tbuckley/cabot-search huggingface dataset:
THU0092 Choronic pain increases independent of the disease activity and depression in females wİth rheumatoİd arthritis
Authors: FG Yurdakul, A Kılıçarslan, H Bodur
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Chronic pain is a key component of rheumatoid arthritis (RA). Although pain is reduced with the control of inflammation at the first years of the disease, pain increases over time with different pathways just as central sensitization. Fatigue, sleep problems and depressive symptoms with chronic pain are common problems in patients with RA (1,2). <h3>Objectives</h3> We aimed to investigate the frequency of widespread pain, sleep disorders, fatigue, and depressive symptoms in RA patients. Furthermore discrepancy of these symptoms and disorders were analyzed between female and male RA patients. <h3>Methods</h3> One hundred and sixty one RA patients (female: 119, male: 42) and 68 healthy controls (female: 52, male: 16) were enrolled in the study. Widespread pain index (WPI) with nineteen body parts that was identified by 2010 fibromyalgia diagnostic criteria was interrogated. Pain visual analog scale (VAS), Health Assessment Questionnaire (HAQ), Physician global assessment (PhGA), Fatigue severity scale (FSS), Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI) were evaluated in both RA patients and healthy controls. Morning stiffness (MS), Rheumatoid arthritis quality of life (RAQOL) and disease activity score 28 (DAS28) were assessed in RA patients. Data were analyzed in female and male RA patients. <h3>Results</h3> The mean PhGA, HAQ, BDI, FSS, WPI values of RA patients were worse than healthy controls (p=0.012, 0.000, 0.008, 0.033, 0.044 respectively). There was no difference between RA and healthy controls in terms of sleep disorders. The mean age, disease duration, MS, swollen joint count, C-reactive protein, PhGA and BDI were similar in female and male RA patients. WPI, VAS pain, tender joint count, HAQ, RAQOL, FSS, PSQI, and DAS 28 were higher in females (Table 1). <h3>Conclusions</h3> RA is a disease that increases fatigue, depressive symptoms and widespread pain.DAS 28 scores were higher due to the increased pain scores and tender joint count that are subjective parameters in female RA patients. Pain scores in females are significantly higher than in males, and pain exacerbated by central sensitization pathway in women may lead to sleep disorders and fatigue, but not increase depressive symptoms. <h3>References</h3> The role of central nervous system in the generation and main tance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia. Lee YC, Nassikas NJ, Clauw DJ. Arthritis Research and Therapy (2011) 13:211–221. Fatigue in patients with rheumatic diseases. Dupond JL. Joint Bone Spine (2011). 78:156–160. <h3>Disclosure of Interest</h3> None declared
THU0095 Impact of ultrasound-detected tenosynovitis and synovitis on disease flare, disability and radiographic progression in patients with ra in clinical remission: results of the starter study
Authors: G Sakellariou, G Filippou, E Bellis, CA Scirè, G Carrara, A Iagnocco
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> In patients with RA in remission subclinical ultrasonographic (US) synovitis (-S) relates to flare and radiographic progression. The impact of tenosynovitis (-T) on flare, disability and radiographic progression is not known. <h3>Objectives</h3> To evaluate the predictive role of US-detected tenosynovitis and synovitis in RA patients in remission on flare, disability and radiographic progression over 12-months. <h3>Methods</h3> STARTER is a multicentre cohort study of the US Study Group of the Italian Society for Rheumatology. Participants were selected on the basis of a reliability exercise and the availability of high-end equipment with high frequencies probes. Patients with RA in remission underwent clinical and US evaluation. US -T and -S were assessed categorically by Grey Scale (GS) and power Doppler (PD) at 11 joints, extensor and flexor tendons in both hands. Patients were assesed at baseline, 6 and 12 months. The primary outcome was flare within 12 months (defined as increase in DAS28&gt;1.2 or &gt;0.6 if final DAS28&gt;3.2). The secondary outcomes were progression of disability (increase ≥2.3 in the Health Assessment Questionnaire (HAQ)) and radiographic progression (increase in the total Sharp van Der Hejide score (SHS) ≥4.3) at 12 months. Logistic models were used to measure the relationship between GS-T/-S, PD-T/-S and outcomes, results were presented as odds ratios (OR) and 95% confidence interval (CI), adjusted for pre-specified confounders. <h3>Results</h3> 361 patients (72.3% f, mean age (sd) 56.1 (13.3), median disease duration (IQR) 7.1 years (3.6–13.5)) were included, complete radiographs were available for 189/361 (52.3%) patients. 