tbuckley/cabot-search huggingface dataset:
AB0853 Denosumab: clinical perspective and drug survival in a seconday care set up in uk
Authors: R Laxminarayan, U Dissanayake, N Sayed, K Narangoda
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Denosumab has become a useful parental therapy for the treatment of osteoporosis. FREEDOM extension study has shown safety and effectiveness of denosumab beyond 8 years. Real life data on the efficacy and safety of denosumab is lacking. There are no studies looking at the drug survival in the osteoporosis population either. Observational data from clinical practice can provide unique clinical perspective for novel therapies like denosumab. <h3>Objectives</h3> 1. To look at the baseline characters of patients receiving denosumab in a secondary care unit in UK. 2. To study the drug survival rate, analyse the reasons for discontinuation of therapy. 3. To assess fractures during the course of denosumab therapy. <h3>Methods</h3> We looked at the case records retrospectively of all the patients receiving denosumab therapy from 01/01/2011 to 31/12/2016. A database to record baseline characters, indications and previous fracture was prepared. Renal function, calcium, alkaline phosphatase (ALP), vitamin D levels at baseline and renal function, calium and ALP levels for each injection visit were noted. Vitamin D status was assessed at least once a year. Reasons to stop therapy were recorded. <h3>Results</h3> 237 patients were offered the treatment. One patient declined the treatment at the beginning. 5 (2.1%) patients had fracture on treatment. 2 had a hip fracture and one of them had a previous fracture (humerus). Other fracture sites were ankle, humerus and metatarsal. None of them had any further fractures during the follow up period. 61 patients discontinued therapy during the course of treatment over 3 years. 8 (4.2%) had infections, 7 (3.6%) due to declining eGFR and 9 (4.7%) were lost to follow up. 1 patient had jaw necrosis after the first injection. 1 developed hepatitis after the first injection which resolved on withdrawal of therapy. 6 (3.1%) patients withdrew consent for therapy. 19 (8%) patients died causes unrelated to denosumab therapy. 23 (9.7%) patients moved away. Treatment was stopped due to other side effects in 3 patients (2 had rash and 1 headache). There were no episodes of hypocalcaemia. <h3>Conclusions</h3> 1. Majority patients were elderly and female. Majority were high risk and had received osteoporosis treatments previously. 2. Denosumab therapy was well tolerated and nearly 2/3rd were stll receiving therapy at 3 years. Treatment was withdrawn due to an adverse event in only 14 (6%) patients. 3. Fracture rate was very low and there were no repeat or multiple fractures. <h3>References</h3> Pappapoulos S et al. The effect of 8 or 5 years of denosumab treatment in postmenopausal women with osteoporosis: results from the FREEDOM Extension study. Osteoporosis Int. 2015 Dec;26(12):2773–83. <h3>Disclosure of Interest</h3> None declared
RAN Translation Regulated by Muscleblind Proteins in Myotonic Dystrophy Type 2
Authors: Tao Zu, John D. Cleary, Yuanjing Liu, Monica Bañez-Coronel, Jodi L. Bubenik, Fatma Ayhan, Tetsuo Ashizawa, Guangbin Xia, H. Brent Clark, Anthony T. Yachnis, Maurice S. Swanson, Laura P.W. Ranum
Journal: Neuron (2017)
SP0169 Eular school of rheumatology. a challenging educational eular project. where are we now?
