bluuebunny/crossref_metadata_2025_split huggingface dataset:
P064 Impact of COVID-19 on physical and mental health of people with inflammatory conditions: the ICEPAC survey
Authors: Hider Samantha , Muller Sara , Gray Lauren , Manning Fay , Brooks Mike , Heining Dominic , Menon Ajit , Packham Jonathan , Raghuvanshi Subhra , Roddy Edward , Ryan Sarah , Scott Ian , Paskins Zoe 
Published: April 2022

Abstract

Background/Aims
Concerns about the risk of COVID-19 infection led to guidelines advocating shielding for many people with inflammatory conditions. We aimed to assess the impact of the pandemic on the self-reported physical and mental health of people with inflammatory conditions.

Methods
2024 patients with inflammatory conditions (RA, PsA, AS, SLE and other) were randomly selected from electronic health records. Survey invites were sent (August 2021 to coincide with relaxation of COVID restrictions) using a combination of SMS and postal approaches. Data collected included demographics, COVID infection and shielding status, physical (MSK-HQ) and mental health (PHQ8 and GAD7) and global impact on physical or mental health (4 options: none-severe). Ethical approval was obtained (REC Ref 21/PR/0867).

Results
639 people completed the survey, of whom 287 (44.9%) completed online. Mean (sd) age was 64.5 (13.1) years and 384 (64.7%) were female. The majority of people had RA although 57 (9%) reported more than one inflammatory condition. 349 (57.9%) of people were advised to shield. Rates of COVID infection were relatively low across the groups (Table 1). 254 (41.2%) reported moderate or severe impact of the pandemic on physical health, which impacted least in people with RA. 244 (39.4%) reported moderate or severe impact of the pandemic on mental health with 175 (28.7%) reporting moderate depression (PHQ8 ≥ &gt;10) and 138 (22.6%) moderate anxiety (GAD-7≥10).

Conclusion
Reported COVID infections were low in our cohort. The pandemic had significant effects on physical and mental health, which appeared less in people with RA than other inflammatory conditions.

Disclosure
S. Hider: None. S. Muller: None. L. Gray: None. F. Manning: None. M. Brooks: None. D. Heining: None. A. Menon: None. J. Packham: None. S. Raghuvanshi: None. E. Roddy: None. S. Ryan: None. I. Scott: None. Z. Paskins: None.
P074 Evaluation of incidence of COVID-19 infection and uptake of COVID-19 vaccine in sarcoidosis patients at a tertiary centre
Authors: Nagra Deepak , Gunawardana Shannon A , Bechman Katie , Birring Surinder , Patel Amit , Galloway James 
Published: April 2022

Abstract

Background/Aims
Sarcoidosis is a multi-system inflammatory disorder, characterised by the formation of non-caseating granulomas. In the UK, a decision was made to include sarcoid patients in the clinically extremely vulnerable group, and they were advised to shield during the COVID-19 pandemic. We investigated the incidence of covid-19 infection and uptake of COVID-19 vaccine within this patient group.

Methods
Consecutive patients attending the King’s College Hospital sarcoidosis clinic over 18 months between 1st January 2018 and 31st August 2020, and were still alive on 31st January 2020, were included in this report. Electronic primary care records and hospital records were reviewed for each patient to evaluate the incidence of RT-PCT confirmed covid-19 infection, hospitalisation, and vaccination status, defined as at least one vaccination. Hospitalisation data was available from four South-East London trusts.

