tbuckley/cabot-search huggingface dataset:
OP0005 Fibromyalgia in patients with rheumatoid arthritis in a 10-year perspective
Authors: SA Provan, C Austad, V Halsaa, HB Hammer, TK Kvien, T Uhlig
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Approximately 10% of patients with rheumatoid arthritis (RA) have coexisting fibromyalgia (FM). Little is known of the cross-sectional and longitudinal relationship between FM and RA disease activity. <h3>Objectives</h3> To examine the cross-sectional and longitudinal relationship between FM and RA disease activity. <h3>Methods</h3> Oslo RA register (ORAR) was established in 1994 as a prospective, observational, longitudinal nested cohort study. The inclusion criteria were RA according to the 1987-ACR classification criteria and a residential address in Oslo. 636 patients in ORAR were asked to participate in a clinical examination in 1999. A trained study-nurse systematically assessed the 18-tender point count and performed 28-tender and 28-swollen joint counts (TJC/SJC). Patients self-reported disease activity and pain related to RA, and completed the Stanford Health Assessment Questionnaire (HAQ). RA disease activity was calculated as DAS28. Fibromyalgia was diagnosed if ≥11 tender points were reported. FM associated variables; fatigue, muscular tenderness, headache, abdominal pain and difficulties concentrating were also scored (0–10 VAS). At the 10-year follow-up patients completed a questionnaire that included RA Disease Activity Index (RADAI) and Routine Assessment of Patient Index Data (RAPID-3). In cross-sectional and longitudinal analyses RA disease activity, FM associated variables and health status were compared between patients with ≥11 and &lt;11 tender points. Level of significance was calculated using ANCOVA models corrected for age, gender, BMI and level of education. The FM associated variables at baseline were also corrected for baseline SJC 28 and C-reactive protein (CRP). The variables in the longitudinal study were corrected for the same variables as the cross-sectional analyses, but additionally for baseline values of the dependent variable when available. <h3>Results</h3> 488 patients agreed to participate in the baseline data-collection and 192 participated at the 10-year follow-up. The mean (SD) age was 59.5 (12.5) years, and 87% were female. There were no significant differences in age, disease duration or participation at follow-up between patients with and without FM, but only women had FM. Patients with FM in addition to RA had higher DAS28, SJC, TJC, pain and patient global VAS, but also higher levels of fatigue, abdominal pain and concentration difficulties (table 1). At the 10-year follow-up patient with FM had significantly higher levels of RA disease activity and pain (figure 1). <h3>Conclusions</h3> Presence of FM in patients with RA was associated with significantly higher levels of RA disease activity both in the cross-sectional and longitudinal perspectives. Secondary FM should be considered in patients with RA not reaching remission. <h3>Disclosure of Interest</h3> None declared
OP0074 Association between a history of mycobacterial infection and the risk of sjÖgren's syndrome: a nationwide, population-based case-control study
Authors: H-H Chen, W-C Chao, T-L Liao, Y-M Chen, C-H Lin, D-Y Chen
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> An increased risk of tuberculosis (TB) has been found in subjects with Sjögren9s syndrome (SS); however, whether TB or nontuberculous mycobacteria (NTM) infection is associated with the risk of SS is still unknown. <h3>Objectives</h3> To explore the association between a history of mycobacterial infection and the risk of newly diagnosed SS. <h3>Methods</h3> After excluding those who had rheumatoid arthritis and systemic lupus erythematosus, we identified 5,751 newly diagnosed SS cases and 86,265 non-SS patients matched (1:15) for age, sex, and the year of first diagnosis date as controls using nationwide, population-based, claims data. The association between the risk of incident SS and a history of treated mycobacterial infection, including TB and NTM, was quantified by odds ratios (ORs) with 95% confidence intervals (CIs) using conditional logistic regression analysis after adjusting for Charlson comorbidity index (CCI) and bronchiectasis. <h3>Results</h3> The mean ± SD age was 55±14 years and the proportion of female gender was 87.8% in newly diagnosed SS cases and non-SS controls. An association was observed between NTM infection (OR, 11.24; 95% CI, 2.37–53.24) and incident SS, but not between TB infection and incident SS (OR, 1.29; 95% CI, 0.97–1.71) after adjustment for CCI and bronchiectasis. The magnitude of the association between NTM and SS risk was greatest among those aged between 45 and 65 years (OR, 39.24; 95% CI, 3.97–387.75). <h3>Conclusions</h3> The present study demonstrates a statistically significant association of newly-diagnosed SS with a history of NTM, but not TB infection. <h3>References</h3> Peri Y, Agmon-Levin N, Theodor E, et al. Sjogren9s syndrome, the old and the new. Best practice &amp; research Clinical rheumatology 2012;26(1):105–17. Mavragani CP, Moutsopoulos HM. The geoepidemiology of Sjogren9s syndrome. Autoimmunity reviews 2010;9(5):A305–10. Elkington P, Tebruegge M, Mansour S. Tuberculosis: An Infection-Initiated Autoimmune Disease? Trends in immunology 2016. <h3>Acknowledgements</h3> The authors would like to thank the Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan, ROC for statistical support. <h3>Disclosure of Interest</h3> None declared
Misdirected care in a misdirected world
Authors: Kamran Abbasi
Journal: BMJ (2017)

Hurricanes and floods tell a story of planetary pain and distress. Many of us love our planet but don’t fully understand it. Our solutions are misdirected, ignoring what matters to the planet. Our interests come first. The same applies to patients. Many of us love our patients but struggle to understand their motivations. Our solutions are misdirected.