Authors: JW Bijlsma
Journal: Annals of the Rheumatic Diseases (2017)

In the last decade EULAR has further developed its educational portfolio. Apart from very educational tracks in the EULAR Congress, EULAR offers: on-line courses (Rheumatology, Connective Tissue Diseases, Scleroderma, Paediatrics, Ultrasound, Health Professionals), that are being followed by thousands of students all over the world text-books, based on the on-line courses live courses, such as the Postgraduate Course, Ultrasound courses, capillaroscopy, epidemiology, immunology, teach the teachers exchange programs, for trainees, scientists, health professionals and patients on-line image library, on-line outcome registry learning DVDs for medical students scientific endorsement of other courses To bring all these offerings under one umbrella, EULAR decided to found the School of Rheumatology. But the School is doing substantially more: we identified 7 areas (classrooms) where we bring enthusiastic and involved people together to evaluate the present needs in those areas and to prioritize new educational activities for those unmet needs. The following classrooms are actively developing new products: Classroom medical students: formulating standard curriculum for musculoskeletal diseases and providing video-materials to support teachers and students. Classroom trainees in rheumatology: start of a journal club, evaluating possibilities to install a European (EULAR) examination to become a rheumatologist, imaging on-line course. Classroom teachers: course on assessment questions was already held, a teach the teachers event is planned. Classroom rheumatologists: development of a pocket primer on rheumatic diseases, to be used as an app. Classroom scientist: preparing a possible on-line course on epidemiology and clinical (trial) research, evaluating possible webinars for basic science methodology. Classroom health professionals: preparing an accreditation system for health professionals; expanding on-line courses. Classroom patients: implementing and distributing lays versions of recommendation; development of a patient partner program in research; webinars on actual items in the form of questions and answers (eg biosimilars). Some of the items on this agenda can be organised within one year, for some others many years are foreseen; it will be a dynamic process. Ideas and support are very welcome via the EULAR Standing Committee on Education, or directly to the EULAR office, attention of the education program manager. <h3>Disclosure of Interest</h3> None declared
Deregulation of microRNA expression in purified T and B lymphocytes from patients with primary Sjögren’s syndrome
Authors: Shu-Fang Wang-Renault, Saida Boudaoud, Gaétane Nocturne, Elodie Roche, Nelly Sigrist, Christian Daviaud, Andreas Bugge Tinggaard, Victor Renault, Jean-François Deleuze, Xavier Mariette, Jörg Tost
Journal: Annals of the Rheumatic Diseases (2017)

MicroRNAs (miRNAs) play an important role in the pathogenesis of autoimmune diseases such as primary Sjögren's syndrome (pSS). This study is the first to investigate miRNA expression patterns in purified T and B lymphocytes from patients with pSS using a high-throughput quantitative PCR (qPCR) approach.Two independent cohorts of both patients with pSS and controls, one for discovery and one for replication, were included in this study. CD4+ T cells and CD19+ B cells were isolated from peripheral blood mononuclear cells by magnetic microbeads and expression of miRNAs was profiled using the Exiqon Human miRNome panel I analysing 372 miRNAs. A selection of differentially expressed miRNAs was replicated in the second cohort using specific qPCR assays.A major difference in miRNA expression patterns was observed between the lymphocyte populations from patients with pSS and controls. In CD4 T lymphocytes, hsa-let-7d-3p, hsa-miR-155-5 p, hsa-miR-222-3 p, hsa-miR-30c-5p, hsa-miR-146a-5p, hsa-miR-378a-3p and hsa-miR-28-5 p were significantly differentially expressed in both the discovery and the replication cohort. In B lymphocytes, hsa-miR-378a-3p, hsa-miR-222-3 p, hsa-miR-26a-5p, hsa-miR-30b-5p and hsa-miR-19b-3p were significantly differentially expressed. Potential target mRNAs were enriched in disease relevant pathways. Expression of B-cell activating factor (BAFF) mRNA was inversely correlated with the expression of hsa-miR-30b-5p in B lymphocytes from patients with pSS and functional experiments showed increased expression of BAFF after inhibiting hsa-miR-30b-5p.This study demonstrates major miRNAs deregulation in T and B cells from patients with pSS in two independent cohorts, which might target genes known to be involved in the pathogenesis of pSS.
