bluuebunny/crossref_metadata_2025_split huggingface dataset:
P172 NRAS Young Voices Panel
Authors: Wilson Debbie L 
Published: April 2022

Abstract

Background/Aims
NRAS understands that inflammatory arthritis affects people of all ages. In early 2020 NRAS decided that a voice of the JIA community was needed to inform and provide guidance on a framework for JIA services at NRAS. The group would also empower younger people with RA, who are often frustrated by the perception that the condition “only affects elderly people”.

Methods
NRAS recruited a group of young people with lived experience of JIA and RA to reflect the target population of the JIA service age range. The group were drawn from diverse backgrounds and now it includes representation from the Cabinet office, health care professionals and experts in youth engagement and digital marketing together with PhD students and creative professionals.

Results
Throughout the last 12 months the Young Voices Panel have developed and prioritised the service framework for young people with inflammatory arthritis and JIA-at-NRAS. One of the main priorities was peer-to-peer support and now having the JIA Parents online group we can offer this to parents, alongside our other new JoinTogether online groups as well (e.g. 18 to 35year olds, Working with inflammatory arthritis, Parenting with inflammatory arthritis and Exercise and Back to Sport with inflammatory arthritis). The Young Voices have shared their stories and experiences in Facebook Live sessions during RAAW, Wear Purple for JIA in November 2020 and recently for the new #WearPurpleForJIA Wellbeing Week in June 2021. Some of the Young Voices were also part of the focus group for the new Medicines in JIA booklet which has now been launched. They spoke with parents during our zoom event Coping with JIA during COVID-19 in March to show parents that their children can thrive in life whilst learning to manage to the ups and downs that RA/JIA has. They also shared their experiences with young people at the young person’s event Navigating your future with inflammatory arthritis in April discussing how to tell friends and partners about their disease and where to find support at university and explain to employers about the conditions. They have also helped NRAS focus on what young people may want from the new JIA digital membership and participated in raising awareness for young people with JIA/RA podcasts and articles for Enable magazine.

Conclusion
The Young Voices Panel have been an integral part of NRAS and will continue to develop the service framework and be the voice of young people with JIA/RA. Feedback from events: “Thank you for sharing your stories and experiences, you are inspirational”. “I am so glad that young people are getting of a voice with regard to being diagnosed with arthritis”.

Disclosure
D.L. Wilson: None.
P184 Are there any ethnic differences in the response to Janus Kinase Inhibitor therapy for the treatment of rheumatoid arthritis?
Authors: Jubber Ameen , Hussain Wajith H. Z , Moorthy Arumugam 
Published: April 2022

Abstract

Background/Aims
Baricitinib is an oral, synthetic Janus Kinase inhibitor. It has become a commonly used drug in the treatment of rheumatoid arthritis (RA), both as combination therapy and monotherapy. Previous studies have compared drug efficacy in different ethnicities, but no studies have compared the efficacy of baricitinib for the treatment of RA in different ethnicities. Given the large South Asian population in Leicestershire, we reviewed our cohort of RA patients on baricitinib to see whether there is any difference in drug response rates between the Asian and Caucasian cohorts.

Methods
This was a retrospective study. Patients included were those under the care of rheumatology at University Hospitals of Leicester (UHL) with a diagnosis of RA and either receiving baricitinib, or had received it in the past. Data was collected using the UHL IT systems, clinic letters, and pharmacy records. In addition to ethnicity, we reviewed patient age, gender, concurrent DMARDs used, previous biologics used, baseline and post-treatment DAS28, dropout from therapy, baseline biochemical assays (anti-CCP and RF status) and radiographic findings. Independent T-test was used to compare continuous data and the Pearson Chi-Square test was used to compare categorical data. SPSS was used to analyse the results.

Results
120 patients were included in the analysis and data was analysed with PFA. There was no statistically significant difference in the mean DAS28 at baseline (Asian 5.17 vs Caucasian 4.65, p value 0.107) and post-treatment (Asian 2.83 vs Caucasian 3.33, p value 0.404) (see table 1). Comparing both ethnicities, there was no statistically significant difference in previous biologics used, the presence or absence of anti-CCP and RF, and radiographic findings of erosions. Limitations of the study include the low proportion of post treatment DAS28 values recorded and absence of data comparing primary or secondary biologic failure.

