tbuckley/cabot-search huggingface dataset:
FRI0668 Sonographic and anatomical description of the subtalar joint
Authors: P Mandl, D Bong, PV Balint, HB Hammer, M Miguel, E Naredo, I Möller
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> The subtalar joint is commonly affected in many rheumatic and musculoskeletal diseases; however, subtalar joint involvement is often neglected or missed during clinical examination due to the fact that the joint is difficult to examine and most clinicians have a limited understanding of its anatomy. <h3>Objectives</h3> To provide a detailed anatomical and US description of the subtalar joint, a single joint that, anatomically, is divided into two separate compartments: the anterior subtalar joint (ASTJ) and the posterior subtalar joint (PSTJ). <h3>Methods</h3> Cadaver specimens of the ankle and foot were examined in detail by ultrasound (US) by rheumatologist experts in musculoskeletal US. The ASTJ of all the specimens were injected with colored latex while the PSTJs were respectively injected with 1ml of latex of a contrasting color under US guidance. Following the injections, the joints were frozen and cut into 2 centimeter sections from medial to lateral in the sagittal plane. Sections were examined independently by three authors for the presence of latex within the ASTJ, PSTJ and, also, to look for the presence of extra-articular latex extravasation or the spread of latex to adjacent articulations by means of a communication with the ankle joint or the adjacent portion of the subtalar joint. <h3>Results</h3> Six cryopreserved intact ankle-foot specimens from three male and three female cadavers (two right and four left), with a mean age of 74 years (range, 66–80 years) were studied. A recommended list of standardized scanning technique which allows sonographers to evaluate both compartments of the subtalar joint (ASTJ and PSTJ) from the medial, lateral and posterior aspect were developed. All of the specimens (6/6, 100%) contained the appropriate colored latex in the appropriate subtalar joint compartment with minimal leakage into the surrounding soft tissues (Figure 1). Of note, five of the six (5/6, 83%) specimens revealed communication between the PSTJ and the posterior tibiotalar joint. There was no communication between the ASTJ and the tibiotalar joint, nor was there evidence of spread of the latex, i.e. communication, from one subtalar joint compartment to the other. <h3>Conclusions</h3> Lack of communication between the ASTJ and the PSTJ and the communication between the PSTJ and the posterior recess of the tibiotalar joint are compatible with other studies. Our study highlights the importance of employing cadaver specimens in musculoskeletal ultrasound, and presents a number of options for US imaging of both the ASTJ and PSTJ that also provide access to these distinct compartments for the purpose of aspiration and injection. <h3>Disclosure of Interest</h3> None declared
AB0255 Evaluation of kinesiophobia in patients with rheumatoid arthritis and ankylosing spondylitis
Authors: M Aykut, B Cakit, E Mert, S Aslan, E Sahingoz, H Genc, FF Ayhan, A Karagoz
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Fear avoidance behavior which is caused by painful injury resulting precision and extreme fear is defined as kinesiophobia. Rheumatoid arthritis (RA) is a chronic, inflammatory and systemic disease with symmetrical arthritis and visceral involvement. Ankylosing spondylitis (AS) is a chronic, inflammatory disease with involvement of the spine or peripheral joints. <h3>Objectives</h3> In our study, we aimed to evaluate the relationships between kinesophobia and disease activity, quality of life (QoL), level of physical activity and emotional status in RA and AS patients. <h3>Methods</h3> We included 42 patients with RA (8 males-M, 34 females-F) (group 1), 49 patients with AS (34 M, 15 F) (group 2) and 29 healthy controls (9 M, 20 F) (group 3) in our study. The QoL was assessed using the health assessment questionnaire (HAQ), kinesiophobia was assesed with Tampa scale of kinesiophobia (TSK), pain was assesed with visual analog scale (VAS), fatigue was assesed with VAS and emotional status was assesed with Beck depression inventory (BDI). Disease activity was assesed with Bath ankylosing spondylitis disease acitivity index (BASDAI) and functional status was assesed with Bath ankylosing spondylitis functional index (BASFI) in patients with AS. Disease activity was assesed with DAS28 in patients with RA. <h3>Results</h3> The mean age was 46.2 in group 1, 43.2 in group 2 and 40.17 in