bluuebunny/crossref_metadata_2025_split huggingface dataset:
P262 The occurrence and characteristics of severe pain in patients with axial spondyloarthritis
Authors: Jones Gareth T , Rotariu Ovidiu , Dean Linda E , MacDonald Alan G , Macfarlane Gary J 
Published: April 2022

Abstract

Background/Aims
Pharmacological management of axial spondylarthritis (axSpA) seeks to control inflammation. Even if successful, available evidence suggests that many patients continue to experience pain. The aim of the current study was to determine the prevalence and characteristics of severe pain among persons with axSpA.

Methods
The Scotland Registry for Ankylosing Spondylitis (SIRAS) collected clinical and patient-reported data from adults seen in secondary care in Scotland with a clinical diagnosis of ankylosing spondylitis. Questionnaires asked about severe pain (high pain intensity; high pain interference; and extreme/unbearable pain), lifestyle, and various aspects of health. The relationship between severe pain and clinical/patient-reported factors was assessed using logistic regression.

Results
929 participants had pain data available (73% male; median symptom duration 20yrs). High pain intensity and pain interference were more common (57% and 42%) than extreme/unbearable pain (11%). Prevalence did not differ with age, although women were less likely to report severe pain than men (Odds Ratios (ORs) 0.56-0.61) as were those with longer duration of education, and those from more affluent areas. The odds of severe pain increased with every 1 unit increase in BASFI (ORs 1.44-1.56). Strong associations were also seen with disease activity, spinal mobility, fatigue, poor sleep, and worse quality of life.

Conclusion
In axSpA, severe pain is common, with a clear socio-economic gradient and major impact on quality of life. Rheumatologists need to be aware of the large unmet need in terms of pain management in this patient group with around 1 in 9 patients reporting extreme/unbearable pain.

Disclosure
G.T. Jones: Grants/research support; Research grant income for biologics registers in axSpA and PsA from the British Society for Rheumatology. The Society receives income from AbbVie, Pfizer, UCB and Amgen to support these registers, current analysis funded by GlaxoSmithKline who were provided with a copy of the results prior to submission. O. Rotariu: None. L.E. Dean: None. A.G. MacDonald: None. G.J. Macfarlane: Grants/research support; Research grant income for biologics registers in axSpA and PsA from the British Society for Rheumatology. The Society receives income from AbbVie, Pfizer, UCB and Amgen to support these registers, current analysis was funded by GlaxoSmithKline who were provided with a copy of the manuscript prior to submission.
P285 The utility of FibroScan in the monitoring of methotrexate therapy in inflammatory arthritis patients
Authors: Amin Mohammad H , Justice Elizabeth 
Published: April 2022

Abstract

Background/Aims
Methotrexate (MTX) is a drug used to treat inflammatory arthropathies. A significant side effect of MTX is liver fibrosis. There are numerous ways to screen for liver fibrosis, liver biopsy being the gold-standard, but its invasive nature and accompanying adverse effects limits its utility as a screening tool. Guidelines advise the use of liver function tests, yet liver enzymes and synthetic liver function may be normal even in advanced disease. This leaves the question of the best screening tool for liver fibrosis unanswered. This data collection seeks to explore the utility of FibroScan in the screening of liver fibrosis in rheumatoid arthritis and psoriatic arthritis patients taking long-term methotrexate.

Methods
A hospital-based survey was conducted where electronic records of rheumatoid and psoriatic arthritis patients, who were referred for FibroScan due to being on long-term methotrexate therapy, were reviewed. Long-term MTX therapy was defined as MTX use of greater than ten years. The following data were collected: demographics, BMI, MTX duration, results of FibroScan, and impact on management. The primary outcome was to determine whether FibroScan altered the patients’ management as this has not been tested in the literature previously. ‘Change of management' was defined as reduction of MTX dose or cessation of MTX therapy. Three secondary outcomes were assessed. Firstly, relationship of BMI (body mass index) with FibroScan result. FibroScan result consisted of median elastography and controlled attenuation parameter (CAP). Secondly, relationship of BMI with impact on management. Finally, relationship of MTX therapy duration with impact on management.