SAT0127 Unfavorable body composition already at the onset of clinical arthritis
Authors: SA Turk, D van Schaardenburg, M Boers, S de Boer, C Fokker, WF Lems, MT Nurmohamed
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Rheumatoid arthritis is associated with an increased cardiovascular (CV) risk. There is mounting evidence that inflammation is involved in the pathogenesis thereof (1). An unfavorable body composition is, independently, associated with an increased CV risk, and often present in established arthritis patients. This unfavorable composition is a loss of muscle mass (sarcopenia), in the presence of a stable or even increased (abdominal) fat mass (sarcopenic obesity) (2). <h3>Objectives</h3> Currently it is unknown when this unfavorable body composition develops. Therefore, we compared body composition in DMARD-naïve early arthritis patients with non-arthritis controls and explored the association with disease activity and traditional CV risk factors. <h3>Methods</h3> A total of 317 consecutive early arthritis patients and 1268 age, gender and ethnicity matched non-arthritis controls (3) had a Dual-energy X-ray absorptiometry scan to assess lean (muscle) mass index (LMI), fat mass index (FMI), fat mass distribution (arms and legs versus trunk) and android to gynoid fat mass ratio. For the obesity definition, the cut offs of Gallaher et al. were applied. For the sarcopenia definition, cut offs based on the control group were applied (mean minus two times SD). In addition, a disease activity score, erythrocyte sedimentation rate, lipid profile (total cholesterol, HDL, LDL and triglycerides) and blood pressure assessments were done. <h3>Results</h3> Early arthritis patients (84% fulfilling the 2010 ACR/EULAR criteria) had a significantly lower mean LMI (p&lt;0.01) compared with controls. Female patients had a higher mean FMI (p&lt;0.01) and more fat was distributed to the trunk in patients (females p&lt;0.01, males p=0.07) (table). The prevalence of an unfavorable body composition (i.e. sarcopenia and sarcopenic obesity) was higher than in controls, for females 5.0% versus 1.3%, OR: 4.2, p&lt;0.01 and for males 8.2% versus 1.5%, OR: 5.7, p&lt;0.01 (figure). A higher FMI, more android fat and more fat distributed to the trunk were associated with higher blood pressure and lipid levels (and lower HDL levels). There was no clear relationship between body composition parameters and disease activity. <h3>Conclusions</h3> Patients at the clinical onset of arthritis more often have an unfavorable body composition (sarcopenia and sarcopenic obesity) than non-arthritis controls. An unfavorable body composition was associated with higher blood pressure and lipid levels (and lower HDL levels). <h3>References</h3> Curr Vasc Pharmacol 2010; 8(2):285–292. Age (Dordr) 2015; 37(6):121. Eur J Epidemiol 2015; 30(8):661–708. <h3>Disclosure of Interest</h3> None declared
THU0297 A novel ultrasound scoring system for giant cell arteritis
Authors: S Monti, C Ponte, G Carrara, F Rumi, A Hutchings, B Dasgupta, R Luqmani
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Colour duplex sonography (CDS) can be used for giant cell arteritis (GCA) to detect inflammatory oedema of the vascular wall, known as "halo". A standardized, quantitative score to grade the severity and extension of vascular involvement detected by CDS has not yet been developed. <h3>Objectives</h3> To develop and test different scoring models of CDS findings in patients with new onset GCA, and to correlate the models with final diagnosis, histologic findings, and outcome. <h3>Methods</h3> We selected patients with a positive CDS and a confirmed diagnosis of GCA from the Temporal Artery Biopsy vs Ultrasound in Diagnosis of GCA (TABUL) study (1). We designed CDS models combining different ultrasonographic information based on available evidence, or hypothesized clinical relevance of size, anatomical distribution, and extent of halos, summing up to a final numeric score. <h3>Results</h3> We included 135 GCA patients (male/female: 43/92), age 73.3±8. Fourty four patients (24%) had a positive CDS, but not a final diagnosis of GCA. We designed 8 different CDS models (Figure 1). Models 1, 4, 6, and 7 were significantly associated with a confirmed diagnosis of GCA (Table 2). Model 7 better discriminated patients with GCA from non-GCA: area under the curve (AUC): 0.844 (0.766–0.923). All, except models 5 and 8, correlated with a temporal artery biopsy (TAB) result diagnostic for GCA. Most models correlated with histologic findings involving the media or transmural infiltrate, but not with small vessel or adventitial involvement. None of the models correlated with permanent ischaemic sequelae, however, the low number of events might have affected the results. <h3>Conclusions</h3> The CDS findings that better correlate with a diagnosis of GCA, and TAB findings are: the number of positive sites, the size of the halo (maximum, rather than average thickness), and the presence of bilateral halos, variably combined into a unique score. We plan to test these models in a new cohort of patients with suspected GCA, to determine their validity. <h3>References</h3> Luqmani R, Lee E, Singh S, et al. The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study.Health Technol Assess 2016;20:1–238. <h3>Disclosure of Interest</h3> None declared
SAT0597 Relationship between lumbar disc herniation and benign joint hypermobility syndrome