group 3. There was no difference among groups with respect to mean age (p&gt;0.05). Kinesiophobia was present in 37 patients in group 1, 22 patients in group 2 and 7 patients in group 3. Statistically significant differences were found among groups with respect to the number of patients with kinesiophobia and to mean scores of pain intensity, fatigue, HAQ and BDI (p&lt;0,05-&lt;0,001). Patients with RA had higher rates of kinesiophobia than patients with AS and healthy controls (p=0.001, p=0,001). Patients with RA had worser scores than patients with AS and healthy controls. Patients with AS had worser scores than healthy controls. In patients with RA and AS, kinesiophobia is associated with pain severity, fatigue, emotional status and QoL. <h3>Conclusions</h3> In our study, patients with RA and AS had higher rates of kinesiophobia. We found that kinesiophobia was related with pain severity, fatigue, depression, disease activity and QoL of the patients. The QoL can be improved through controlling kinesiophobia by reducing pain, depression and fatigue. <h3>Disclosure of Interest</h3> None declared
AB0194 Journey of a patient with rheumatoid arthritis: delay in diagnosis and treatment
Authors: A Luissi, JE Rosa, F Vergara, FS Pierini, M Scolnik, MV Garcia, ER Soriano
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> It has been shown that there is a window of opportunity for treatment in Rheumatoid Arthritis (RA). Several Argentinean studies showed an average of 8 months to arrive to a rheumatology visit and 12 months to receive DMARDs. There aren9t recent studies. <h3>Objectives</h3> To establish delay time from onset of rheumatoid arthritis (RA) symptoms to the first rheumatology visit, to diagnosis of the disease and to the beginning of treatment with DMARDs; and to assess impact of such delay on structural damage, in a cohort of RA patients. <h3>Methods</h3> A retrospective study was performed including all patients with RA (fulfilling ACR/EULAR 2010 criteria) seen at a Prepaid Medical Health Plan between 2002–2015. Diagnosis delay and its impact on functional capacity measured by HAQ-A and structural damage by Sharp van der Hejde score (SvdH) was estimated. Demographic and clinical data, and dates ofdiagnosis, onset of symptoms and HAQ-A were extracted from electronic medical records. Svdh score was performed by an experienced rheumatologist. <h3>Results</h3> 246 patients (mean age at diagnosis 67.25±14 years, 199 (81%) female) were included. Clinical presentation was poliarticularin 49% of the cases, oligoarticularin 47% and monoarticular in 3%. 79% had high titers of anti-cyclic citrullinated peptide antibodies, 12% low titers, and 9% were negative. Rheumatoid factor was positive in 82.5%. Mean time of follow up was 7 years (SD: 3.8). At the end of the follow-up,median HAQ-A (n=145) was 0.125 (IRQ: 0–0.87). Hands and feet lastxray available were analized in 171 patients. Median Svdh score was 15 (IQR: 6–33). 242 patients (98.4%) received DMARDs as initial treatment: methotrexate monotherapy (76%) was the most frequent one. 41 patients (17%) received biological agents at some point of their disease. Table 1 shows different delay times in accessing rheumatology consultation, diagnosis and beginning of treatment. At the end of follow up, 21 patients (12.28%) had noradiological damage (Svdh score =0). In the ROC curve (AUC 0.57,95% CI: 0.45 - 0.69), 5.6 months of diagnosis delay was the best cut off valueto discriminate the presence of erosions (SvdH erosions score&gt;0), with a sensitivity and specificity of 54.17% and 61.90%, respectively. Delay in diagnosis greater than 12 months (n=70) was associated with significantly radiological damage: Svdh mean 30.91 (IC 95% 21.99–39.79) vs 21.32 (IC 95% 16.93–25.72); p=0.0325. <h3>Conclusions</h3> In a Prepaid Medical Health Planwith ease of referral, there is still a significant delay in diagnosis and treatment of RA patients.Delay in diagnosis greater than 12 months was associated with more radiological damage. <h3>Disclosure of Interest</h3> None declared
SP0191 Principles of non-pharmacological management of regional musculoskeletal disorders
Authors: P Oesch
Journal: Annals of the Rheumatic Diseases (2017)

