bluuebunny/crossref_metadata_2025_split huggingface dataset:
P025 Do referrals to rheumatology meet the new British Society of Rheumatology (BSR) guidelines for adult patients with osteoporosis? A retrospective audit of a tertiary osteoporosis service
Authors: Baldeweg Friederike , Bubbear Judith , Keen Richard 
Published: April 2022

Abstract

Background/Aims
British Society of Rheumatology (BSR) released national guidance in September 2021 outlining appropriate referrals to adult rheumatology departments from primary care. Our tertiary metabolic bone service accepts referrals from primary care, secondary care and internal referrals.

Methods
We retrospectively audited the new patient referrals for 50 patients with osteoporosis seen in our clinic over the 6 months prior to the guidance publication. 86% were referred from primary care, 6% from secondary care and 8% from our orthopaedic colleagues. 92% patients were female and 8% patients were male. Mean age was 61.7 years (range 17- 85 years).
Results:
We found that the majority of patients with osteoporosis referred to our specialist service were within the new BSR guidance (45/50 patients or 90% of patients). Reasons for referring patients outside of the BSR guidance included deterioration in bone mineral density without fracture and a family history of osteoporosis. Of these patients, four were referred from primary care and one from secondary care (another rheumatology department). Of the 50 patients seen in our clinic, 48% were advised to commence parenteral bone protection medication. 2% were advised to start hormone replacement therapy (HRT) only. 6% were advised to either start or continue oral bisphosphonates. 38% of patients were advised to remain without bone protection treatment and monitor. 2% were given an alternate diagnosis other than osteoporosis.

Conclusion
We plan to undertake a further audit for a period of 6 months after the release of the guidance.
No funding to declare

Disclosure
F. Baldeweg: None. J. Bubbear: None. R. Keen: None.
P031 Assessing the safety and efficacy of JAK inhibitors in inflammatory arthritis
Authors: Smedley Imogen 
Published: April 2022

Abstract

Background/Aims
JAK inhibitors were recently licensed in the UK and have been shown to be efficacious in refractory moderate to severe rheumatoid arthritis and psoriatic arthritis. We aim to assess their efficacy and safety in use in clinical practice in NHS Tayside. Additionally, there have been several emerging safety concerns, particularly regarding infections and venous thromboembolism risk.

Methods
This project was an observational retrospective case note review of 130 patients. We assessed JAK-inhibitor efficacy via mean change in DAS28 and number of tender and swollen joints at 6 months after initiating therapy. Additionally, 6-month and 2-year drug survival rates were calculated. The presence of adverse events was evaluated.

Results
At 6 months JAK inhibitor therapy produced a mean reduction in DAS28 of 2.04 (p = 0.096) and a mean reduction in number of swollen joints of 3.72 (p = 0.002). Drug survival was 81.42% at 6-months and 51.25% at 24-months. Non-smokers, those with BMI &lt;30, biologic naïve patients and those prescribed a concomitant cDMARD all achieved a greater reduction in DAS28. 53 patients (40.77%) experienced an adverse event, including venous thromboembolism, acute diverticulitis and herpes zoster reactivation. In addition to these, 40.91% of patients experienced dyslipidaemia.

Conclusion
JAK-inhibitors are efficacious in controlling active disease in inflammatory arthritis, however, are better suited to some patients over others based on emergency concerns about side effect profiles. Longer follow up is needed to assess long term efficacy.

Disclosure
I. Smedley: None.
P039 Septic arthritis caused by Mycoplasma hominis in a patient with systemic lupus erythematosus
Authors: Hum Ryan M , Iftikhar Hajira , Tang Elaine Y , Bruce Ian , Ho Pauline 
Published: April 2022

Abstract

Background/Aims
Mycoplasma hominis is a commensal bacterium of the genitourinary tract which can be associated with infection in immunocompromised patients. Colonisation with M. hominis has been associated with reactive arthritis and septic arthritis. We describe a case of M. Hominis septic arthritis in a patient with SLE on maintenance immunosuppression.

