Arrived safely? Audit of documentation of successful transfer into adult care of young people attending paediatric rheumatology clinics

24 BSPAR130 ARRIVED SAFELY? AUDIT OF DOCUMENTATION OF SUCCESSFUL TRANSFER INTO ADULT CARE OF YOUNG PEOPLE ATTENDING PAEDIATRIC RHEUMATOLOGY CLINICS N. Chanchlani, M. McGee and J. E. McDonagh Whipps Cross Hospital, London, Birmingham Children’s Hospital and University of Birmingham, Birmingham Children’s Hospital, Birmingham, UK Correspondence to: N. Chanchlani. E-mail: nchanchlani@doctors.org.uk Introduction: Concerns regarding the transfer of information at the paediatric–adult interface have been raised. Although tracking of patients into adult services is recommended, lapse of care at this time is reported, including a departmental audit in 2007 showing the latter occurred in 25% of patients. Aims: To determine the success of transfer to adult care from a paediatric rheumatology service. Method: Retrospective case note review of all transferred patients from 2007–12. Results: Preliminary data (2009 –12) reveals 92 patients were transferred to 25 adult rheumatologists. Of patients transferred, the mean age at diagnosis was 10 years (2–16) and mean age at transfer was 17 years (16–19). 63% (n1⁄458) were female and 32% (n1⁄4 29) were non-caucasian. 65% (n1⁄460) had Juvenile idiopathic arthritis. 57% (n1⁄452) were on a DMARD/biologic during transfer. 38% (n1⁄4 36) had a co-morbidity. The median (mean, range) duration between final paediatric and first adult appointment was 98 days (112.84, 17 –457). Three patients were lost to follow up. Successful transfer, defined by receipt of a letter from the first and/or second adult appointment occurred in 97% (n1⁄490) and 62% (n1⁄4 52) of cases respectively. Seven were currently being transferred and not included. Referral letter, transfer summaries, and copy letters were sent to the adult team in 72% (n1⁄466) of cases, and copied to 73% (n1⁄448) of patients. Conclusion: Although improvement in transfer organization is evident since 2007, variation within this service exists with significant lapses of care occurring for some patients. The potential impact on care will be discussed. Disclosure statement: The authors have declared no conflicts of interest. ABSTRACT 25 BSPAR13225 BSPAR132 LABORATORY INVESTIGATION OF THE ROLE OF TOLL-LIKE RECEPTORS ON KIDNEY CELLS IN PATHOGENESIS OF LUPUS NEPHRITIS E. S. Sen, G. I. Welsh, A. V. Ramanan and M. A. Saleem Academic Renal Unit, University of Bristol and Departments of Paediatric Rheumatology and Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK Correspondence to: E. S. Sen. E-mail: ethan.sen@doctors.org.uk Introduction: LN is a serious complication of JSLE. Previous studies have suggested a role for toll-like receptor 7 (TLR7) and TLR9 in SLE pathogenesis. Podocytes are specialized cells in the glomerular filtration barrier. Biopsies from LN patients have demonstrated higher TLR7 and TLR9 expression in glomeruli compared with controls. Aims: To examine the role of TLR7 and TLR9 in podocytes to identify potential targets for more effective therapies of LN. Method: Conditionally immortalized human podocytes were cultured. Quantitative PCR and Western blotting were used to detect TLR7 and TLR9 expression at the mRNA and protein level respectively. The effects of lipopolysaccharide (LPS), an inflammatory stimulus, imiquimod (TLR7 agonist), CpG (TLR9 agonist) and dexamethasone were examined. Phosphorylation of NFkB was assessed with Western blotting and a cell proliferation assay used to estimate cell survival. Results: Treatment of podocytes with LPS was associated with increased expression of TLR7 at the protein level with comparatively little change in TLR9. Exposure to imiquimod or CpG increased phosphorylation of NFkB. There was preliminary evidence of less phosphorylation of NFkB when cells were treated with dexamethasone prior to TLR agonists. Initial results from the cell proliferation assay suggested lower levels after imiquimod or CpG treatment for 24 h. Conclusion: This study suggests that podocytes express TLR7 and TLR9. Agonists of these receptors have effects on intracellular signalling. If confirmed, the TLR-NFkB pathway in kidney cells may be a potential target for novel therapies in LN. Disclosure statement: The authors have declared no conflicts of interest. ABSTRACT 26 BSPAR13326 BSPAR133 MEASLES IMMUNITY IN PAEDIATRIC RHEUMATOLOGY PATIENTS ON IMMUNOSUPRESSIVE CHEMOTHERAPY D. Gaynor, P. Riley, J. Corbett and N. East Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK Correspondence to: D. Gaynor. E-mail: dannig1@yahoo.co.uk Introduction: There have been 105 confirmed cases of measles since the start of 2013 in Greater Manchester. Highest numbers are in unimmunized children aged 10–14, reflecting the national picture and the poor historic levels of MMR uptake in this group. Aims: To audit paediatric rheumatology patients on immunosuppressive chemotherapy to see how many have been vaccinated, how many MMR vaccinations they had received and how many of our patients were deemed susceptible to measles on serology testing. Method: A retrospective collection of vaccination status of all paediatric rheumatology patients on immunosuppressive chemotherapy with prospective data collection of immune status via blood serology. Variables included MMR status and antibody status. Results: We have 249 patients on immunosuppressive chemotherapeutic agents. 146 of them have been screened for measles immunity. 129 patients have a result. 107 patients have measles IgG detected and are therefore considered to have adequate measles immunity. 20 patients have no measles IgG detected and are therefore considered susceptible to measles. Of these 20 patients considered susceptible 4 patients have not received any MMR vaccination whilst 9 patients received 2 MMR vaccinations. Conclusion: Of at least 41 patients who have received two MMR vaccinations, a quarter of them are not immune. Immunity cannot be assumed from vaccination status alone. All patients who require immunosuppressive chemotherapy should have their measles antibody status checked prior to commencing therapy. Disclosure statement: The authors have declared no conflicts of interest. ABSTRACT 27 BSPAR13427 BSPAR134 SPELLING OF MEDICATION NAMES IN YOUNG PEOPLE’S BLOGS ABOUT JUVENILE ARTHRITIS N. J. Gray, K. Harvey, J. Prescott, R. Roberts, K. L. Shaw, F. J. Smith, R. Stephenson, D. Terry, K. Fleck and J. E. McDonagh Independent Researcher, University of Nottingham, University of Central Lancashire, UCL with Pharmacy Research UK and Arthritis Care, University of Birmingham, Birmingham Children’s Hospital FT, Correspondence to: J. E. McDonagh. E-mail: j.e.mcdonagh@bham.ac.uk Introduction: There are a significant number of adults in the UK who struggle to cope with the context-specific demands on their literacy: medication poses specific challenges. For young people with juvenile POSTER PRESENTATIONS iii9