The two main components of non-pharmacological management of regional musculoskeletal disorders are a thorough assessment followed by rehabilitative care. Assessment includes a careful history, level of daily activities and participation, including occupation, rehabilitative care to date, possible presence of psychosocial problems, sports and hobbies. Special attention must be given to patient9s expectations and personal objectives. A systemic enquiry is also important, as regional pain may be due to an underlying medical condition. Clinical examination consists of observation of posture, mobility, and whether there is evidence of wasting, asymmetry, deformity, or muscle imbalances. Palpation of soft tissue and bony structures follows to identify areas of tenderness, lumps, myofascial trigger points, tendon crepitus. Assessment of active and passive movements in all planes follows looking for specific restrictions. Examination is not restricted to the site of pain; as for example upper limb pain syndromes may be referred from the neck. In some patients further medical investigation is necessary when a thorough history, examination, and ultrasonography do not provide sufficient diagnostic information. This may involve blood tests, plain radiography, CT or MRI. Rehabilitative care is a customized process, which aims to achieve an optimal functional outcome and participation in all aspects of life. Active rehabilitation and a gradual return to normal activities are key points in successful treatment of regional pain syndromes. Progressive exercise is a fundamental part of the treatment of most regional musculoskeletal complaints. The goal is to work towards full, specific, pain free functional activity. In myofascial pain syndromes and non specific arm pain in particular, there is a need for review of postural issues and ergonomics and building aerobic fitness. In addition, providing information to the patient about the nature of the condition, beneficial and negative habits and activities, self help exercises, expected response to treatment and outcome should all be part of the approach to these patients. Psychological interventions may complement rehabilitative care. Cognitive and behavioral methods focus on changing the patient9s interpretation and reaction to pain. The main assumption of a behavioral approach is that pain and pain disability are influenced by somatic pathology and also by psychosocial factors (eg, patient9s attitudes and beliefs, psychological distress and illness behavior). Consequently, the behavioral treatment of regional musculoskeletal disorders does not primarily focus on removing an underlying organic pathology, but on the reduction of disability through modification of environmental contingencies and cognitive processes. <h3>Disclosure of Interest</h3> None declared
SP0123 Uncovering the equity gap in rheumatic and musculoskeletal diseases
Authors: P Putrik
Journal: Annals of the Rheumatic Diseases (2017)

The aim of this lecture is to discuss the current evidence on the socio-economic inequities in disease outcomes in RMDs. Socio-economic determinants at the individual and country level will be considered, as well as the interplay between these factors. In particular, attention will be given to the role of different socio-economic factors in the access to biologic DMARDs in rheumatoid arthritis. <h3>Disclosure of Interest</h3> None declared
Temporal stability of multitrigger and episodic viral wheeze in early childhood
Authors: Ben D. Spycher, Cara Cochrane, Raquel Granell, Jonathan A.C. Sterne, Michael Silverman, Eva Pedersen, Erol A. Gaillard, John Henderson, Claudia E. Kuehni
Journal: European Respiratory Journal (2017)

The distinction between episodic viral wheeze (EVW) and multitrigger wheeze (MTW) is used to guide management of preschool wheeze. It has been questioned whether these phenotypes are stable over time. We examined the temporal stability of MTW and EVW in two large population-based cohorts. We classified children from the Avon Longitudinal Study of Parents and Children (n=10 970) and the Leicester Respiratory Cohorts ((LRCs), n=3263) into EVW, MTW and no wheeze at ages 2, 4 and 6 years based on parent-reported symptoms. Using multinomial regression, we estimated relative risk ratios for EVW and MTW at follow-up (no wheeze as reference category) with and without adjusting for wheeze severity. Although large proportions of children with EVW and MTW became asymptomatic, those that continued to wheeze showed a tendency to remain in the same phenotype: among children with MTW at 4 years in the LRCs, the adjusted relative risk ratio was 15.6 (95% CI 8.3–29.2) for MTW (stable phenotype) compared to 7.0 (95% CI 2.6–18.9) for EVW (phenotype switching) at 6 years. The tendency to persist was weaker for EVW and from 2–4 years. Results were similar across cohorts. This suggests that MTW, and to a lesser extent EVW, tend to persist regardless of wheeze severity.