Conclusion
This is the first study of its kind and found no significant difference in baricitinib response between the Asian and Caucasian cohorts. Future studies are needed to evaluate this subject further. Such data is important as it can contribute to a body of evidence that may in future help inform clinical decision making.

Disclosure
A. Jubber: None. W.H.Z. Hussain: None. A. Moorthy: None.
P189 A longitudinal study of psychological predictors of response to adalimumab in patients with rheumatoid arthritis
Authors: Raza Nahrin , Nair Nisha , Plant Darren , Hyrich Kimme , Morgan Ann W , Isaacs John , Wilson Anthony G , Barton Anne 
Published: April 2022

Abstract

Background/Aims
The treatment of rheumatoid arthritis (RA) has improved since the introduction of targeted biological disease-modifying antirheumatic drugs (bDMARDs), such as adalimumab. However, no treatment options for RA are universally effective. Psychological factors may have an important role in treatment response. Published data reported that pre-treatment psychological variables such as an increased treatment necessity belief correlated with better adherence to adalimumab in RA patients. This current study aimed to investigate whether psychological factors correlate with change in 4V-DAS28-CRP as well as subcomponents of the score in adalimumab-treated RA patients.

Methods
Psychological, clinical and demographic data and DAS28 scores were collected pre-treatment, and at 3,6, and 12-months post-treatment, as part of a prospective national study, BRAGGSS. Sixteen pre-treatment clinical and psychological variables were tested for association with treatment response at 3 and 12 months. Multiple linear regression models were analysed and a Bonferroni corrected p-value of &lt; 0.003 was applied at each interval to assess significance.

Results
Data was available for 501 patients at 3 months follow up. Pre-treatment Beliefs about Medicine Questionnaire (BMQ) scores with regards to treatment necessity (P = 0.001), and two domains of the Illness Perception Questionnaire (IPQ), which were treatment belief and treatment control (P = 0.0001), correlated with the change in DAS28 by 3 months (Table 1). At 12 months, data were available for 362 patients. The treatment belief domain of the pre-treatment Illness Perception Questionnaire correlated with the change in tender joint count (P = 0.001) (Table 1). At 12 months no other sub-components correlated with the psychological variables.

Conclusion
Pre-treatment scores with regards to Illness Perception and Beliefs about Medicine correlated with 4V-DAS28-CRP response at 3 months. Of the subcomponents of DAS28, the psychological variables showed the highest correlation with tender joint count; as the tender joint count receives the highest weighting in the 4 variable DAS28 score, this may confound the assessment of treatment response. It will be necessary to undertake further analyses to assess the predictive value of these potentially modifiable psychological variables identified, but to also understand factors contributing to these psychological scores, such as the role of severe disease itself on psychological beliefs.

Disclosure
N. Raza: None. N. Nair: None. D. Plant: None. K. Hyrich: None. A.W. Morgan: None. J. Isaacs: None. A.G. Wilson: None. A. Barton: None.
P190 Unsupervised automated clustering of mass cytometry data identifies unique CD4+ T cell subsets in rheumatoid arthritis
Authors: Mulhearn Ben , Marshall Lysette , Sutcliffe Megan , Barton Anne , Raychaudhuri Soumya , Viatte Sebastien 
Published: April 2022

Abstract

Background/Aims
Treating rheumatoid arthritis (RA) continues to rely heavily on a trial-and-error approach. The potential of deep immunophenotyping of peripheral blood remains to be proven in tailoring treatment to an individual’s biological variability. Here, we aim to compare the analysis of single-cell data using an unsupervised automated clustering approach with conventional biaxial gating to identify T cell imbalances RA.

Methods
Unstimulated and stimulated peripheral blood mononuclear cells from 10 RA and 10 healthy controls (HC) were immunophenotyped by mass cytometry (CyTOF) using a T-cell panel. Firstly, a conventional biaxial gating strategy and standard definitions of Th cell subsets were applied to compare subset frequencies between cases and controls. Secondly, publicly-available unsupervised analytical workflows [1] were used to automatically define cell clusters hypothesis-free. Their differential abundance between RA and HC was assessed with Mixed-effects modelling of Associations of Single Cells (MASC)[2].

