tbuckley/cabot-search huggingface dataset:
SAT0142 Pulmonary hypertension among hispanic patients with rheumatoid arthritis: a case-control study
Authors: J. R. Azpiri-López, D. A. Galarza-Delgado, I. J. Colunga-Pedraza, J. A. Dávila-Jiménez, E. E. Abundis-Márquez, A. H. Guillén-Lozoya, F. J. Torres-Quintanilla, R. E. Ramos-Cázares, R. Vera-Pineda, J. A. Cárdenas-de la Garza
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory, multifactorial disease that mainly affects synovial joints. Pulmonary artery hypertension (PAH) can appear as a complication of connective tissue diseases. It is possible that pulmonary artery systolic pressure (PASP) in RA may be elevated due to interstitial lung disease, pulmonary vasculitis, pulmonary veno-occlusive disease, or cardiac disease (1). Although right heart catheterization is the gold standard, Doppler echocardiography has proved to be a reliable non-invasive method for detecting PAH (2). <h3>Objectives:</h3> To determine the prevalence of PAH in RA patients and compare it to matched controls. <h3>Methods:</h3> A case-control study with RA patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and matching controls were included. Exclusion criteria: poor acoustic window, absence of tricuspid regurgitation (TR), prior atherosclerotic cardiovascular (CV) disease and overlap syndromes. Patients were matched using age, sex and comorbidities. Transthoracic echocardiogram was performed by a board-certified cardiologist. PASP was calculated using the Bernoulli equation: TR velocity<sup>2</sup> × 4 + right atrial pressure according to ASE's guidelines. We used Denton's definition of PAH on Doppler echocardiography as an estimated PASP≥30 mmHg (3). <h3>Results:</h3> A total of 76 RA patients and 52 matched controls were included. Demographic and clinical characteristics of both groups are shown on table 1. As shown on table 2, the mean PASP was higher RA patients (27.14±6.34 mmHg) than controls (24.68±5.44 mmHg) (<i>P=</i>0.024). PASP≥30 mmHg prevalence was significantly higher in RA patients (34.2% vs 11.5%; <i>P=</i>0.004). <h3>Conclusions:</h3> Elevated PASP, suggesting PAH, was more prevalent on RA patients than controls. A higher number of CV events that cannot be explained by traditional risk factors have been reported in RA patients; and it is possible that the elevation in the PASP could contribute to the problem. Prospective studies are needed to evaluate the role of elevated PASP in morbidity and mortality of RA patients. <h3>References</h3> [1]Panagiotidou E, et al. Rheumatoid arthritis associated pulmonary hypertension. Respir Med Case Reports2017;20:164–7. [2]Udayakumar N, et al. Pulmonary hypertension in rheumatoid arthritis-Relation with the duration of the disease. Int J Cardiol2008;127(3):410–2. [3]Denton CP, et al. Comparison of Doppler Echocardiography and Right Heart Catheterization To Assess Pulmonary Hypertension in Systemic Sclerosis. Br J Rheumatol1997;36:239–43. <h3>Disclosure of Interest:</h3> None declared
THU0356 Synergistic effect of cumulative corticosteroid dose and immunosuppressants on avascular necrosis in patients with systemic lupus erythematosus
Authors: H.-H. Kwon, S.-Y. Bang, S. Won, Y. Park, J.-H. Yi, Y.B. Joo, H.-S. Lee, S.-C. Bae
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Avascular necrosis (AVN) is one of the most common organ damage in patients with systemic lupus erythematosus (SLE) and often causes serious physical disability. <h3>Objectives</h3> The aims of this study were to investigate clinical risk factors associated with symptomatic AVN and to analyse their synergistic effects in a large SLE cohort in Korea. <h3>Methods</h3> Patients with SLE were enrolled and followed from 1998 to 2014 in the Hanyang BAE Lupus cohort, in whom damage was measured annually according to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. AVN was confirmed by imaging study if patients had symptoms. To determine risk factors for AVN, clinical, laboratory, and therapeutic variables were analysed by logistic regression. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were calculated to measure interactions between significant variables. <h3>Results</h3> Among 1,219 SLE patients, symptomatic AVN was the most common type of musculoskeletal damage (10.8%, n=132). SLE patients with AVN showed an earlier onset age, demonstrated AVN more commonly in conjunction with certain other clinical manifestations such as renal and neuropsychiatric disorders, and received significantly higher total cumulative corticosteroid dose and immunosuppressive agents than did patients without AVN. However, in multivariable analysis, only two variables including use of a cumulative corticosteroid dose greater than 20 g (odds ratio (OR) 3.08, p=0.005) and use of immunosuppressants including cyclophosphamide or mycophenolate mofetil (OR 4.34, p=0.002) remained as significant risk factors for AVN. Patients with cumulative corticosteroid dose &gt;20 g and immunosuppressants use had a 15.44-fold increased risk for AVN, compared with patients without these risk factors (p&lt;0.001). RERI, AP, and S, which define the strength of interactions between two risk factors, were 9.01 (95% confidence interval (CI) 1.30–16.73), 0.58 (95% CI 0.36–0.81), and 2.66 (95% CI 1.42–4.99), respectively, supporting the presence of synergistic interactions in the development of symptomatic AVN in our Korean lupus cohort. <h3>Conclusions</h3> An individual risk assessment for AVN development should be made prior to and during treatment for SLE, especially in patients with high-dose corticosteroid and immunosuppressant use regardless of clinical manifestations and disease activity. <h3>Disclosure of Interest</h3> None declared