Results
A total of 16 patients were identified. With regards to primary outcome, 29.4% of patients had their management changed secondary to FibroScan. In terms of secondary outcomes, positive correlations were found between BMI and median elastography and CAP. Mean BMI was greater in patients who had their management changed. Patients whose MTX was stopped had a greater mean MTX therapy duration.

Conclusion
These data show the utility of FibroScan to screen for liver fibrosis in patients on long-term MTX therapy. It recommends that practitioners consider FibroScan in patients who have been taking MTX for longer than 10 years, especially if they have associated risk factors such as high BMI.

Disclosure
M.H. Amin: None. E. Justice: None.
P287 The impact of restricted access to targeted therapies for rheumatoid arthritis on rheumatologists and the service they can provide
Authors: Walker David , Robinson Sandra 
Published: April 2022

Abstract

Background/Aims
Just under half of the clinical commissioning groups (CCGs) in England restrict the number of targeted therapies that can be prescribed for rheumatoid arthritis (RA) before an individual funding request (IFR) is required. We were interested to explore the impact of this on rheumatology services and rheumatologists themselves.

Methods
A national survey of rheumatologists who prescribe high-cost drugs was developed to explore prescribing restrictions by CCGs, the impacts on the service and the strategies adopted to mitigate this. Results from the survey were then used to develop an interview schedule for semi structured interviews with five rheumatologists to explore this in more detail.

Results
A total of 53 rheumatologists started the survey. 23 participants (44%) were restricted in their use of high-cost drugs. Restrictions were mainly by total number rather than mode of action. For 46, (88%) restrictions were communicated through local guidelines. 41% had additional local restrictions either through their pharmacy (5%), local pathways (10%) or a multi-disciplinary team meeting (MDT; 27%). 51% routinely discussed high-cost drugs with colleagues, with 21% discussing only complicated patients. The effect on the service was rated: a lot = 43%; moderately =24%; and a little or not = 7%. 95% said it affected their practice e.g., persisting with ineffective therapy. Blueteq was used by 69%; 29% were negative or very negative about it, 29% were neutral, and 23% were positive about it. 19% had it completed by someone else. Strategies for mitigating the restrictions included: 43% of participants had used a foot instead of a hand in the DAS28; 68% had changed diagnostic category to justify treatment; 51% had negotiated a local pathway. Three themes emerged from the semi-structured interviews. Theme 1) Persistence with partially effective therapy was used to avoid running out of options. There was genuine distress about the poor service that was being delivered. Theme 2) IFRs do not work but negotiating alternative pathways with the CCG can. Theme 3) Bluetec is an extra burden in the process but is OK if you do not have to fill it in yourself.

Conclusion
Restricting the number of targeted therapies that can be prescribed for RA has a detrimental effect on the service and the prescribers involved which often results in persistence with partially effective therapies. Continuing partially effective therapies is not satisfactory if there may be more effective therapies available.
Acknowledgements: On behalf of the EVA-RA Joint Working Group.

Disclosure
D. Walker: Consultancies; Galapagos, Eli Lilly. S. Robinson: None.
P289 The effectiveness of interventions to reduce psychological distress in patients with autoimmune rheumatic conditions: a systematic review of effectiveness
Authors: Hulley-Mills Jamie , Sliverthorne Christine , Jones Bethan , Hooper Jo , Robson Joanne , Dures Emma , Daniels Jo , Thompson Miles , Ndosi Mwidimi 
Published: April 2022

Abstract

Background/Aims
Autoimmune rheumatic conditions are multisystem chronic disorders associated with increased psychological distress. Consequences include poor medication adherence and high levels of disease activity. Psychological interventions may reduce distress and change health behaviours. We aimed to determine the effectiveness of interventions for psychological distress in patients with autoimmune rheumatic conditions.