Results
The King’s College Hospital database identified 416 patients with biopsy confirmed sarcoidosis. Of the complete cohort, the median age was 55.7 years, 193 patients (46%) were male, and 178 patients (43%) were of black ethnicity. A proportion of patients were taking prednisolone (n = 116, 28%) and DMARDs (n = 73, 18%). The incidence of RT-PCR confirmed covid-19 infection was 48/416 patients (12%). Of these infections, 16/48 (33%) were prior to vaccine availability, including one patient who required an intensive care admission. Post vaccine availability, 9/32 infections were in vaccinated individuals, 8/32 in unvaccinated and 15/32 were of unknown timing; there were 2 recorded hospital admissions but no intensive care admissions, neither patient was immunosuppressed and one was unvaccinated. Uptake of at least one covid-19 vaccine was 287/416 patients (69%). Of the cohort who opted not to have a vaccine (n = 129), the median age was 53.7 years, 60 patients (47%) were male, 58 (45%) were black ethnicity and 22 (17%) were white ethnicity. The only demographic variable to predict covid-19 vaccine uptake was ethnicity; patients of black ethnicity were less likely to have the vaccine than those of white ethnicity (OR = 0.56, p = 0.041). In vaccinated individuals, there were 9/287 cases (3%) of RT-PCT confirmed covid-19 infection, of which one patient required hospitalisation but not intensive care.

Conclusion
The incidence of covid-19 infection in our cohort is comparable to that of London (12%), despite an extremely clinically vulnerable population. Vaccine uptake was lower in sarcoid patients (69%) than the national comparator in adults (90%) and was especially low in the black ethnic population.

Disclosure
D. Nagra: None. S.A. Gunawardana: None. K. Bechman: None. S. Birring: None. A. Patel: None. J. Galloway: None.
P079 Building quality improvement capacity for rheumatology: outcomes from the first BSR national workshop
Authors: Sharp Charlotte A , Benson Rosalind , Baird Hannah , MacPhie Elizabeth 
Published: April 2022

Abstract

Background/Aims
Quality improvement (QI) is now an expected part of healthcare professional practice. After identifying a gap in available training and successfully delivering a QI course for 35 clinicians at the Northwest Rheumatology Club, trainee representatives were invited by the BSR invited to convene a national workshop.

Methods
The first BSR Quality Improvement Practical Methodology Workshop was held in March 2021 (online, due to COVID-19). Materials were adapted from the well-established Trainees Improving Patient Safety through Quality Improvement (TIPSQI) initiative. Plenaries covered the Model for Improvement, process mapping, SMART aims, driver diagrams, stakeholder engagement, illustrated using rheumatology-specific case-studies. Delegates (with mixed experience / professional role) practiced using tools in small, facilitated, breakout rooms. Pre-course surveys informed course design. Post-course and six-month follow up surveys evaluated impact. Because there are no validated tools to evaluate the impact of QI training, Kirkpatrick’s four-step hierarchical model, commonly used in this context, was employed.

Results
Of 30 delegates (consultants, trainees, pharmacists, nurses, physiotherapists), 28, 22 and 4 completed pre-course, post-course and six-month surveys, respectively (Table 1). For Kirkpatrick level 1, ‘reaction’, all respondents were ‘satisfied’, with 100% recommending to colleagues. Using driver diagrams as an exemplar to evaluate level 2, ‘learning’, pre-course, delegates were: not aware 16/28(57.1%), aware 9/28(32.1%), confident to use 3/28(10.1%), 0/29(0%) confident to teach. Post-course improvements showed confidence to use 22/22(100%), and teach 12/22(54.6%) (maintained at six months). Given low numbers of six-month respondents, assessing long-term impact is challenging. Evaluating level 3, ‘behaviour’, all 4/4(100%) respondents conducted QI post-course, with 2/4(50%) teaching. Delegates reported that the course gave confidence to use tools and support others. In evaluating level 4, ‘results’, 1/4(25%) felt the course had changed the impact of their work, with 3/4(75%) reporting time and institutional constraints as barriers to conducting QI.

Conclusion
The QI course has been commissioned as a BSR annual ‘core educational’ offering, with feedback showing it was needed, wanted, and effective in delivering core QI principles. In response to six-month feedback, additional post-course-support is planned in future, aiming to capacity build expertise in QI and embed a sustainable culture of improvement across the rheumatology community.