Methods
A 27-year-old woman presented with a 2-week history of a swollen left elbow and fatigue which affected her ability to work. Otherwise, she was systemically well and afebrile. She had an established diagnosis of SLE since she was aged 8 years, and her SLE had included mucocutaneous, central nervous system, renal involvement, and haemolytic anaemia. Her SLE was controlled on azathioprine, hydroxychloroquine, and prednisolone 5mg daily. Clinical examination revealed a mildly warm, non-erythematous, tender and swollen left elbow with a 40° flexion deformity. Initial investigations showed raised CRP 41mg/L and ESR 32mm/hr. White blood cell and platelet count were normal. Procalcitonin was insignificant at &lt; 0.1ng/mL. Complements and urine analysis were normal, and dsDNA was negative. X-ray of the left elbow showed joint effusion. Ultrasound revealed active synovitis, subcutaneous oedema and purulent material in the joint. The fluid aspirate was straw coloured. Microscopy showed inflammatory cell count of 4230 white blood cells/mm, with 91% neutrophils. She was treated as probable septic arthritis with intravenous (IV) flucloxacillin. After 48 hours on IV antibiotics, her CRP remained elevated, and she developed pyrexia. Blood and joint fluid cultures were negative. MRI scan confirmed active synovitis with features suggesting joint infection. On discussion with microbiology, oral doxycycline was added on day 3 to cover possible atypical organisms. After a further 4 days the swelling, range of movement, and pain in her elbow had significantly improved. She was discharged home with oral flucloxacillin and doxycycline. On day 16 M. hominis was identified from the Bacterial Identification Services Colindale, by partial sequencing of 16s rDNA from the joint aspirate. She was therefore advised to continue with oral doxycycline for a total of 6 weeks.

Results
After treatment, her CRP, ESR and range of movement returned to normal.

Conclusion
This case highlights the potential pathogenicity of M. hominis in immunocompromised patients. A literature review found 35 published case reports of septic arthritis by M. hominis, with two occurring in patients with SLE. Approximately 70% of the affected cases were in immunocompromised patients who had a poor response to empirical antibiotic therapy. However, identification of M. hominis on joint aspiration and subsequent treatment with appropriate antibiotics resulted in good outcomes for all published cases.

Disclosure
R.M. Hum: None. H. Iftikhar: None. E.Y. Tang: None. I. Bruce: None. P. Ho: None.
P043 Challenges in the diagnosis and management of immune-mediated necrotizing myopathy in a patient on long-term statins
Authors: Khan Faris , Kuttikat Anoop 
Published: April 2022

Abstract

Background/Aims
Statins are very common medications prescribed for cardiovascular disease prevention and with their ever-increasing use; we expect a significant increase in even the rarest side-effects. Immune-mediated necrotising myopathy (IMNM) is a rare type of autoimmune myopathy characterised by relatively severe proximal weakness and is most associated with the development of anti-HMGCoAR (3-hydroxy-3-methylglutaryl CoA Reductase) autoantibodies in statin users. The objective of this clinical case report is to highlight this rare condition to avoid incorrect diagnosis, particularly in primary care, to ensure prompt and specific management.

Methods
A 51-year-old female presented to her GP with gradual onset muscle weakness particularly around her shoulders and legs. She had a history of hypercholesterolemia, for which she had been on atorvastatin 20mg daily for 4 years.

Results
Following a blood test by her GP, a raised CK of 16,670 iU/L prompted a hospital admission due to suspected skeletal muscle damage. MRI scan of thighs showed features of myositis and muscle biopsy showed necrotic regenerating muscle fibres with lymphohistiocytic inflammation consistent with necrotizing myopathy. Blood tests revealed positive anti-HMGCoAR antibodies (negative ANA, DNA, ENA & other myositis-specific antibodies) confirming a diagnosis of anti-HMGCoAR IMNM. Atorvastatin was stopped and treatment was initiated with high-dose IV methylprednisolone followed by oral prednisolone tapering course. She showed only minor improvement in symptoms over the initial 6 weeks. Methotrexate was then added, with gradual improvement in her symptoms and normalization of CK over the next 6 months.