Victoria Wright has a facial disfigurement. Born with cherubism, she looked like any other girl until the age of 4. Then, her jaw …
Strategies That Delay Market Entry of Generic Drugs
Authors: Kerstin Noëlle Vokinger, Aaron S. Kesselheim, Jerry Avorn, Ameet Sarpatwari
Journal: JAMA Internal Medicine (2017)

Increasing prescription drug expenditures in the United States are primarily driven by high brand-name drug prices. Although generic competition helps lower drug prices, manufacturers of brand-name drugs often work to delay the availability of generic versions of their products. Strategies to forestall generic competition include patenting peripheral aspects of a drug or modified formulations that do not add clinical value, paying generic manufacturers to settle lawsuits challenging the validity of patents on brand-name drugs ("reverse payment" settlements), denying generic manufacturers access to drug samples necessary for bioequivalence testing, misusing risk evaluation and mitigation strategies, and filing citizen petitions with the US Food and Drug Administration (FDA). To address such tactics, the federal government can interpret existing patenting standards more strictly and promote certain types of patent challenges to ensure that patents are granted or upheld only for true innovations. Congress can enact pending legislation that would help discourage reverse payment settlements and compel brand-name manufacturers to share drug samples for bioequivalence testing. Finally, the FDA can provide earlier guidance on bioequivalence determinations for complex generic products and adopt the presumption that late-filed citizen petitions should be summarily rejected.
AB0890 Systemic lupus erythematosus and gout: really an unusual association?
Authors: N Quilis, M Andrés
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Patients with systemic lupus erythematosus (SLE) often suffer from cardiovascular comorbidity such as hypertension, dyslipidemia or coronary heart disease. However, the association with gout – an independent cardiovascular risk factor – is considered unusual - it is not reported in the EULAR textbook (1)-, and might not be taken into account when acute arthritis occurs in SLE patients, also due to the predominance of women in this disease. <h3>Objectives</h3> To review our experience regarding SLE patients who developed gout, and to perform a literature review of reported cases to date. <h3>Methods</h3> Retrospective review of patients with SLE and crystal-proven gout in our Rheumatology Unit, a tertiary care center. We recorded clinical and laboratory variables related to both diseases. Then, we performed a bibliographical review in Pubmed (1965 – 2016) to identify reported cases of coexistence of both diseases. <h3>Results</h3> Out 189 SLE patients seen in our Unit, we have identified two cases with crystal-proven gout: 1) A 68 years-old woman with SLE and nephritis diagnosed 30 years ago, who developed polyarthritis affecting her hands. 2) A 47 years-old man with lupus for 22 years with nephritis and renal failure, who developed acute arthritis involving right knee and ankle. In both cases, urate crystals were demonstrated at synovial fluid. The table shows the results of the literature review together with our two cases. To date, 36 cases with coexistent SLE and gout have been reported. Median age at time of gout diagnosis was 43.5 years (p25–75 32.5–52.0), being 26 females (72%). SUA levels were found notably high (median 13.5mg/dL), and tophi, a marker of gout severity, were demonstrated in almost half of cases (44.4%). The majority of patients (91%) were on glucocorticoids at time of gout diagnosis. According to common factors leading to hyperuricemia, lupus-related renal damage (86%) and use of diuretics (83%) predominated in the series. <h3>Conclusions</h3> Data supports including gout into the differential diagnosis of episodes of acute arthritis in SLE patients. This makes crucial the routine analysis of all synovial fluid samples, but especially in patients with long-term disease, renal impairment, and diuretic use. <h3>References</h3> EULAR Textbook on Rheumatic Diseases. BMJ, 2015. <h3>Disclosure of Interest</h3> None declared
AB0276 Evaluation of adherence to drug treatment in patients with rheumatoid arthritis
Authors: AE-AM Alhefny, SA Mobasher, MA El-Rahman Abd, NH Shedid, HM Sakr, RM Hassan