Visa cap is costing NHS trusts thousands in failed applications
Authors: Tom Moberly
Journal: BMJ (2018)

NHS trusts are spending thousands of pounds on recruiting overseas doctors only to have most of their visa applications refused, data obtained by The BMJ show.

The Dudley Group NHS Foundation Trust in the West Midlands made four applications a month for tier 2 visas for doctors recruited from outside the European Economic Area between December 2017 and May 2018, and all 24 of these applications were rejected, data released in response to a freedom of information request show. The trust estimated that it spent £4500 (€5110; $6025) in processing and paying fees for …
AB1439-HPR The effects of different exercise protocols on functional status and aerobic capacity in patients with ankylosing spondylitis
Authors: S Oksuz, E. Unal, G. Arın
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Although there is the emphasis on the importance of lifelong regular exercise to improve the efficacy of medication in the treatment of ankylosing spondylitis (AS) patients, there is a lack of information about the safe exercise dosage in clinical practice. <h3>Objectives</h3> In this study, we aimed to investigate the effects of different exercise protocols on functional status and aerobic capacity in patients with ankylosing spondylitis. <h3>Methods</h3> Thirty-one ankylosing spondylitis patients were evaluated and grouped according to their arrival order. Patients' spinal mobility (Bath Ankylosing Spondylitis Mobility Index), disease activity (Bath Ankylosing Spondylitis Disease Activity Index), flexibility (back scratch test), pulmonary functions (forced vital capacity with pulmonary function test, maximal inspiratory and expiratory pressures with respiratory muscle strength test), aerobic capacity (oxygen consumption test with submaximal modified Bruce protocol), fatigue level (Fatigue Severity Scale) and sleep quality (Pittsburgh Sleep Quality Index) were assessed. Group 1 (n=16) did both aerobic training and clinical pilates exercises, while group 2 (n=15) only did aerobic training. Patients did exercises for 8 weeks, 3 days a week under the supervision of a physiotherapist and then measurements were repeated. <h3>Results</h3> According to the measurements, it was found that disease activity level, respiratory muscle strength was improved (p&lt;0.05) in both groups. When clinical pilates exercise was given additionally to aerobic training spinal mobility (BASMI score), upper extremities flexibility, forced vital capacity, fatigue severity and sleep quality (p&lt;0.05) was also improved. <h3>Conclusions</h3> As a result of the study, it was noted that when clinical pilates exercises applied together with the aerobic exercise training in ankylosing spondylitis patients, effectiveness on functional status and aerobic capacity was increased. <h3>Disclosure of Interest</h3> None declared
Development, Proliferation, and Growth of the Mammalian Heart
Authors: Marie Günthel, Phil Barnett, Vincent M. Christoffels
Journal: Molecular Therapy (2018)

During development, the embryonic heart grows by addition of cells from a highly proliferative progenitor pool and by subsequent precisely controlled waves of cardiomyocyte proliferation. In this period, the heart can compensate for cardiomyocyte loss by an increased proliferation rate of the remaining cardiomyocytes. This proliferative capacity is lost soon after birth, with heart growth continuing by an increase in cardiomyocyte volume. The failure of the injured adult heart to regenerate often leads to the development of heart failure, a major cause of death. With the recent observation of a small fraction of cardiomyocytes that appear to have retained the proliferative capacity within the adult heart, as well as the identification of developmental pathways such as the Hippo-signaling pathway that can invoke mature cardiomyocyte proliferation, more studies are taking a knowledge-based mechanistic approach to heart regeneration. A key question being asked is if this knowledge can be used therapeutically to reinitiate cardiomyocyte proliferation after injury such as myocardial infarction. In this respect, uncovering and understanding the mechanisms and conditions that give rise to a fully functional and adaptive heart in the developing embryo could provide us with the answers to many of the questions that are now being asked.