Conclusion
IMNM is unique in that it does not improve with statin discontinuation alone, and usually requires a combination of steroid and steroid-sparing immunosuppressant. Early diagnosis is crucial as commencing treatment early leads to better outcomes in patients. Anti-HMGCoAR antibodies are highly specific for this condition and not associated per se with hyperlipidaemia, self-limiting statin side effects or genetic muscle disease. In patients presenting with muscle weakness who are taking statins, it is beneficial to perform anti-HMGCoAR antibody test (especially if persistent symptoms despite statin cessation) to promptly differentiate this rare condition from more common but less severe statin related myotoxicities.

Disclosure
F. Khan: None. A. Kuttikat: None.
P052 Case series: a rare form of calcinosis in patients with systemic sclerosis-myositis overlap
Authors: Achieng Sheilla , Samaranayaka Muditha , Herrick Ariane L 
Published: April 2022

Abstract

Background/Aims
Calcinosis is a well described entity that occurs in systemic sclerosis (SSc) and dermatomyositis. In patients with SSc, calcinosis typically occurs over pressure points but very rarely, widespread calcinosis may occur, presenting in an extensive pattern. We present a case series of four patients with SSc with this rarer form of diffuse calcinosis with the aim of raising awareness of this poorly recognised pattern of debilitating disease.

Methods
Four cases of SSc with extensive calcinosis were identified from a cohort of 461 patients with SSc who had attended a tertiary referral centre over the preceding 3 years, and their case notes reviewed.

Results
Demographic and clinical features of the four patients are summarised in Table 1. All four patients had the diffuse cutaneous subtype of SSc in the context of 102 patients [22%] of the entire SSc cohort of 461 patients, and all had overlapping features of myositis. Two were anti-Scl 70 antibody positive and the other two were anti-PMScl- positive. Widespread calcinosis was evident in all four patients in a pattern akin to ‘sheets’ of calcified deposits, very different to the lobular pattern of disease that has been well-described in the literature. Development of calcinosis occurred between one and six years of the onset of SSc, and in one patient the calcinosis discharged through skin at multiple sites. In all patients, treatment included mycophenolate mofetil. Treatments tried for the calcinosis included intravenous sodium thiosulfate in two patients (on the basis of anecdotal reports), but without significant clinical improvement.

Conclusion
It is well recognised that dystrophic calcification in SSc usually associates with disease duration. In our case series, however, all four patients presented with calcinosis very early on in the course of their disease and another striking point was that all had overlapping features of diffuse cutaneous SSc and myositis. Awareness of this widespread pattern of disease (and its associations) is lacking, highlighting a need for further research into the pathophysiology of this rare phenotype of debilitating calcinosis to identify future targeted treatments.

Disclosure
S. Achieng: None. M. Samaranayaka: None. A.L. Herrick: None.
P065 Post COVID-19 vaccination inflammatory arthritis: a case series of patients at a district general hospital
Authors: Fordham Sarah E , Achilleos Katerina M , Bhagat Shweta S , Sykes Mark P 
Published: April 2022

Abstract

Background/Aims
Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has undoubtedly changed the course of the pandemic and lessened hospital admissions and death as a result of the aforementioned virus. Reactive arthritis has been reported with other vaccinations, for example influenza, and now it seems patients are presenting with similar symptoms post SARS-CoV-2 vaccination, the first human mRNA vaccine to be used against a virus. There are occasional case reports in the literature of patients developing various rheumatological conditions post COVID-19 vaccination including reactive arthritis and polymyalgia rheumatica. Currently the Summary of Product Characteristics (SmPC) for Pfizer BioNTech, Moderna and AstraZenica vaccinations only list myalgia and arthralgia as side effects in the musculoskeletal and connective tissue disorders section. Our aim was to collect data in a prospective manner on patients who presented to clinic with a new rheumatological condition which was believed to have been triggered by receiving a COVID-19 vaccination and their progress was followed over time.

Methods
Data have been collected prospectively from patients who have presented to the West Suffolk NHS Foundation Trust rheumatology department with symptoms which are thought to be attributable to COVID-19 vaccination over the last five months.