Disclosure
C.A. Sharp: None. R. Benson: None. H. Baird: None. E. MacPhie: Other; EM is the North West Rheumatology Club secretary and meetings have been sponsored by MSD, UCB, Abbvie and Lilly.
P080 Self-management individualised learning environment in rheumatoid arthritis
Authors: Bosworth Ailsa M 
Published: April 2022

Abstract

Background/Aims
An important but insufficient aspect of care in people with inflammatory arthritis (IA) is empowering them to acquire a good understanding of their disease and build their ability to deal effectively with the practical, physical and psychological impacts of it. This extends beyond drug therapy and emphasises the ability to self-manage, with the right support, as an essential component of care. Good self-efficacy and coping skills benefit and reduce health and financial burden to the individual as well as the health service, benefitting society overall. Provision of excellent supported self-management education is at the heart of what NRAS does and it was due to the difficulty of getting Commissioners to fund our group self-management that led to our deciding to build an e-learning programme to replace our 6- week face-to-face programme.

Methods
In 2019 with initial funding in place, we partnered with an e-learning platform provider who would help us realise our goal of developing a state-of-the art e-learning experience in a modular format for people with RA. We wanted the programme to be 1) simple to use; 2)interactive; 3)engaging; 4)able to measure impact through learning objectives and use of a validated patient reported outcome measure. The programme also had to be integrable with our Salesforce database within NRAS enabling us to target resources to individuals, driven by identified need.

Results
The pandemic delayed progress, however, we launched with 4 modules on 17th September, 2021. The four modules comprise: Foundation Module covering the importance of self-management which has the RA Impact of Disease PROM embedded; Newly Diagnosed; Meet the Team and Managing Pain and Flares. A fifth module on Medicines in RA will be launched by end 2021. SMILE meets NICE Quality Statement 3, against which teams are audited, and aligns with EULAR Recommendations for implementation of self-management strategies in IA. Since launch 3 weeks ago, nearly 300 people have registered. Well over 100 baseline RAID PROMs have been completed and we are starting to collect valuable data which will enable us to target more resources where they are needed.

Conclusion
SMILE-RA provides patients with a unique, engaging educational resource which they can watch and watch again with their family. It is also a useful resource for AHPs new to rheumatology. Further modules will be added in 2022 and beyond. Many modules on a wide range of topics are planned and so this is an on-going project which has input from health professionals and people with lived experience at its heart. Patients and HCPs have welcomed this new resource at a time when the rheumatology workforce is in crisis. We will be presenting more data in Q1 2022 which will be available for congress.

Disclosure
A.M. Bosworth: None.
P094 Occupation and work productivity in individuals with early inflammatory arthritis: results from the National Early Inflammatory Arthritis Audit
Authors: Bechman Katie , Cook Emma , Houssien Abdullah , Amlani-Hatcher Paul , Ledingham Jo , Galloway James , Walker-Bone Karen 
Published: April 2022

Abstract

Background/Aims
To continue working, work in the same occupation or work the same number of hours is one of the most important outcomes for individuals with inflammatory arthritis but is often diminished during the very early phases of disease. Our objectives were to describe occupation and work status in individuals with early inflammatory arthritis (EIA) from the National Early Inflammatory Arthritis Audit (NEIAA) and assess the impact of occupation and treatment response on work disability.

Methods
NEIAA is an observational cohort of adults with newly diagnosed EIA seen in rheumatology services in England and Wales between May 2018 and March 2020. Self-reported occupation was coded using the UK Standard Occupational Classification and classified using the National Statistics Socio-Economic Classification (NS-SEC). Work disability was assessed at diagnosis, 3 months, and 12 months, using the work productivity and activity impairment (WPAI) score, with absenteeism data dichotomized between those who reported any sick-leave and those who did not. Multilevel mixed-effects linear regression models were used to examine associations between occupation and WPAI score at baseline and over 12 months. Variables for adjustment were decided a priori and included only age and sex.

Results
There were 12,663 individuals with EIA, with 5999 (48%) in paid work defined as greater than 20 hours per week. Occupation data were available for 3720 individuals, with the highest proportion of patients in lower managerial, administrative, professional (n = 773) and semi-routine (n = 761) roles. At diagnosis, 171 patients (4.7%) had stopped work and 336 (9.2%) had changed jobs because of their EIA. Absenteeism was reported by 685 patients (29.5%). Compared to the higher managerial, administration and professional occupation group, the other occupational types demonstrated a greater level of productivity loss due to presenteeism and overall work impairment. Individuals in semi routine and routine occupations were more likely to stop work due to EIA. In the 12 months after diagnosis, absenteeism, presenteeism and overall impairment improved across all occupations. Achieving a good EULAR response at 3 months, but not occupational type, was associated with improvement in work outcomes over time (p value &lt;0.001).