Abstract 14891: Six-minute Walk Distance Predicts the Readmission due to Decompensated Heart Failure in Early Elderly and Late Elderly Patients With Chronic Heart Failure
Authors: Minoru Tabata, Michitaka Kato, Ryosuke Shimizu, Ayako Akiyama, Yumi Kamada, Shinya Tanaka, Nobuaki Hamazaki, Akihiro Aoyama, Kentaro Kamiya, Takashi Masuda
Journal: Circulation (2015)

Background: Patients with chronic heart failure (CHF) are frequently readmitted to the hospital. Six-minute walk distance (6MWD) is a clinical measure to assess their exercise capacity and prognosis. However, few reports documented whether the 6MWD reflects the exercise capacity and prognosis in elderly CHF patients. Purpose: This study aimed to investigate whether the 6MWD measured at the hospital discharge predicted the readmission due to decompensated CHF in early elderly and late elderly CHF patients. Methods: Patients who were admitted to the hospital were prospectively followed up for 3 years after the discharge, if they had the first hospitalization due to CHF with NYHA III or IV. Consequently, we studied 177 patients (74±6 years, 112 males) and investigated their 6MWD at the discharge and readmission over 3 years. Patients were divided into 2 groups: early elderly group (65-74 years; n=108) and late elderly group (≥75 years; n=62). We determined significant factors affecting the readmission due to CHF and their cut-off values in the two groups using multivariate logistic regression analysis and the area under the receiver operating characteristics (ROC) curve. Results: 50 % of early elderly patients and 42 % of late elderly patients were readmitted within 3 year after the discharge. The multivariate logistic regression analysis detected the 6MWD at the discharge as a significant limiting factor for readmission in the two groups (P&lt;0.001, respectively). The odds ratio of readmission with each 10-meter decrease of 6MWD and its cut-off value were 1.34 (P&lt;0.001) and 405 meters for the early elderly group, and 1.37 (P&lt;0.001) and 345 meters for late elderly group, respectively (Figure). Conclusion: This study demonstrated that the 6MWD was shown as a strong predictor for readmission due to decompensated heart failure in elderly patients with CHF. The predictive cut-off values of 6MWD were 405 and 345 meters in the early elderly and late elderly patients, respectively.