Results
Nineteen patients had a new inflammatory condition that appeared to have been triggered by the COVID-19 vaccination. The mean age of onset of symptoms is 65.2 years (range 22-85 years) with the mean number of days between vaccine and symptom onset of 9.6 days. 89% presented within 14 days of vaccination. Eleven patients received the Pfizer BioNTech vaccine and 6 the AstraZeneca vaccine. Seven patients presented after their first vaccine and seven after their second. Three had symptoms after both. The most common presentation was a small joint polyarthritis (8 patients) and polymyalgia rheumatica type symptoms (5). All but one were seronegative. So far, outcomes have varied between self-resolution or conservative management (6 patients), short- and long-term prednisolone requirement (6) and initiation of disease modifying anti-rheumatic drugs (5).

Conclusion
The emergence of post-COVID-19 vaccine inflammatory arthritis appears to be a new condition which rheumatologists will be required to treat. With the introduction of booster vaccinations and third doses this phenomenon is likely to be seen in clinic for the foreseeable future. Further data are required in order to guide best treatment options and enable better prognostic indicators.

Disclosure
S.E. Fordham: None. K.M. Achilleos: None. S.S. Bhagat: None. M.P. Sykes: None.
P077 Developing a better explanation of osteoarthritis: results from a conjoint analysis of patient preferences
Authors: Paskins Zoe , Nicholls Elaine , Grossmann Heiko , McRobert Cliona , Peat George , Shivji Noureen , Bartlam Bernadette , Croft Peter , Jinks Clare , Maddison John , Main Chris , Quicke Jonathan , Porcheret Mark , Protheroe Joanne , Cottrell Elizabeth 
Published: April 2022

Abstract

Background/Aims
Despite the negative impact of osteoarthritis (OA) and existence of evidence-based guidelines, many patients and professionals lack clarity about the nature of OA and effective treatment strategies. This project aims to improve OA explanations in consultations and investigate the extent to which different explanation statements impact on intention to self-manage OA.

Methods
Participants registered at four general practices, aged ≥45 years, with a recorded consultation for OA in the previous two years were mailed a survey. The survey included eight pairs of potential OA explanation statements for participants to select the explanation that would most help them to self-manage their OA, alongside questions on socio-demographics, OA symptoms, comorbidity and health literacy. The OA explanations were designed using a partial-profile choice-based conjoint analysis (profile strength 4, comparison depth 3) from a set of 11 theoretically informed key attributes (Table 1). Each attribute contained two statements: one representing current information sources, and one a newly designed statement from our previous co-design work with patients and stakeholders.

Results
The survey response rate was 22% (428/1980) (average age = 65 years [SD = 10]; 66% female). The newer statement was preferred to the existing statement for 10 of the 11 statements (indicated by a positive regression coefficient) and 8 of these differences were statistically significant (p &lt; 0.05) (Table 1). Sensitivity analyses (e.g. to adjust the model to allow for within person correlation of response, and to test for 2-way interactions between model attributes) did not change the findings from the primary model.

Conclusion
Patients with OA preferred the newer statements, with one exception (causes). The preferred statements have been discussed with the project’s Patient Advisory Group and the statements combined into a written leaflet and animation, and further assessed using Flesch reading ease and Flesch Grade level. Our conjoint analysis has provided evidence about what explanation statements patients with OA prefer and improve likelihood of self-management. The next step is to evaluate the leaflet and written animation in think-aloud qualitative interviews before refining the OA explanation and widespread dissemination.

Disclosure
Z. Paskins: None. E. Nicholls: None. H. Grossmann: None. C. McRobert: None. G. Peat: None. N. Shivji: None. B. Bartlam: None. P. Croft: None. C. Jinks: None. J. Maddison: None. C. Main: None. J. Quicke: None. M. Porcheret: None. J. Protheroe: None. E. Cottrell: None.
P085 NRAS New2RA Right Start for people newly/recently diagnosed with RA
Authors: Bosworth Ailsa M , McNicol Iain 
Published: April 2022

Abstract

Background/Aims
The National Rheumatoid Arthritis Society (NRAS) follows best practice, evidence-based standards in all we do. Whilst huge strides have been made in the diagnosis and treatment of Rheumatoid Arthritis (RA), the impact on quality of life can be significant and for many, RA remains hard to come to terms with. Anxiety and depression are frequent co-morbidities seen in RA, particularly in the early stages. This can impede people’s ability to acquire knowledge about their disease together with supported self-management skills and coping strategies. The aim of Right Start is to improve outcomes of the newly/recently diagnosed with RA through a framework of emotional, educational and peer support, and access to high quality supported self-management resources tailored to individual need.