Results
Applying unsupervised automated clustering algorithms clearly identifies unusual marker combinations and a Th1/Th17 : Th2/Treg imbalance in RA in this small sample size, while conventional analytical techniques fail to do so. Cell clusters, including a classical pro-inflammatory Th1-like (IL-2+ T-bet+) subset and a novel IL-17+ T-bet+ subset were significantly enriched in RA compared to HC (odds ratio 4.9, P = 6.6 x 10-4; odds ratio 5.5, P = 1.1 x 10-2). In contrast, a FoxP3+ IL-2+ HLA-DR+ cluster was amongst those reduced in RA (odds ratio 0.2, P = 2.0 x 10-7).

Conclusion
Automated clustering techniques are more powerful than conventional analytical methods when analysing high-dimensional single-cell data. A hypothesis-free approach allows identification of novel cell clusters with unexpected marker combinations, such as T-bet and IL-17, which might otherwise be overlooked with biaxial gating.
References[1] Robinson MD et al. 2017. F1000Research.[2] Fonseka CY et al. 2018. Sci. Transl. Med.

Disclosure
B. Mulhearn: None. L. Marshall: None. M. Sutcliffe: None. A. Barton: None. S. Raychaudhuri: None. S. Viatte: None.
P206 A survey to explore how our rheumatoid patients used the British Society for Rheumatology electronic patient-reported outcome measure platform
Authors: Fish Sarah J , Brazendale Jane , Greenall Carol , MacPhie Elizabeth 
Published: April 2022

Abstract

Background/Aims
Patient-reported outcome measures (PROMs) engage and empower patients, providing a powerful tool in understanding the impact of healthcare interventions. Where PROMs are embedded in clinical practice, trends can be recognised, informing treatment decisions. In August 2020, the British Society for Rheumatology launched its ePROM platform; in March 2021 recruitment of our Rheumatoid arthritis (RA) patients commenced. Six months later, we were keen to explore patient engagement, confidence completing self-reported DAS28 and determine if patients viewed ePROMs as enhancing their care.

Methods
The ePROMs platform was discussed with patients with stable RA. To date 88 RA patients are registered, each was sent an immediate DAS28 followed by six monthly DAS28’s. In September 2021 a survey was created on SurveyMonkey® and emailed to patients registered. The survey gathered: age, employment status, disease duration and treatment pathway, previous use of apps to record DAS28, utilisation of ePROMs to record DAS28, response times to DAS28 completion requests, engagement with DAS28 patient video before completion of DAS28, time taken to complete DAS28 electronically, confidence assessing own joints, experience of ePROMs influencing patient involvement in own care, benefits of ePROMs for patient, suggestions for improvement.

Results
The response rate was 23.8% (21), with 42.8% (9) of respondents having completed a DAS28 ePROM. See table of ePROM survey results. The majority of respondents were 65+ years old with 10+ years’ disease duration and unemployed/retired. Under half had completed a self-reported DAS28, of those over 70% had viewed the patient video and over 90% felt confident completing the DAS28, with 90% feeling that ePROMs increased their involvement in care. Patients commented that with ePROMs they feel well connected to the team. One patient reported, ‘Exact answers are given. I feel face to face, l say that I feel fine when I don't’.

Conclusion
Only 42.8% of our RA patient respondents have engaged with the ePROMs platform and completed a DAS28, of which 90% of patients were confident completing a self-reported DAS28. For respondents who have engaged with ePROMs, their experience has been positive and empowered them to feel involved in their care.

Disclosure
S.J. Fish: None. J. Brazendale: None. C. Greenall: None. E. MacPhie: Other; EM is the North West Rheumatology Club secretary and meetings have been sponsored by MSD, UCB, Abbvie and Lilly.
P209 Subgroups of refractory rheumatoid arthritis and difficult to treat features highlight differences in comorbidity and smoking history - a single-centre observational study
Authors: Rogers George , Tan Yvonne , Shukla Rudresh , Gorodkin Rachel , Parker Ben , Bruce Ian , Humphreys Jennifer , Barton Anne , Hyrich Kimme , Bruce Ellen , Ho Pauline , Buch Maya H 
Published: April 2022

Abstract

Background/Aims
Limited therapeutic efficacy and ‘difficult to treat’ (D2T) characteristics mean some rheumatoid arthritis (RA) patients cycle through multiple therapies to achieve their treatment targets. The aim of this study was to evaluate for subgroups of refractory RA (RefRA) in a real-world population and describe D2T characteristics.