Conclusion
Work disability is prevalent in individuals with EIA at diagnosis, with variation across occupation types. In the first 12 months after diagnosis improvements in all work outcomes are seen, with the greatest change in those who achieve a good EULAR response.

Disclosure
K. Bechman: None. E. Cook: None. A. Houssien: None. P. Amlani-Hatcher: None. J. Ledingham: None. J. Galloway: Consultancies; Sanofi, Novartis, Pfizer, Janssen, UCB. Grants/research support; Eli Lilly. K. Walker-Bone: None.
P096 Analysis of frailty in rheumatoid arthritis and its relationship with disease activity, hospitalization and mortality: findings from the Scottish Early Rheumatoid Arthritis cohort and UK Biobank
Authors: Hanlon Peter , Morton Fraser , Siebert Stefan , Jani Bhautesh , Lewsey Jim , McAllister David , Mair Frances 
Published: April 2022

Abstract

Background/Aims
Frailty is present in relatively young people with rheumatoid arthritis (RA) but its association with longitudinal outcomes is unclear. This study aimed to assess the prevalence of frailty in RA and its association with disease activity, all-cause mortality, and hospitalisation.

Methods
People with RA identified from Scottish Early Rheumatoid Arthritis cohort (recruited at diagnosis, mean age 58.2) and UK Biobank (identified using diagnostic codes occurring prior to baseline assessment, mean age 59). Frailty was quantified using the frailty index approach (a cumulative count of age-related deficits, assessed in both datasets) and the frailty phenotype (based on low grip strength, weight loss, low physical activity, exhaustion and slow walking speed, assessed in UK Biobank only). Disease activity was assessed using DAS28-score in SERA. Relationship between baseline frailty and all-cause mortality and unscheduled hospitalization was assessed adjusted for age, sex, socioeconomic status, smoking and alcohol (model 1), plus DAS28 in SERA (model 2). In SERA, changes in frailty index, DAS28, self-rated health and HAQ-DI were reassessed after 6 months.

Results
Using the frailty index, frailty was common in SERA (12% moderate, 0.3% severe) and UK Biobank (20% moderate, 3% severe). In UK Biobank 23% were frail using the frailty phenotype. Frailty index was associated with DAS28, age and female sex. Both the frailty index and frailty phenotype were associated with all-cause mortality and unscheduled hospitalisation. In SERA, the relationship with hospitalisation was attenuated after adjusting for DAS28 (table). In SERA, as DAS28 fell over time with treatment, 46% of moderately frail participants improved to mildly frail or robust states after 6 months. However, despite these improvements, participants with moderate or severe frailty at baseline had higher mean DAS28, greater functional impairment, poorer self-rated health, and still had higher mean frailty index than people who were robust or mildly frail at baseline.

Conclusion
Frailty is common in early and established RA and associated with hospitalisation and mortality. Frailty in RA is dynamic and, for some, may be ameliorated through controlling disease activity in early disease. Future work should explore how best to identify individuals likely to benefit from specific treatment strategies.

Disclosure
P. Hanlon: Grants/research support; Medical Research Council Clinical Research Training Fellowship (MR/S021949/1). F. Morton: None. S. Siebert: None. B. Jani: None. J. Lewsey: None. D. McAllister: None. F. Mair: None.
P102 The hidden face of Behcet’s syndrome; central nervous system involvement, a single-center experience
Authors: Yıldırım Reşit , Dinler Mustafa , Arslan Ayşe E , Bilge Nazife S. Y , Kaşifoğlu Timuçin 
Published: April 2022

Abstract

Background/Aims
Neurologic involvement in Behcet’s syndrome (BS) remains an unelucidated area that needs further attention. In this study, we aimed to analyze the patterns of neurologic involvement and evaluate their association with other clinical features.