AB1214-HPR Spinal brucellosis: a retrospective study of 30 cases
Authors: S Rekik, S Boussaid, I Abdelkafi, S Hela, I Cheour, M Elleuch
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Brucellosis is a major health problem in Mediterranean countries including Tunisia. The clinical presentation of this zoonosis varies considerable but osteoarticular involvement and spinal brucellosis particulary is the commonest complication. <h3>Methods</h3> This study was carried out between 2000 and 2015. One hundred and six patients with infectious spondylodicitis hospitalized in the department of rheumatology were analyzed. All patients were thoroughly interrogated subjected to a rigorous clinical examination and a battery of investigations including: complete blood count, urine analysis, blood culture, erythrocyte sedimentation rate, C - reactive protein (CRP) and serology for brucellosis. The imaging of spine ordered including: X-ray, bone scan and magnetic resonance imaging (MRI) with contrast enhancement. <h3>Results</h3> Thirty of the 106 patients (28%) proved to have spinal brucellosis. The mean age of these patients was 53 years (range 15–68 years) and female/men ratio at 1.5. The mean delay of diagnosis was 8 months. The following symptoms were observed: fever in 14 patients and back pain in all of patients. Other symptoms were less frequently observed, such as splenomegaly (2 patients), peripheral adenopathy (5 patients) and diarrhea (2 patients). Laboratory exams showed elevated erythrocyte sedimentation rate in 13 patients, high levels of CRP in all patients and leukocytosis in 11 cases. Wright serology was positive in 21 of the patients. Brucella melitensis was isolated in blood cultures in 2 cases. Standard X-rays were performed in all patients. They showed signs of spondylodiscitis in the lumbar spine in 20 cases, cervical in 2 cases and dorsal in 8 cases. Ct-scan and MRI confirms the diagnosis and showed associated epiduritis in 2 cases or abscess in 6 cases. Bone biopsy with histopathological examination was performed in 7 cases. A combination of cycline and rifampicin was given to all patients. The duration of therapy was between 6 and 8 weeks. <h3>Conclusions</h3> Brucellosis is present with various clinical signs in endemic areas and may simulate many diseases. The need for prompt diagnosis and treatment of spinal brucellosis is of utmost importance to prevent serious bone destruction and severe neurologic Sequelae. <h3>Disclosure of Interest</h3> None declared
SAT0256 Multi-target therapy with mizoribine, tacrolimus, and prednisolone in lupus nephritis: analysis of 47 cases
Authors: R Kawato, R Rokutanda, M Kishimoto, M Okada
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Mizoribine (MZB), an inosine monophosphate dehydrogenase inhibitor, is an effective glucocorticoid-sparing agent for gromerulonephritis and variety of rheumatic diseases. However, its clinical usefulness as multi-target therapy in patients of lupus nephritis has been unclear. <h3>Objectives</h3> To evaluate efficacy of multi-target therapy with MZB, tacrolimus (TAC) and prednisolone (PSL) for lupus nephritis. <h3>Methods</h3> We extracted all the cases with lupus nephritis treated with PSL, MZB, and TAC during period from 2008/1 to 2016/10. Retrospective medical chart review was performed to collect following data; baseline patient characteristics, dose of PSL, serum creatinine, urine protein, compliment, anti-DNA ab, remission rates, and safety profiles. We define complete remission as urine protein &lt;0.5 g/gCre and normal serum creatinine, partial remission as urine protein decreasing more than 50% at baseline, and &lt;3g/day, and normal serum creatinine or increasing within 15%. Patents9 records were followed from the beginning of multi-target treatment to 12 months after. <h3>Results</h3> 43 cases (female; n=37, male; n=6, mean age; 37.4 years old) were included for analysis. Of 30 cases who underwent renal biopsy, 10 cases were classified as class IV nephritis, and 7 cases were classified as class III nephritis. Mean urine protein (g/gCr) at baseline, at 3 months, and at 6 months are 1.9, 0.4, and 0.4, respectively. Mean dose of steroid was 32.8 mg/day at baseline, 9.8 mg/day at 3 months, and 8.7 mg/day at 6 month. 79.1% of the patients achieved complete remission at 3 months, and the remission rate was more than 80% at 6 months and later. As for adverse events, 14 cases had some Infection, 3 out of 14 needed antibiotics treatment. Four cases had renal impairment after starting TAC, all of them recovered after stopping or decreasing dose of TAC. <h3>Conclusions</h3> Multi-target therapy with MZB, TAC and PSL showed good remission rate, and few severe adverse events. We need the further evaluation of long-term efficacy of the therapy. <h3>Disclosure of Interest</h3> None declared
New (Very High) Prices on Old Drugs
Authors: Saate Shakil, Rita F. Redberg
Journal: JAMA Internal Medicine (2017)

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