Methods
Patients on their third or more targeted therapy were identified from the electronic health record (EHR) at Manchester Royal Infirmary. Demographic and clinic information were obtained. Raised disease activity was identified as DAS28ESR&gt;3.2. Findings of power Doppler joint synovitis on ultrasound (PDUS) if undertaken within a month of clinical assessment. These data were used to categorise patients as raised disease activity and PD positive (persistent inflammatory RefRA, PIRRA) or raised disease activity in the absence of PD (non-inflammatory RefRA, NIRRA). Descriptive analyses were used to describe the characteristics in the two groups. Missing data were counted as negative observations.

Results
82 patients who were on a third advanced therapy or higher were identified. 41/82 (50%) had raised disease activity and 32/41 (78%) had MSUS performed. 18/32 (56%) of these were PIRRA and 14/32 (44%) were NIRRA. Table 1 details demographic and clinical characteristics in the two groups as well as the controlled RefRA population.
The PIRRA group had more erosive disease [13/18 (72%) PIRRA vs 8/14 (57%) NIRRA] and smoking history [9/18 (50%) of PIRRA vs 5/14 (35%) of NIRRA]. The PIRRA group also had greater levels of co-morbidity but previous bDMARD toxicity was comparable between the two groups.
Whilst the DAS28ESR was higher in the PIRRA group, there were only marginal differences in the tender and swollen joint counts and CRP compared to NIRRA.
The controlled RefRA population as expected showed notably lower DAS28-ESR and individual components although more similar to the PIRRA group with regards to comorbidity.

Conclusion
Just over half of the ref-RA cohort with raised disease activity had MSUS-detected synovitis and may be regarded as PIRRA. The PIRRA group had higher disease activity although joint counts and even acute phase were comparable. Higher smoking history and comorbidity appear to distinguish PIRRA and NIRRA in this cohort.

Disclosure
G. Rogers: None. Y. Tan: None. R. Shukla: None. R. Gorodkin: None. B. Parker: None. I. Bruce: None. J. Humphreys: None. A. Barton: None. K. Hyrich: None. E. Bruce: None. P. Ho: None. M.H. Buch: None.
P225 A case of PL-7 positive amyopathic dermatomyositis associated with autoimmune liver disease
Authors: Lee Martin A , Scott-Lang Victoria , Raja Kaiser , Sahu Sharmishta 
Published: April 2022

Abstract

Background/Aims
Amyopathic dermatomyositis (ADM) is a variant of dermatomyositis (DM) characterized by the presence of pathognomonic skin features of dermatomyositis but without clinical muscle weakness. ADM is believed to account for about 20% of cases of DM.

Methods
We present the case of a 40-year-old lady who presented in May 2020 with a 6-week history of periorbital oedema and a heliotrope rash. She had a past medical history of rectosigmoiditis diagnosed on colonoscopy in 2018 managed with mesalazine 2g once a day. Blood tests revealed a transaminitis (ALT 372 u/l, AST 201 u/l). Full blood count was normal as were inflammatory markers (ESR 4 mm/hr, CRP 2 mg/dl) and renal function (creatinine 63.9 umol/l). CK was normal (72 u/l). A non-invasive liver screen including hepatitis B and C, caeruloplasmin, alpha-fetoprotein and anti-mitochondrial antibodies was negative. A liver ultrasound was reported as normal. An ANA was positive and an ENA screen revealed positive RNP-68, S/RNP and anti-smooth muscle antibodies. Atypical pANCA antibodies were also positive. A myositis antibody screen revealed a positive PL-7 antibody. A skin biopsy of the affected area around the eye demonstrated prominent dermal periadnexal and perivascular chronic inflammation composed mainly of lymphocytes and plasma cells consistent with a connective tissue disease. A liver biopsy confirmed autoimmune liver disease (AILD). Tumour markers (CEA, CA 125 and CA 19-9) were normal and a CT scan of the chest, abdomen and pelvis to rule out occult malignancy was normal. Full lung function tests including transfer factor were normal. A diagnosis of PL-7 positive ADM with associated AILD was made.