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> the medication adherence is very vital issue nowadays, especially in RA patients. <h3>Objectives</h3> to measure the frequency of the adherence in RA patients, and evaluate the common factors influencing RA patients adherence to drug treatment aiming at improving disease outcome. <h3>Methods</h3> a Prospective cohort study of 100 patients with RA under treatment, fulfilled the American College of Rheumatology/European League Against Rheumatism (ACR/ EULAR) (1) criteria. All patients subjected to Full history taking and clinical examination, (DAS 28 ESR), Health Assesment Questionnaire (HAQ) score, Visual Analouge Scalez (VAS) scale, CBC, ESR, CRP titer, RF titer, ACPA titer and Power Doppler U/S for both hands, patients also respond to specific questionnair containing questions about sociodemographic data, medication, health care system and Compliance Questionnaire of Rheumaology (CQR). <h3>Results</h3> The baseline adherence rate (CQR≥80) was 37%. The nonadherent RA patients to drug treatment were older, living outside Cairo, with low educational level and smokers, they also had higher DAS28ESR score, HAQscore, ESR, CRP titer and more frequent active synovitis in Doppler ultrasound. The cost of medication (61%), non-availability of medication in pharmacy (58%), forgetting the medication (36%), patients9 lack of belief in the benefit of treatment (38%), inadequate follow up or discharge planning (23%) and polypharmacy (medication load) (20%) were the most common factors in nonadherent patients table (3). After 9 months of the follow up and trying to correct the causes of nonadherence, the adherence rate increased to (68.75%).Also there was improvement in disease activity, improvement in functional state and improvement in the quality of life. <h3>Conclusions</h3> Low adherence rate was associated with higher disease activity, functional disability. Patient education, financial support, good physician patient relationship, simplification of the prescription, facilitation their communication, using MSUS were found to improve the patient adherence and improve the disease outcome. <h3>References</h3> Aletaha D, Neogi T, Silman A et al, Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum 2010:62:2569–2581. Dowman B, Campbell R, Zgaga L et al, Estimating the burden of rheumatoid arthritis in Africa: A systematic analysis. J Global Health 2012;2(2):1–9. Wasserman A, Diagnosis and Management of Rheumatoid Arthritis.American Family Physician J 2011:84(11):1245–1252. <h3>Disclosure of Interest</h3> None declared
Treatment of lung cancer patients in multidisciplinary (MDC) and serial care (SC) clinics.
Authors: Meredith Ray, Nicholas Ryan Faris, Fedoria Elaine Rugless Stewart, Matthew Smeltzer, Nana Boateng, Meghan Brooke Meadows, Courtney Foust, Bianca Jackson, Anita Patel, Carrie Fehnel, Cheryl Houston-Harris, Raymond S Signore, Edward T Robbins, Raymond U. Osarogiagbon
Journal: Journal of Clinical Oncology (2017)

8522 Background: MDC may improve the quality of care for complex diseases. We compared the use of stage-appropriate treatment for lung cancer patients in a co-located MDC to serially-referred (SC) patients within the same healthcare system. Methods: Prospective cohort study of newly-diagnosed lung cancer patients enrolled before onset of treatment from MDC or the standard clinics (SC). Eligible pts had ECOG PS 0-2. Stage-appropriate treatment selection was determined using National Comprehensive Cancer Network (NCCN) guidelines based on clinical stage just before treatment onset. Differences in stage-based treatment rates were calculated using Chi-squared tests. Results: 162 had MDC and 317 SC. Compared to serial care patients, MDC patients were more likely black (37% v 30%) female (51% vs 48%), older (median 69 vs median 66) and less likely commercially insured (36% v 43%). Surgical resection was more frequently used for early stage patients in MDC: 72% v 58% for stage IA/IB (p = 0.2259); 58% v 31% for stage IIA/B and IIIA (T3N1M0) (p = 0.0375). MDC patients also had trends towards higher rates of recommended concurrent chemoradiation therapy for stage IIIA (T4N0-1M0) (75% vs 53%) (p = 0.5835), IIIB (T1-3N3, T4N2) (78% v 68%), but equal rates of concurrent chemoradiation therapy for stage IIIA (T1-3N2M0) (68% vs 68%). Stage IV patientss were more likely to receive chemotherapy or targeted therapy in MDC v SC (87% vs 80%) (p = 0.3795). Conclusions: Lung cancer patients in the MDC model are more likely to receive recommended stage-appropriate treatment than those in the usual serial care model, despite relatively adverse demographic characteristics. Clinical trial information: NCT02123797.