98/326 (30.6%) patients had a flare within 12 months, 70/340 (20.59%) had an increase in HAQ and 39/189 (20.6%) radiographic progression. Results are presented in Table 1. Flare was predicted only if –T and –S, assessed by both GS and PD, were concurrently present, while both –T and-S and their combination did not predict HAQ or SHS progression. <h3>Conclusions</h3> In patients with RA in clinical remission, US-detected synovial and tenosynovial inflammation relates to the risk of flare, while in a short term follow-up the effect on disability and radiographic progression is limited. These results might have been influenced by the short follow-up and limited power for secondary outcomes. US might integrate the clinical management of RA patients in clinical remission. <h3>Disclosure of Interest</h3> None declared
Determinants of Market Exclusivity for Prescription Drugs in the United States
Authors: Aaron S. Kesselheim, Michael S. Sinha, Jerry Avorn
Journal: JAMA Internal Medicine (2017)

The high prices of brand-name prescription drugs are a growing source of controversy in the United States. Manufacturers of brand-name drugs can command high prices because they are protected from generic competition by two types of government-granted monopoly rights. The first are patents on the drugs that generally define the basic period of brand-name-only sales. The second is awarded at the time of US Food and Drug Administration (FDA) approval and usually defines the minimum time until a generic can be sold. The initial patents last for 20 years and may be extended to account for time spent in clinical trials and regulatory review; other laws prevent approval of other manufacturers' versions of new drugs for about 6 to 7 years, and for new biologics for 12 years. Overall, most new drugs receive about 12 to 16 years of market exclusivity from both kinds of monopoly protection combined. We reviewed the peer-reviewed medical and health policy literature to identify studies that described the different types of patent protection and regulatory exclusivities that shield brand-name prescription drugs from competition and thus help to sustain high drug prices. We also identified potential policy reforms intended to modify exclusivity periods to address public health needs by balancing drug affordability and industry revenue. The goal of policy in this area should be to ensure that drug market exclusivity periods provide for fair return on investment but do not indefinitely block availability of lower-cost generic drugs.
AB0258 Age and quality of life among rheumatoid arthritis patients treated with biologic agents
Authors: N Oguro, N Yajima, Y Miwa
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Rheumatoid arthritis (RA) is a common autoimmune disease of unknown etiology which is characterized by symmetric, chronic inflammatory, peripheral polyarthritis. If it is untreated or unresponsive to therapy, inflammation and joint destruction lead to loss of physical function, inability to carry out daily tasks of living. In addition to problems related to pain and inflammation, patients with RA are also affected by psychological problems such as anxiety and depression. It has been a while since, the biologic agents have let RA patients to early remmision, and improved their Quality of life (QOL). A few studies show relevance between age and QOL among RA patients. Lambert et al. found that age was positively correlated with pain, indicating that increasing age made the situation worse. <h3>Objectives</h3> This study aimed to assess the relationship between age and QOL of RA patients who has been treated with biologic agents. <h3>Methods</h3> 149 RA patients who treated with biologic agents at Showa University Hospital, Showa University Northern Yokohama Hospital and Showa University Koto Toyosu Hospital were recruited from 2005 to 2016. This study design was retrospective cohort study. Loss to follow-up was eliminated. The patients were divided into two groups, whose age was 65 years old and over (elderly) and under 65 (adults). The primary outcome was the change of QOL in 6months9. QOL was measure using SF-36, and we use physical component scale (PCS) and mental component scale (MCS). Logistic regression analysis was performed. <h3>Results</h3> Among 149 RA patients, the mean age was 57 years old and 85.9% was female. 