Methods
This was a systematic review of effectiveness which included randomised controlled trials of psychological interventions in adults with autoimmune rheumatic conditions. We searched MEDLINE, BNI, CINAHL, EMBASE, EMCARE, PsycINFO, NICE Evidence and The Cochrane Library. Two reviewers screened titles and abstracts and assessed the methodological quality of the included studies using Cochrane Risk of Bias 2 tool. Data were extracted by one reviewer and checked by a second. In each study, the effectiveness data were determined by extracting the reported means (and standard deviation) for each group and calculating the standardised mean differences using RevMan 5.4 software (The Cochrane Collaboration, 2020). The data on primary outcomes (anxiety and depression) are reported here.

Results
The search identified 96 studies. The process of screening and assessing for eligibility resulted in 20 studies for inclusion. Of these, one study had an overall low risk of bias and 19 had ‘some concerns’, mainly due to inadequate blinding and no information on pre-specified analysis plan. Only eight studies reported the effects on anxiety and 10 studies reported on depression. These studies included 919 patients in total. Most interventions were based on cognitive behavioural therapy and the context of delivery ranged from face-to-face individualised treatment to online group therapy. They often included education on topics such as stress and fatigue. Interventions often trained participants to develop skills in relaxation, problem-solving, and thought reframing. Goal setting and action planning were common to help participants make behaviour changes and apply their learning. Table 1 summarises disease group, type of intervention, comparator, outcome measure, and effects.

Conclusion
Conclusion: Most interventions were effective in reducing anxiety and depression in autoimmune rheumatic conditions. However, given the clinical heterogeneity and ‘some concerns’ about the included quality of studies, more work is needed to understand the mechanisms of the intervention effectiveness.

Disclosure
J. Hulley-Mills: None. C. Sliverthorne: None. B. Jones: None. J. Hooper: None. J. Robson: None. E. Dures: None. J. Daniels: None. M. Thompson: None. M. Ndosi: None.
P298 Ocular manifestations in a giant cell arteritis cohort
Authors: Smith Sonja Mansfield , Al-Hashimi Mustafa , Ducker Georgina , Jones Colin , Mukhtyar Chetan 
Published: April 2022

Abstract

Background/Aims
The ophthalmic features of giant cell arteritis involve a spectrum of severity, from transient symptoms to bilateral visual loss due to anterior ischaemic optic neuropathy or, less commonly, central retinal or cilioretinal artery occlusion. Data of reported ocular involvement are varied, with a range of 10-70%. The variation may be related to the specialty of the unit reporting the data. We run an interdisciplinary service in a tertiary academic unit and report a complete picture of the frequency and nature of ocular involvement in GCA.

Methods
The records of 350 consecutive patients, diagnosed objectively on the basis of biopsy or imaging, were reviewed. In our centre, the hospital pathway mandates all individuals with suspected GCA to have a formal ophthalmology assessment including visual acuity, pupil exam and full dilated fundus assessment. We recorded the common signs and symptoms using a structured form which included ophthalmologic symptoms and examination findings, along with symptoms commonly associated with GCA: scalp tenderness, headache, jaw claudication, shoulder girdle stiffness, anorexia, night sweats, weight loss, and fever.

Results
From January 2012 to September 2021, 350 individuals were diagnosed with GCA by biopsy, ultrasonography or positron emission tomography. The mean age was 74 ± 7.7 years. 237 (68%) of patients were females. 99 (28%) presenting with GCA had visual symptoms and or signs. 34 had mono-ocular and two had binocular loss of vision. A summary of the key visual symptoms and signs are shown in Table 1. Only five patients with visual symptoms did not have any symptoms commonly associated with GCA.

Conclusion
We report the frequency of visual involvement in one of the largest cohorts of individuals with GCA. 28% have ocular symptoms. Partial or total monocular field loss occurred in 12% of cases. 1.4% of patients may be presenting with visual symptoms as the only sign of GCA. Rarely, permanent visual loss may occur without any other manifestation of GCA.