SAT0666 Inflamation beyond clinical remission: ultrasound as a tool to guide us to remission
Authors: P. Estrada, C. Diaz-Torné, V. Torrente, P. Moya, C. Moragues, D. De La Fuente, S. Ros, J. Ramirez, M. Moreno, E. García, M. Puyol, N. Busquets, A. Ponce, J. De Agustín
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Among patients with RA in remission, subclinical synovitis (SS) has a prevalence of 45% and is associated with an increased risk of clinical relapse and progression to structural damage. US is a sensitive and accessible tool for evaluating SS<sup>1,2,3</sup>. <h3>Objectives</h3> To analyse US as a tool for evaluating SS in RA patients treated with tocilizumab (TCZ), in order to assess remission, and from there on propose therapeutic tapering. <h3>Methods</h3> Multicenter, 1 year follow up study in 45 patients with RA treated with TCZ. The project was aproved by Ethics Committees and all the patients gave their informed consent. At each visit: DAS28, SDAI, CDAI, mHAQ, US grey scale (GS) and Power Doppler (PD) parameters for 32 joints (J) and 28 tendons (T), with a semiquantitative scale from 0–3 points. A quantitative index was obtained for J and T in GS and PD and overall (EG +PD) for each patient/visit. SS was considered as the presence of synovitis with PD(+)≥2. Our intra and interobserver kappa index was 0.8. <h3>Results</h3> A significant reduction of all clinical indexes and US variables was observed in all patients. Patients were divided into two groups: remission (R) and no remission (NR) according to whether they achieved DAS28 ≤2.6 at 12 months. Group R achieved DAS28 ≤2.6 after mo 3, whereas US showed SS (GS+, PD &gt;2) until mo 12. The final overall PD value in the R group was 0.6 (±0.9). <h3>Conclusions</h3> A significant number of patients achieve clinical remission within a few months of starting TCZ. The R group, achieved a good EULAR response since mo 3; a progressive improvement in PD, persisted until mo 12. We consider that these findings refer to SS. From our data we consider that dose tapering should not be initiated until at least 9 months from the start of remission. <h3>References</h3> [1] doi 10.1002/art.22190 [2] PMID 27050636 [3] doi 10.1093/rheumatology/kex084 <h3>Disclosure of Interest</h3> None declared
SAT0651 Carotid ultrasound in patients with arthritis: ¿in which patients does it re-stratify cv risk?