92 out of 149 patients (61.7%) were adult group and 57 (38.3%) were elderly group. Adjusted with sex, disease duration, DAS28-ESR, HAQ, and with or without complications which are interstitial lung disease, diabetes mellitus, and chronic kidney disease, there was no significant difference in change of MCS in 6 months9. But those of PCS was significantly higher in adult9s group (regression coefficients -7.25; 95% Confidence Interval (CI) -11.7 to -2.77; <i>p</i>=0.0018). <h3>Conclusions</h3> There is a possibility that, younger patient who suffers with RA could achieve better quality of life than those of elderly patients after treatment with biologic agents. <h3>References</h3> Izabela Roma (2014) Quality of life and elderly patients with rheumatoid arthritis, Rev Bras Reumatol 2014;54(4):279–286. ULF Jakobsson (2002) Pain and quality of life among a older people with rheumatoid arthritis and/or osteoarthritis, Journal of clinical Nursing 2002;11;430–443. <h3>Disclosure of Interest</h3> None declared
OP0185 Immunohistologic study of synovitis from patients with undifferentiated arthritis who evolved to rheumatoid artrhitis or psoriatic arthritis after follow-up
Authors: A Cuervo Aguilera, R Celis, J Ramírez, MV Hernández, V Ruíz-Esquide, J Inciarte-Mundo, R Sanmartí, JD Cañete
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Undifferentiated Arthritis (UA) is defined as an inflammatory oligo/poly arthritis that does not fulfil criteria for a definitive diagnosis.Delay in diagnosis and treatment leads to poor prognosis. Previous studies have found differences in the cellular infiltrate between the synovitis of Rheumatoid Arthritis (RA) and Spondyloarthritis, including psoriatic arthritis (PsA) <h3>Objectives</h3> To identify synovial biomarkers that may be useful to diagnose patients with early UA <h3>Methods</h3> Retrospective longitudinal study.Patients with UA followed in our Arthritis Unit,who underwent arthroscopy between 2000 and 2014.Synovial biopsy were stained by immunohistochemistry with the following antibodies:CD3 for T cells,CD20 for B cells,CD79 for B cells,CD138 for plasma cells,CD31 for vessels,CD68 for macrophages,CD15 for neutrophils,CD117 for mast cells and hsp47 for fibroblasts, and quantified by Digital Image Analysis (Olympus).The same antibodies were evaluated in RA and PsA control groups <h3>Results</h3> 55 UA and 78 controls were included.Table 1 shows the clinical, serological and demographic characteristics.Among patients with UA, 23 (42%) patients met criteria for RA and 32 (58%) for PsA during follow-up.Synovitis of patients with UA had higher macrophage (CD68+) density in total tissue (p=0.008) and sublining (SL) (p=0.012) than the control group.The UA that evolved to RA had a higher density of CD3 T lymphocytes than the control RA group (p=0.014). No differences were observed in cells of adaptive immunity (CD20 B lymphocytes, CD138 plasma cells), innate immunity (CD117 mast cells, CD15 neutrophils), vessels (CD31) between the 4 groups.The area (%) stained by anti-hsp47 (synovial fibroblasts) in SL was higher in the RA control group than in the PsA (p=0.003) <h3>Conclusions</h3> This is the first immunohistological study of synovitis in a significant group of patients with UA who developed AR or PsA during follow-up. Although there are some differences between the UA and control groups in the density of CD68+ macrophages and lymphocytes T CD3+, these do not appear to be useful for an early diagnosis of UA. On the other hand, unlike the results of some previous studies, we not found differences between the cellular infiltrate (adaptive immunity, innate immunity or vessels) in patients with RA and PsA. The fact that some patients with UA were undergoing treatment prior to synovial biopsy and its retrospective character limit the results of this study <h3>Acknowledgements</h3> Financed: "Fondo de Investigaciόn Sanitaria" (PI14/00785. JD Cañete) del Instituto de Salud Carlos III (ISCIII). Co-financed by BECA FER-2015. Premis "Emili Letang", Hospital Clínic. BECA MSD-Sociedad Catalana de Reumatología <h3>Disclosure of Interest</h3> None declared
SAT0114 Poor cardiovascular risk management in rheumatoid arthritis patients despite an explicit cardiovascular risk management program