Methods
800 patients with BS diagnosis according to The International Criteria for Behcet’s Disease (ICBD) followed in our center were retrospectively screened and 55 patients with central nervous system involvement and 20 patients with non-vascular BS were enrolled in this study. These patients were classified as sinus vein thrombosis (SVT), parenchymal involvement, and mixed (SVT and parenchymal). These groups were compared in terms of demographic and clinical features.

Results
Thirty-two (58,2%) of the patients were male. Distribution of neurologic involvement were as follows; 22 (40%) with isolated sinus vein thrombosis (SVT), 25 (%45) with isolated parenchymal, and 8 (%15) with mixed pattern. Central nervous involvement was the diagnostic feature of BS in 25 patients. Headache was the most common symptom followed by neurologic deficits and dizziness (44%, 25%, 16%). The most common sites of involvement were subcortical and periventricular areas followed by brainstem (63% vs 37%). In SVT group, positive family history of BS (p &lt; 0.001) and previous deep vein thrombosis (DVT) (p:0.004) were found higher. Smoking history, erythema nodosum, cardiac and pulmonary involvement were significantly higher in parenchymal group (p &lt; 0.001) (Table 1).

Conclusion
Although brainstem involvement is considered as more characteristic in BS, white matter and periventricular involvement were also found as common in our study. Notably, these subgroup analyses may suggest the speculation that BS shows clusters even within the neuro-vascular involvement.

Disclosure
R. Yıldırım: Other; Reşit Yıldırım is a member of Rheumatology journal as an associate editor. M. Dinler: None. A.E. Arslan: None. N.S.Y. Bilge: None. T. Kaşifoğlu: None.
P114 A service evaluation of the Myositis clinic at London North West University Healthcare Trust
Authors: Welding Imogen , Isaacs Anthony 
Published: April 2022

Abstract

Background/Aims
The idiopathic inflammatory myopathies (IIM) are a heterogeneous group of rare diseases, primarily characterised by inflammation of skeletal muscle which leads to muscle weakness, but often involving several other organ systems. The myositis service at London North West University Healthcare Trust (LNWUH) was created in 2017 with the aim of standardising care and improving clinical outcomes for patients. The International Myositis Assessment and Clinical Studies Group (IMACS) established disease activity core set measures to validate clinical response to treatment in studies, but the optimal treatment and real world data on clinical outcomes for patients with IIM is not well described. We undertook a service evaluation to understand the cohort, assess the effectiveness of the service, and in order to inform future service improvements for patients with IIM.

Methods
We performed a retrospective analysis of the IIM cohort at LNWUH as of January 2021, which consisted of 40 patients. Data were gathered from electronically stored notes and results.

Results
65% of our cohort were female, 35% were male. The age range was 18-85. The most common subgroup was dermatomyositis (22.5%). The presenting symptoms included muscle weakness (82.5%), dysphagia (32.5%) and interstitial lung disease (ILD) (27.5%). The most common primary antibody was HMG-CoA reductase, followed by anti-Jo1. More than one antibody was present in 47.5% of patients. three patients had no detectable antibody. 1 in 5 patients had a normal creatine kinase (CK) at baseline. 89% had a raised troponin at baseline, with only two of these having confirmed cardiac involvement on imaging (echocardiogram or cardiac MRI). 30% of the cohort are currently taking mycophenolate mofetil (MMF), 27.5% are taking methotrexate, and 20% are taking hydroxychloroquine. 30% of patients have received rituximab, 20% intravenous immunoglobulin (IVIg), and 7.5% cyclophosphamide. Normalisation of CK was seen in 80% of patients, compared with 20% for pulmonary function tests (PFTs). 63% of patients were in clinical remission one year after diagnosis. Three patients died, two from MDA5-positive rapidly progressive interstitial lung disease.

Conclusion
In our cohort of patients with IIM, most patients had a significant improvement in their CK and muscle strength with treatment, but there remain challenges. We have established a baseline demographic and clinical outcome data for our cohort that will be used to make service improvements in line with the BSR guideline in development “Adult patients with idiopathic inflammatory myopathy”, and to assess future performance of the service.

Disclosure
I. Welding: None. A. Isaacs: None.