THU0028 Type i interferon signature in the peripheral blood and CXCL4 plasma levels in patients with systemic sclerosis
Authors: NI Vlachogiannis, V-K Bournia, A Nezos, PF Christopoulos, M Patsouras, PG Vlachoyiannopoulos, CP Mavragani, PP Sfikakis
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Type I Interferon (IFN) pathway is activated in Systemic Sclerosis (SSc) and represents a therapeutic target currently being tested in clinical trials, while higher IFNα levels have been also associated with pulmonary fibrosis in these patients. On the other hand, <i>in vitro</i> experiments using plasmacytoid dendritic cells from patients with SSc suggest an interplay between the chemokine (C-X-C motif) ligand 4 (CXCL4), a potential biomarker in SSc, and type I IFN. [1] <h3>Objectives</h3> To test the hypothesis that type I IFN-induced gene expression in the peripheral blood associates with particular clinical and laboratory features, including plasma CXCL4 levels, in patients with SSc. <h3>Methods</h3> Forty six patients with limited and 19 with diffuse SSc (60/65 women, aged 54±14 years, disease duration ranging between 0.5–27 years) and 20 healthy controls were examined. Peripheral whole blood samples (3ml) were subjected to cDNA synthesis and the expression of 3 genes (IFIT1, MX1, IFI44) that are preferentially induced by type I IFN was quantified by real time PCR. Type I IFN individual scores were calculated as described [2]; scores were arbitrarily considered as high when exceeding the mean value plus 3SD of the corresponding healthy control scores. Plasma CXCL4 levels were determined by ELISA. <h3>Results</h3> A high type I IFN score (i.e.&gt;8) ranging from 8.4 to 145 was found in 21/65 (32.3%) patients with SSc, compared with none of 20 healthy controls (p:0.002). SSc patients with high type I IFN scores demonstrated higher erythrocyte sedimentation rate and lower diffusing lung capacity for carbon monoxide (DLCO) levels than the remaining patients (p:0.002 and p:0.02, respectively, by Mann-Whitney U test). Other disease variables, including extent of skin involvement and autoantibodies, were not associated with high type I IFN score. Individual type I IFN scores positively correlated with the corresponding CXCL4 plasma levels (Spearman9s r: 0.53, p-value: 0.02). <h3>Conclusions</h3> A prominent type I IFN signature was observed in the peripheral blood of one third of patients with SSc in association with upregulated inflammatory response, reduced DLCO levels and higher CXCL4 plasma levels. Further prospective data are required to establish the role of type I IFN as an additional novel biomarker in SSc. <h3>References</h3> van Bon L, Affandi AJ, Broen J, et al. Proteome-wide analysis and CXCL4 as a biomarker in systemic sclerosis. N Engl J Med 2014;370:433–43. doi:10.1056/NEJMoa1114576. Nezos A, Gravani F, Tassidou A, et al. Type I and II interferon signatures in Sjogren9s syndrome pathogenesis: Contributions in distinct clinical phenotypes and Sjogren9s related lymphomagenesis. J Autoimmun 2015;63:47–58. doi:10.1016/j.jaut.2015.07.002. <h3>Disclosure of Interest</h3> None declared
SP0023 Review of wearable technologies
Authors: AM Clarke-Cornwell
Journal: Annals of the Rheumatic Diseases (2017)

Working environments have in recent times become less physical with the increase in sedentary, computer-based occupations. Sedentary time is known to be associated with a number of health-related outcomes, including obesity, heart disease, diabetes, cardiometabolic risk factors, some cancers and early mortality, independent of physical activity. There is limited research that has examined sedentary time and physical activity and associations with musculoskeletal conditions, despite these being responsible for the majority of work-related ill health and days absent from work. The validity and practicality of objective and subjective techniques to measure physical behaviour have been widely reported; however, there is no gold standard that is valid, accurate, reliable and also practical. Self-reported methods can be practical and low-cost, but are subject to recall