Authors: M Heslinga, I van den Oever, E Griep, H Griep-Wentink, Y Smulders, W Lems, M Boers, A Voskuyl, M Peters, D van Schaardenburg, M Nurmohamed
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> In 2011, we started a cardiovascular (CV) risk management program for rheumatoid arthritis (RA) patients visiting Reade in the Netherlands. We previously reported the presence of under treatment of hypercholesterolemia and hypertension [1]. <h3>Objectives</h3> To assess the effectiveness of our CV risk management program after one year. <h3>Methods</h3> CV risk screening was performed at baseline and we informed the general practitioner (GP) about the results, including advices regarding the initiation of cardio preventive drugs. In high risk patients, antihypertensives were recommended when systolic blood pressure &gt;140 mm/Hg and statins were recommended when low-density lipoprotein &gt;2.5 mmol/l. The decision to start preventive medication was left to the GP. CV risk screening was repeated after one year. Patients completed a questionnaire about the actions that were taken following the results of the initial screening. <h3>Results</h3> Of the 266 patients 202 (76%) were female, the mean age was 58±11 years. After one year, 88 out of 134 patients who received inadequate or no treatment at baseline were still untreated or undertreated. Of the 188 (71%) patients who were at high CV risk and who did have an indication to start therapy, only 7.5% was contacted by their GP and another 6.8% arranged an appointment themselves. While the 10-year CV risk did not decrease in the group as a whole, a risk reduction was found in the patients that started medication. Remarkably, 42% of patients reported lifestyle changes, including more exercise (20%), diet adaption (16%) and weight loss (9%). <h3>Conclusions</h3> It is striking that one year after the introduction of our CV risk management program, only 14,3% patients with an indication for preventive treatment visited their GP and only 14% started with CV risk lowering drugs. This is mainly caused by the small percentage of high risk patients that contacted their GP. On the other hand, a high percentage reported the start of healthy lifestyle. These results underscore the need for a short-term follow-up, in close collaboration with primary care providers to ensure appropriate CV risk management. This is a future implementation project that will be initiated shortly. <h3>References</h3> Ann Rheum Dis 2015;74:192. <h3>Disclosure of Interest</h3> None declared
SAT0398 Pregnancy outcomes in korean women with ankylosing spondylitis
Authors: EH Park, JK Jun, SM Lee, YW Song, EB Lee
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Ankylosing spondylitis (AS) is a chronic, systemic, inflammatory disease that primarily affects the sacroiliac joints and spine. Despite overwhelming prevalence of AS in men, it can also occur in women. Since AS mainly affects the sacroiliac joints, a special attention should be paid to the normal labors and pregnancy outcomes in these female patients. However, very little is known about the impact of AS on pregnancy outcomes due to rare occurrence of the disease in women. <h3>Objectives</h3> To investigate the pregnancy outcomes in Korean female patients with AS. <h3>Methods</h3> All of the 27 deliveries from 20 AS female patients who had been cared at Seoul National University Hospital between February 1994 and June 2016 were retrospectively evaluated through medical record review. After matching each pregnancy of the AS women with the pregnancies of the control group on a 1 to 4 ratio based on maternal and gestational age, pregnancy outcomes of AS patients were compared with those of the control group. Pregnancy outcomes included cesarean section (CS) rate, preterm birth, low birth weight infant, fetal growth restriction (FGR), fetal malformations and preeclampsia. Each pregnancy was considered as a separate observation, and outcomes between the groups were compared by regression models estimated using Generalized Estimating Equations (GEEs) to account for the matched nature of the data. For zero events in either group in which GEE models do not converge, Fisher9s exact test or Chi-square test were used. <h3>Results</h3> Caesarean section (CS) was performed in 44.4% of deliveries among women with AS compared with 20.4% in controls (p=0.002) (Table 1). The indications of CS included previous uterine surgery, breech position, placenta previa, placental