% at 18 months and 12% at 2 years.

Conclusion
Prevalence rates for knee, ankle and MTP joint swelling are initially high then stabilise, with largest reductions observed at 6 months. Joint tenderness prevalence rates follow a similar course but are consistently higher than joint swelling. Walking disability affects a significant proportion of patients throughout the first 2 years of RA. Clinically important rates of active foot/ankle disease are present amongst those classed in DAS28-remission.

Disclosure
N. Kelleher: None. G.J. Hendry: None.