and social desirability bias; whereas objective devices, such as accelerometers, can be expensive, but allow for information on intensity, frequency and duration of activity to be measured. The Health Survey for England 2008 used both subjective and objective measures of physical activity: they found that 39% of men and 29% of women were meeting the recommended levels of physical activity when asked via a questionnaire. In comparison, when physical activity was objectively measured using an accelerometer, it was found that only 6% of men and 4% of women met these targets. Wearable technologies, including research grade accelerometers (e.g. activPAL™) and consumer wearables (e.g. FitBit), are increasingly being used in research, not only to measure physical behaviours but may also be useful in facilitating and monitoring behaviour change. This work will present an overview of wearable technologies used in research, what they can (and can9t) measure, and in particular their application in musculoskeletal research. <h3>Disclosure of Interest</h3> None declared
SAT0690 Risk of hospitalized infection in cancer patients with autoimmune diseases: a single-center cohort study
Authors: H-H Chen, D-Y Chen
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Whether the risk of hospitalized infection is associated with autoimmune diseases in incident cancer patients is unknown. <h3>Objectives</h3> To examine the risk of hospitalized infection in incident cancer patients with autoimmune diseases compared with those without autoimmune diseases. <h3>Methods</h3> During 2000–2016, we identified 37,027 incident cancer patients from the Cancer Registry database of Taichung Veterans General Hospital. Autoimmune diseases included rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS), psoriasis (PSO)/psoriatic arthritis (PSA), antiphospholipid syndrome, polymyositis, dermatomyositis, systemic sclerosis, Sjögren9s syndrome, mixed connective tissue disease, multiple sclerosis, neuromyelitis optica, palindromic rheumatism, myasthenia gravis, Hashimoto9s thyroiditis, immune thrombocytopenic purpura, autoimmune hemolytic anemia, juvenile idiopathic arthritis, adult onset Still9s disease, Crohn9s disease, ulcerative colitis, Wegner9s granulomatosis, and uveitis. Of all subjects, 1,334 had autoimmune diseases. The association between autoimmune diaseases and hospitalized infection risk was shown by calculating hazard ratios (HRs) with 95% confidence intervals (CIs) using cox proportional regression analyses after adjusting for baseline age, sex, cancer stage, hemoglobulin (Hgb), creatinine (CR), log(ALT), log(WBC), and use of biologic agents or tofacitinib. <h3>Results</h3> Among all cancer subjects, the mean ± SD age was 60.2±14.7 years, and the proportion of male gender was 55.7%. Of the 1,334 patients with autoimmune diseases, 338 (25.3%) patients had RA, 221 (16.6%) patients had SLE, 61 (4.6%) patients had AS, 151 (11.4%) patients had PSO/PSA, and 563 (46.8%) had other autoimmune diseases. The incidence rates of hospitalized infection were 143.8 per 10<sup>3</sup> years in patients with autoimmune diseases and 118.9 per 10<sup>3</sup> years in patients without autoimmune diseases. The risk of hospitalized infection was higher in patients with RA and SLE, but not in patients with AS, PSO/PSA, or other autoimmune diseases. Prior use of biologic agents or tofaitinib did not increase hospitalized infection risk. Other risk factors for hospitalized infection included elder age (HR, 1.01; 95% CI, 1.01–1.1), higher cancer stage, CR (HR, 1.04; 95% CI, 1.02–1.06), log(WBC) (HR, 1.21; 95% CI, 1.14–1.28). Female gender (HR, 0.65; 95% CI, 0.62–0.68) and Hgb (HR, 0.89; 95% CI, 0.88–0.90) were associated lower hospitalized infection risk. <h3>Conclusions</h3> Hospitalized infection was associated with a comorbidity of RA or SLE in incident cancer patients. <h3>Acknowledgements</h3> With thanks to Cancer Registry database and Clinical Informatics Research &amp; Development Center of Taichung Veterans General Hospital for the Support of Clinical data. <h3>Disclosure of Interest</h3> None declared