abruption, fetal distress, and cephalopelvic disproportion (CPD), which were comparable between two groups. When excluding the cases of elective CS, 16 pregnant women with AS were tried for the vaginal delivery. Among them, 15 cases (93.8%) achieved successful vaginal deliveries, which was comparable to the successful vaginal delivery rate in controls (86/90 (95.6%), p=0.566). CS due to CPD was done in 1 case (8.3%) of AS women, while there was no case in the controls (p=0.353). Interestingly, the severity of sacroiliitis in AS patients did not show any association with CS (p=0.342). Women with AS had a higher frequency of LBW compared to the controls (22.2% vs 8.3%, p=0.024). However, there was no statistically significant difference in other adverse pregnancy outcomes, including preterm birth, FGR, fetal malformations, and pre-eclampsia. <h3>Conclusions</h3> Although pregnant women with AS are concerned about CPD during their labors due to the involvement of the sacroiliac joints, vaginal deliveries can be tried in patients with AS. The obstetric and perinatal outcomes in women with AS were also comparable to normal pregnant women. <h3>Disclosure of Interest</h3> None declared
Response by Bress et al to Letters Regarding Article, “Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States: Projections from NHANES (National Health and Nutrition Examination Survey)”
Authors: Adam P. Bress, Holly Kramer, Richard S. Cooper
Journal: Circulation (2017)
AB0547 The prevalence and the risk factor of hypertension and dyslipidemia in systematic lupus erythematosus patients: exploratory research
Authors: Y Miura, M Saito, K-E Sada, N Yajima
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Hypertension (HT) and dyslipidemia (DL) are the risk factors for all-cause mortality, cardiovascular and cerebrovascular disease, and end-stage renal disease in SLE patients <sup>1)</sup>. Neither disease activity nor chronic damage were associated with the metabolic syndrome in SLE patients <sup>2)</sup> and there were few reports about the risk factors of HT and DL in Japanese SLE patients. <h3>Objectives</h3> We aimed to describe a prevalence of HT and DL and to identify the risk factor of HT and DL in Japanese SLE patients. <h3>Methods</h3> All SLE patients visited at Showa University Hospital and Okayama University Hospital from January 2016 to September 2016, were enrolled in a cross-sectional study. SLE patients who satisfied American College of Rheumatology (ACR) criteria were included. HT was defined as usage of anti-HT drugs and DL was defined as usage of anti-DL drugs. We performed descriptive statistics and binomial logistic regression analysis to identify the risk factors of HT and DL. Variables considered possible risk factors were BMI, drinking status, smoking status (current smoking), current daily dose of glucocorticoids, past maximum dose of glucocorticoids, lupus nephritis, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI). <h3>Results</h3> In total, 244 participants were enrolled. The mean age was 46.2±15.3 years, and 222 (91%) were female. The mean current daily dosage of glucocorticoids was 6.7±5.9 mg, and the mean SLEDAI-2K was 5.0±5.2 and the mean SLICC/ACR-DI was 1.3±1.7. The prevalence of HT and DL were 29.1% (71/244) and 22.1% (54/244). Both HT and DL were confirmed in 11.9% (29/244) patients. On binomial logistic regression analysis, BMI (regression coefficients (β)= -0.095; 95% confidential interval (CI) = -0.173 to -0.020), drinking status (β =0.443; 95% CI =0.000 to 0.879), past maximum dosage of glucocorticoids (β= -0.018; 95% CI = -0.036 to -0.004) and lupus nephritis (β= -0.727; 95% CI =0.230 to 1.241) were identified as the significant independent risk factors of HT. On the other hand, only age (β= -0.030; 95% CI = -0.055 to -0.006) was identified as the independent risk factor of DL. There was no independent risk factor of having both DL and HT. <h3>Conclusions</h3> Our results could help to identify patients at higher risk of HT and DL. <h3>References</h3> Hsin-Hui Yu. et al. Statin reduces mortality and morbidity in systemic lupus erythematosus patients with hyperlipidemia: A nationwide population-based cohort study. Atherosclerosis. 2015;243:11–18. Cecilia P Chung. Et al. High prevalence of the metabolic syndrome in patients with systemic lupus erythematosus: association with disease characteristics and cardiovascular risk factors. Ann Rheum Dis. 2007;66:208–214. <h3>Disclosure of Interest</h3> None declared