Authors: F. Sivera, N. Martinez-Alberola, R. Martin-Domenech, G. Albert-Espi, C. Fernandez-Carballido, T. Pedraz-Penalva
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To explore in which patients with inflammatory rheumatic disease, the findings in a carotid ultrasound result in a change in cardiovascular (CV) risk stratification as compared to the CV risk measured with the SCORE index. <h3>Methods</h3> Longitudinal prospective study in patients included in a program geared at CV risk factor screening followed by optimisation of their treatment. Patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) were included in the program. In a nurse-led single-visit, the existence and adequate control of classic CV risk factors were recorded. SCORE index was calculated and then modified according to EULAR recommendations. CV risks was stratified according to European guidelines. A carotid ultrasound was performed in patients with a low, intermediate or high-risk stratification in order to assess intimal-media thickness (IMT) and plaques. If plaques were detected, CV risk was re-stratified to very high risk. From this program, patients who had completed the baseline evaluation and the carotid ultrasound were selected. The characteristics of patients with findings in carotid ultrasound that allowed re-stratification to those without these findings were compared. <h3>Results</h3> A total of 181 patients have completed the baseline work-up, including the carotid ultrasound. 122 (67%) of the patients were women with a mean age of 55 (±11) years of age. Included patients had RA (n=96, 53%), SpA (n=37, 20%) or PsA (n=48, 27%). A diagnosis of DM was performed in 19 (10%), hypertension in 78 (43%) and hypercholesterolemia in 92 (51%); 38 (21%) were active smokers and 63 (35%) were obese (BMI &gt;30). Mean SCORE index (modified according to EULAR recommendations) was 2.4 (±1.7). Risk stratification before ultrasound was 145 (80%) patients with intermediate risk and 36 (20%) with high risk. Carotid ultrasound imaging showed plaques in 43 patients (bilaterally in 14). In these, risk was re-stratified as very high risk. Overall, 11 patients showed a thickening of IMT; all presented plaques as well. Final risk stratification after including the carotid ultrasound findings showed 110 patients with intermediate risk, 28 with high risk and 43 with a very high risk. In table 1, the characteristics of the 43 patients whose carotid ultrasound findings resulted in a risk re-stratification vs the 138 with no risk modification. <h3>Conclusions</h3> Patients with risk modification due to carotid ultrasound findings were older and were more frequently hypercholesterolemic. Performing a carotid ultrasound in these patients seems to offer especially relevant information. <h3>Disclosure of Interest</h3> None declared
FRI0489 Utility of apremilast in refractory oral and/or genital ulcers in behÇet’s disease
Authors: B. Atienza-Mateo, J. Loricera, M.D. García-Armario, I. Castellví, F. Sivera, J. Graña, J. Calvo-Alen, I. de la Morena, F. Ortiz-Sanjuán, J.A. Román-Ivorra, A. Pérez-Gómez, S. Heredia, C. Díez, J.J. Alegre, C. Moriano, E. Díez, T. Pérez, M. Martín, A. Ybáñez, J. Narváez, A.I. Turrión, S. Romero-Yuste, L.C. Domínguez-Casas, N. Vegas-Revenga, J.L. Martín-Varillas, J.L. Hernández, C. González-Vela, M. Á. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Behçet's disease (BD) is characterised by recurrent oral and/or genital ulcers accompanied by ocular, cutaneous, articular, gastrointestinal, and/or neurologic manifestations. Oral and/or genital aphthous ulcers are often refractory to conventional treatment. Apremilast is an orally-active small molecule which inhibits phosphodiesterase-4 (PDE-4) that modulates some inflammatory pathways. <h3>Objectives</h3> Our aim was to assess the efficacy of apremilast in BD patients with oral and/or genital ulcers refractory to conventional treatment. <h3>Methods</h3> Retrospective national multicenter open-label study on 19 BD patients treated with apremilast at standard dose of 30 mg twice daily. The main outcome was achievement of oral ulcers remission. <h3>Results</h3> We included 19 patients (14 women and 5 men) with a mean age of 43.6±14.8 years. Before apremilast, all patients had also received several systemic conventional drugs: oral corticosteroids (n=18), colchicine (n=19), NSAIDs (n=10), methotrexate (n=10), azathioprine (n=10), cyclosporine (n=6), infliximab (n=3), adalimumab (n=5), dapsone (n=3), etanercept (n=1), mycophenolate mofetil (n=1), tocilizumab (n=1). The main clinical symptoms for starting apremilast were oral aphthous ulcers (n=19) and genital ulcers (n=14). Other manifestations present at apremilast onset were arthralgia/arthritis (n=6), folliculitis/pseudofolliculitis (n=6), asthenia (n=5), furunculosis (n=1), erythema nodosum (n=1), erythematosus and scaly skin lesions (n=1), psoriasis (n=1), deep venous thrombosis (n=2) and ileitis (n=1). Table 1 shows the evolution of the patients. After a median follow-up of 6 [interquartile range, 5–10] months, most of the patients experienced clinical improvement. In this period of time, 11 patients developed any side-effect: dyspepsia (n=5), nauseas (n=4), diarrhoea (n=4), abdominal pain (n=4), headache (n=3), loss of appetite (n=3), weight loss (n=1) and halitosis (n=1). Three patients had to reduce the dose to 30 mg/day. Apremilast was discontinued in 4 patients: because of not obtaining the expected improvement (n=2), due to desire of pregnancy (n=1) and due to development of neurological involvement (n=1). <h3>Conclusions</h3> Apremilast leads to a rapid and maintained improvement in many patients with refractory mucocutaneous ulcers of BD. Even in patients refractory to several systemic drugs including biologic therapy. However, the development of adverse digestive effects is frequent. <h3>Disclosure of Interest</h3> None declared
Prospective assessment of circulating endothelial cells (CECs) as markers of activity of first-line treatment in advanced clear cell renal cell carcinoma (CCRCC): The CIRCLES study (SOGUG 2011-01).