Methods
Right Start involves a simple, 4-step process: • a call (up to 1 hr) with a member of our helpline. • 1:1 peer support from trained volunteers with RA, 24/7 online community support • a tailored package of hard copy information with e-links of interest sent by post • further follow up available by helpline and individual peer support Right Start enables health professionals to meet their responsibilities against NICE Quality Standard 33, Statement 3, on which they are audited through National Early Inflammatory Arthritis Audit (NEIAA), and the EULAR Recommendations for implementation of self-management strategies in inflammatory arthritis.

Results
Since launch at BSR 2019, 71 rheumatology units have referred over 400 patients to this service. Approx. 1/3rd couldn't be contacted and after 3 attempts, a letter and newly diagnosed pack are sent, inviting contact at future date. Anecdotally people are highly satisfied with this service and a number of units are referring multiple patients. To gather empirical data on the impact of the service NRAS has partnered with Manchester University to undertake an Enhanced Right Start pilot in 5 UK rheumatology units involving the use of validated patient reported outcome and experience measures from the users recruited, and quantitative and qualitative data from the health professionals. The pilot is due to commence before end 2021. Meantime, referrals continue to grow.

Conclusion
The NHS rheumatology workforce is in crisis and Right Start enables professionals to offer evidence-based education and supported self-management resources to optimise patient care. A Nurse Consultant (West Middx.) said of the service: “I have found Right Start to be an excellent resource for people who have recently been diagnosed with RA. When time is limited time in clinic, a referral provides the patient with tailored information which complements the education I have been able to provide. Feedback from patients has been positive particularly relating to the phone calls with the NRAS helpline team and the NRAS volunteer with RA. I would definitely recommend the service.”

Disclosure
A.M. Bosworth: None. I. McNicol: None.
P086 Patient perceptions of musculoskeletal ultrasound as an educational tool in a rheumatology podiatry clinic
Authors: Newcombe Lisa , Tougher John , Kelleher Nancy , Woodburn Jim , Barn Ruth 
Published: April 2022

Abstract

Background/Aims
Emerging evidence suggests musculoskeletal ultrasound (MSUS) may benefit patient understanding of their inflammatory arthritis and medication adherence. The overall objective was to explore patient perceptions of MSUS when used as a patient education tool in relation to foot problems in people with rheumatic and musculoskeletal diseases (RMD).

Methods
Consecutive patients attending a rheumatology podiatry clinic at the Queen Elizabeth University Hospital Podiatry Department, Glasgow, were invited to participate. To gather information on how useful MSUS was for patient understanding of their foot problems, participants completed a brief questionnaire before and after their MSUS scan. MSUS assessment of affected foot structures was conducted by a single podiatrist with MSUS training (LN) using an Esaote MyLabAlpha portable US machine. Participants were shown both grayscale and power Doppler MSUS still images with/without video clips and caliper measurements depending on the presenting complaint. Anatomical foot models were used to orientate patients to foot anatomy and corresponding MSUS images.

Results
A total of 43 (12 male: 31 female) participants were recruited with a mean (SD) age of 50 (12) years and median disease duration (IQR) of 6 (1,10) years. The most common RMD was spondylarthopathy (30%) followed by RA (23%). In this group, the rearfoot region (35%) was most frequently involved. The most frequently affected structure was tendons (30%) with multiple structures affected in 19%. A range of mechanical and inflammatory MSUS diagnoses were made. 56% of participants had not previously seen MSUS of the joints or tendons, with the remaining 44% unsure. 93% reported the MSUS scan improved understanding of their foot pain and 98% reported it will make them more likely to adhere to podiatry treatments and advice [Table 1]. 98% also reported that MSUS was more useful than other educational resources for understanding their foot pain. Still images were selected most frequently as the method that made the most sense to participants.

Conclusion
This study provides preliminary evidence of the potential value of MSUS as an educational tool in podiatry, with potential to enhance adherence with podiatry interventions and rehabilitation programmes. Further work using a follow up design is required.

Disclosure
L. Newcombe: None. J. Tougher: None. N. Kelleher: None. J. Woodburn: None. R. Barn: None.