Disclosure
S. Mansfield Smith: None. M. Al-Hashimi: None. G. Ducker: None. C. Jones: None. C. Mukhtyar: None.
P300 Comparison of birth rates, gestational diabetes and non-standard maternal deliveries between Takayasu arteritis patients and the England and Wales population
Authors: Groves David J , Rutter Megan , Lanyon Peter C , Odingo Myron , Grainge Matthew J , Bythell Mary , Aston Jeanette , Stevens Sarah , Hannah Jennifer R , Mason Justin , Pearce Fiona A 
Published: April 2022

Abstract

Background/Aims
Takayasu arteritis (TAK) is a chronic, inflammatory vasculitis of the aorta and primary branches, particularly prevalent in women of childbearing age. We studied pregnancy outcomes for women with TAK compared to the general population.

Methods
All people in England with an ICD-10 diagnostic code for TAK 1997/98 to 2020/21 were identified from Hospital Episode Statistics (HES) using National Congenital Abnormality and Rare Disease Registration Service (NCARDRS) data (CAG 10-02(d)/2015). To improve precision of estimated date of diagnosis, we used an English hospital case register of 122 TAK patients. We analysed all HES admissions occurring after their clinician-confirmed diagnosis date and before their first TAK ICD code in HES to identify codes which indicated likely TAK-related activity, and then applied these to the whole NCARDRS cohort. Maternity-related ICD-10 and OPCS-4 code admissions after the estimated diagnosis date were extracted and age-specific values were calculated for number of births, TAK patient years and birth rates. ONS published national data was used for comparison.

Results
We identified 1,437 people with TAK. Between 2001 and 2021, there were 133 babies born (129 singleton, 2 twin births, no stillbirths) to 85 mothers. Mean maternal age at first delivery was 32.2 years (SD 5.3, median 33.2), above the UK mean of 27.8, with age-specific birth rates compared to the 2019 general population (see table). Overall birth rate in women with TAK was 68% of the national England/Wales rate. Gestational diabetes (GDM) was present in 13/131 (9.9%) but large variation in UK prevalence estimates makes national comparison difficult. Mothers with GDM had a median age of 37 and delivery was by C-section in 9/13 cases. For non-GDM, 50% (95% CI: 41%, 59%) were C-section; this is significantly higher than the UK level of 26%. 12% were vacuum and/or forceps assisted deliveries, approximately equal to the general population.

Conclusion
The birth rate in women with TAK is lower than the general population and C-section rates higher. Causes are complex and might include patient choice, reduced fertility related to cytotoxic treatment, or physician recommendation, highlighting the importance of equitable access to specialist pre-conception counselling for people with rare autoimmune diseases.

Disclosure
D.J. Groves: None. M. Rutter: None. P.C. Lanyon: None. M. Odingo: None. M.J. Grainge: None. M. Bythell: None. J. Aston: None. S. Stevens: None. J.R. Hannah: None. J. Mason: None. F.A. Pearce: None.
Tetralogy of Fallot
Authors: Chase Julia R. , Fliehman Maci , LeGal Michael , Spicer Whitney , Rogers Julia L. 
Published: April 2022

Abstract:
The Physician Fee Schedule was updated in 2021 by the Centers for Medicare and Medicaid Services. A case study on Tetralogy of Fallot, the most common cyanotic congenital heart defect, is presented with guidance in billing the office visit to reflect the current guidelines.
Reliability of Third Ventricle Assessment by Transcranial Ultrasound: A Computational Model of the Effect of Insonation Angle
Authors: De Cassai Alessandro , Geraldini Federico , Calandra Sabrina , Munari Marina 
Published: April 2022

Introduction:
Transcranial sonography (TCS) is a bedside examination which is currently used in multiple neurocritical care settings. Third ventricle ultrasound is usually a simple technique, though a large insonation angle could lead to an overestimation of third ventricular diameter. The aim of this study was to use a mathematical model to evaluate the impact of probe inclination on the false positive rate when using TCS to evaluate third ventricle enlargement.

Methods:
Using R software, we simulated a pool of 100,000 fictitious patients with a normal third ventricle size (diameter from 0 to 9 mm) in daily follow-up for ventricle enlargement for 30 consecutive days using TCS. Each day, a different, random insonation angle (α) was generated and a corresponding measured diameter calculated as: measured diameter=real diameter/cos α. If the measured diameter was >9.0 mm, the simulation registered a “misdiagnosis” episode and the simulation loop was interrupted; otherwise, the simulation continued to its thirtieth iteration.