Results
The patient’s ADM and AILD were successfully treated with a reducing course of budesonide (6mg three times daily for 4 months reduced to 3mg twice daily for four months then 3mg daily for 3 months) and mycophenolate mofetil 720mg twice daily. Currently, 16 months after her initial presentation, the patient’s ADM and AILD are in remission and she remains on mycophenolate mofetil 720mg twice daily.

Conclusion
Anti-PL-7 is one of a number of anti-aminoacyl tRNA synthetase (ARS) antibodies that are associated with DM, polymyositis (PM) and ADM. Other anti-ARS antibodies include Jo-1, PL-12, EJ, OJ, KS, ZO and YRS/HA. Antibodies to PL-7 have been reported to be associated with milder muscle involvement than antibodies to Jo-1. Antibodies to PL-7 have been associated with severe interstitial lung disease (ILD). An association between AILD and inflammatory myositis has been reported in the literature but only in a handful of case reports. To the best of our knowledge however, AILD has not previously been reported in PL-7 positive DM, PM or indeed ADM.

Disclosure
M.A. Lee: None. V. Scott-Lang: None. K. Raja: None. S. Sahu: None.
P246 Revision to musculoskeletal domain of BILAG-2004 index to incorporate ultrasound findings
Authors: Sandler Robert D , Vital Edward M , Prabu Athiveer , Riddell Claire , Mahmoud Khaled I , Teh Lee-Suan , Edwards Christopher J , Yee Chee-Seng 
Published: April 2022

Abstract

Background/Aims
The BILAG-2004 index grades musculoskeletal (MSK) inflammation as mild (C), moderate (B) and severe (A), based on clinical features. In a recent study, 27% of SLE patients with MSK pain have ultrasound (US) synovitis without swelling, and respond better to therapy than those with normal ultrasound. We aimed to revise the MSK domain of the BILAG-2004 index to improve its utility in modern practice.

Methods
An MSK sub-committee reviewed the existing BILAG-2004 MSK definitions and glossary, then re-analysed data from recent studies to propose revised definitions.

Results
The new definitions/changes are: (i) BILAG-C arthralgia (if US is not performed) is defined as a classical inflammatory symmetrical small-joint distribution of symptomatic joints on clinical assessment, based on the features most associated with US inflammation in a previous study. If US is performed, all previous BILAG-C patients are reclassified: (ii) BILAG-B now includes patients without swelling if they have significant synovitis/tenosynovitis on US in symptomatic joints/tendons; (iii) patients with arthralgia without swelling are scored as BILAG-D instead of C, if US of the symptomatic joints has been performed and is normal; (iv) a more detailed definition of functional impairment is provided for BILAG-A. Data from 221 symptomatic SLE patients (BILAG-A-C) in two recent studies were re-analysed in the light of the above changes. 121/221 (54.8%) were graded clinically as having arthralgia / myalgia (BILAG-C) on BILAG-2004 . Of these, 53/121 (43.8%) had evidence of synovitis (GS &gt; 1 or PD &gt; 0) or tenosynovitis (GS &gt; 0 or PD &gt; 0) on US. The effect on grading if US were performed on all BILAG C cases is shown in table 1.

Conclusion
Future versions of the BILAG index will allow the use of US to classify patients who are graded as mild inflammatory arthritis (BILAG-C) to moderate (BILAG-B) or non-inflammatory pain (BILAG-D/E). Although US is not required for all assessments it may be used when there is diagnostic uncertainty. This is in keeping with clinical practice in inflammatory arthritis care, and similar to use of other investigations (e.g. renal biopsy) that contribute to BILAG assessments of other systems.

Disclosure
R.D. Sandler: None. E.M. Vital: None. A. Prabu: None. C. Riddell: None. K.I. Mahmoud: None. L. Teh: None. C.J. Edwards: None. C. Yee: None.