Authors: Daniel E. Castellano, Emilio Esteban, Luis Leon Mateos, Aranzazu Gonzalez del Alba, María José Méndez-Vidal, Jose Angel Arranz Arija, Xavier Garcia del Muro, Laura Basterrechea, Miguel Angel Climent Duran, Francisco Javier Perez, Juan Francisco Rodriguez-Moreno, Juan Virizuela Echaburu, Susana Hernando Polo, Jesús García-Donas
Journal: Journal of Clinical Oncology (2014)

e22019 Background: CECs counts have been proposed as a marker of endothelial damage in CCRCC. However, standardization of the technics of assessment and an homogeneous definition of CECs are lacking. Additionally no study has evaluated neither the evolution of CECs during long periods of treatment nor their potential to anticipate radiological progression. We aimed to investigate both issues using a reproducible and widespread device. Methods: An observational prospective multicenter study was designed. Patients with confirmed advanced CCRCC on first line treatment (any drug) who had not progressed after 3 months on therapy were considered eligible. CECs (CD146+, CD 105+,CD 45- DAPI + cells assessed by the Cell Search system), were determined every 6 weeks for 15 months or radiological tumor progression. External monitoring of clinical data was performed. Results: 75 patients (29% female, 71% male) were included between June 2011 and January 2013 in 11 Spanish institutions. Median age was 63 years (range 37-81). Distribution of patients according to MSKCC risk categories was: good 36%, intermediate 59% and poor 4%. 90% of patients received sunitinib, 5% pazopanib, 4% both (treatment switch due to toxicity) and 1% temsirolimus. With a median follow-up of 9 months (range 2.8-24), 40% of patients have progressed and one death has been recorded. Median progression free survival (PFS) was 17.2 months (CI95% 13.2-21.3) since treatment initiation. A median of 6 determinations per patient was performed (range 1-14). At baseline median CECs count was 50 cells/4 ml (range 4-485). A trend towards worse PFS was found in patients with basal CEC levels below the median (p= 0.067 Breslow test). No significant differences were found between baseline and last CECs counts and PFS did not differ between patients with an increase or a decrease of CECs along treatment. Conclusions: CEC counts remain stable during first line treatment in CCRCC and do not predict the moment of radiological progression. Interestingly baseline determinations seem to correlate with outcome and could be a reliable marker of efficacy of antiangiogenic therapy.
PARE0017 Supporting young people with rmds in managing issues around relationships, pregnancy and sexuality
Authors: W. Olsder, L. van Nieuwkoop, A.A.J. Haenen
Journal: Annals of the Rheumatic Diseases (2018)

Therefor did the Swedish National Assyrian Organization (SNAO) take the initiative to start a knowledge-sharing project together with the Swedish Rheumatism Association and the Swedish Neuro-Association to inform and educate the kids and their parents with the Assyrian background.Objectives: The aim of this project is to empower the persons and families suffering of an RMD or/and neurological disease among the immigrants from Syria and to break barriers within the immigran's society as well as saving on the national welfare system.Results: To achieve such a project the SNAO applied for funds from the Swedish General Inheritance fund nad worked closely with the Swedish Rheumatism Association as well as the Swedish Neuro-Association.The project included other stakeholders that could embrace the goal and use unconventional methods to mark the point and reach out to the target group..Organizing weekend seminars open for to the target group .Working with Läsa för integration (Reading for integration) http://www.lasaforintegration.se/index.html .Opratat is a theater group that lifts difficult subjects to the surface and make a pedagogic scen of the subject.http://anhoriga.se/opratat/ .The Swedish Disability Rights Federation: that enable the project to reach a broader target but also to reach the decision makers.References: The project reach a great number of immigrant with an Assyrian background and could inform the attendees about their right and how the Swedish society works.