Results:
Of the 100,000 “patient” simulations, 30,905 (30.9%) had an erroneous TCS diagnosis of ventricular enlargement. Angles of insonation >35 degrees contributed to 79.3% of the total misdiagnoses of ventricular enlargement (false positive rate, 3.71%), whereas misdiagnosis was rare when the insonation angle was ≤15 degrees (1.30% of the total misdiagnoses; false positive rate, 0.06%).

Conclusion:
Using probe inclinations <15 degrees, erroneous diagnosis of third ventricular enlargement was rare. Our results suggest that TCS has a low rate of false positives when the angle of insonation is minimized.
Omission of Axillary Staging and Survival in Elderly Women With Early Stage Breast Cancer
Authors: Castelo Matthew , Hansen Bettina E. , Paszat Lawrence , Baxter Nancy N. , Scheer Adena S. 
Published: April 2022

Objectives:
Determine if axillary staging is associated with survival in elderly women with breast cancer.

Background:
Axillary staging in women ≥ 70 years with early-stage breast cancer is controversial. Older randomized evidence has not shown axillary staging improves survival, but recent observational studies have been mixed and widespread de-implementation of the practice has not occurred.

Methods:
This was a population-based cohort study using the Surveillance, Epidemiology, and End Results registry. Women ≥ 70 years diagnosed with T1–T2 invasive breast cancer from 2005 to 2015 were included. Overlap propensity score weighting was used to adjust for confounders. Overall survival (OS) was determined and hazard ratios (HRs) reported with 95% confidence intervals (CIs). Breast cancer-specific survival (BCSS) was determined using competing risks analysis and subdistribution hazard ratios (sdHRs) reported. Additional adjustment was performed for receipt of chemotherapy and radiotherapy.

Results:
One hundred forty-four thousand three hundred twenty-nine elderly women were included, of whom 22,621 (15.7%) did not undergo axillary staging. After overlap propensity score weighting, baseline characteristics were well balanced between the 2 groups. Women who did not undergo axillary staging were significantly less likely to receive chemotherapy (adjusted relative risk, 0.58; 95% CI, 0.54–0.62) or radiotherapy (adjusted relative risk, 0.53; 95% CI, 0.52–0.54), and had significantly worse OS (adjusted HR, 1.22; 95% CI, 1.19–1.25), and BCSS (adjusted sdHR, 1.14; 95% CI, 1.08–1.21) compared to those that had staging.

Conclusions:
These findings suggest elderly women with early-stage breast cancer who do not undergo axillary staging experience worse outcomes. Reasons for this disparity may be multifactorial and require further investigation.
Are Infection Rates Increased After Sterilization of the External Fixator During Staged Internal Fixation of High-Energy Tibial Plateau Fractures?
Authors: Moon Tyler James , Haase Lucas , Haase Douglas , Ochenjele George , Wise Brent , Napora Joshua 
Published: April 2022

Objectives:
To compare infection rates after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not.

Design:
Retrospective cohort study.

Setting:
Two academic Level 1 trauma centers.

Patients/Participants:
Two hundred forty-four patients met inclusion and exclusion criteria between the 2 institutions.

Intervention:
Prepping of the external fixator into the surgical field during second-stage definitive open reduction and internal fixation. 162 patients were in the prepped group, and 82 patients were in the nonprepped group.

Main Outcome Measurements:
The primary outcome was the rate of deep infection after definitive fixation. Secondary outcome was operative time.

Results:
There were no significant differences in infection rates between prepped (11.7%) and nonprepped (18.3%) groups (P = 0.162). Patients in the prepped groups had significantly decreased operative time (168.2 minutes vs. 221.9 minutes, P < 0.001) even after controlling for confounders in regression analysis.

Conclusions:
There is no increased risk of infection associated with prepping and maintenance of the external fixator during definitive internal fixation for high-energy tibial plateau fractures. These data suggest that this practice may lead to shorter operative times as well.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.