Authors: MR Albeer, FK Abd alrazaq, MH Alosami
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Benign joint hypermobility syndrome (BJHS) can present with a wide variety of musculoskeletal disorders.Benign joint hypermobility syndrome (BJHS) is a hereditary disorder characterized by the presence of musculoskeletal symptoms in persons with generalized joint laxity in the absence of systemic rheumatologic disease (1–3). Lumbar disc herniation (LDH) is a common cause of low back pain. On the other hand, low back pain may be a presenting symptom in patients with BJHS. <h3>Objectives</h3> to evaluate relationship between Lumbar disc herniation and BJHS. <h3>Methods</h3> The study included 100 patients diagnosed with LDH depending on history, clinical examination and MRI findings and another 100 healthy control participants. All, patients and healthy controls were assessed for BJHS using the revised (Brighton 1998) criteria. <h3>Results</h3> the mean age was (35.4±8.9) year and (33.72±8.3) for patients and controls respectively, there were 43 males and 57 females in each group. The mean BMI was (27.6±4.8) kg/m<sup>2</sup> in patients and (28.3±4.6) in controls. No significant differences found between the groups regarding the age, sex and BMI in all comparisons (P.value&gt;0.05). The mean Beighton score was significantly higher among patients in comparison to controls; itwas (2.3±1.62) versus (1.2±1.35) in controls group; on the other hand major and minor criteria were significantly more prevalent among patients rather than controls, in all comparisons (P.value&lt;0.05). BJHS was more prevalent among patients rather than controls, 55% of the patients had BJHS compared to 21% of controls, the odds ratio was (4.6) and (P.value &lt;0.05). BJHS was more prevalent among females compared to males, from the total number of all participants, BJHS was present in 76 participants, and of them 47 were females versus 29 males, (P.value &lt;0.05). It had been significantly found that subjects with BJHS in both groups (patients and controls) were relatively shorter than those without BJHS, P.value &lt;0.05. The correlation analysis of BJHS with the MRI findings of LDH in patients group showed no significant differences among patients with and without BJHS, in all comparisons P.value &gt;0.05. <h3>Conclusions</h3> BJHS is more prevalent among patients with LDH. There is no significant relationship between presence of BJHS in LDH patients and MRI findings. <h3>References</h3> Hakim AJ, Grahame R. Joint hypermobility. Best Pract Res Clin Rheumatol 2003; 17:989–1004. Simmondsa JV, Keer RJ. Hypermobility and the hypermobility syndrome. Man Ther 2007; 12:298–309. Beighton P, Grahame R, Bird H. Hypermobility of Joints. New York, Verlag; 1983.p.125–49. <h3>Disclosure of Interest</h3> None declared
AB0497 Six cases of macrophage activation syndrome as presenting manifestation of systemic lupus erythematosus
Authors: F Dall'ara, I Cavazzana, M Frassi, M Taraborelli, M Fredi, F Franceschini, L Andreoli, A Tincani, P Airò
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Macrophage Activation Syndrome (MAS) is a life-threatening syndrome characterized by excessive immune activation. It can be triggered by conditions affecting immune homeostasis, such as infections, malignancies and rheumatologic disorders, including Systemic Lupus Erythematosus (SLE). In previous studies, prevalence of MAS among SLE patients ranged from 0.9% to 4.6%. <h3>Objectives</h3> To describe the presentation and treatment of both MAS and SLE in patients with both syndromes. <h3>Methods</h3> Monocentric retrospective evaluation: patients with MAS according to HLH classification criteria were identified in our cohort of SLE patients (classified according to ACR and SLICC criteria)followed for at least 1 year between 1972 and 2014. <h3>Results</h3> Among 511 patients with SLE (mean age at diagnosis:31 years ±2),6 patients (1.2%)with MAS were identified (all female). Their main clinical and laboratory features are reported in table 1.Median HLH score was 226.5 (IQR 204–254),with a probability of having MAS of 96%.In all cases MAS happened simultaneously to the onset of SLE.Median age at diagnosis was 31.5 years, median SLEDAI was 12.All patients had fever above 38°C,lymphadenopathy,hematological involvement,and high titer ANA positivity. Workup for infections and malignancies was negative in all cases.All patients were treated with corticosteroids (100% received intravenous immunoglobulin pulse of methylprednisolone);concomitant medications were: cyclosporin A in 83%, IVIG in 67%, granulocyte colony-stimulating factor in 17%, mycophenolate mofetil in 17%, etoposide in 17% and plasma exchange in 17%. Two patients required haemotransfusion.All cases required hospital admission, and 2 were admitted in intensive care unit. No death from MAS was observed (median follow up: 34.5 months;IQR25–48).One patient died 44 months after after MAS for pulmonary adenocarcinoma.Table 1:main clinical and laboratory features at diagnosis of SLE and MAS <h3>Conclusions</h3> MAS is a rare complication in our SLE cohort and can complicate the onset of SLE, but it seems to be a very uncommon manifestation during the course of the disease.Fever may be a red flag for possible MAS, particularly if temperature is persistently above 38° in absence of signs and symptoms of underlying infection.In our series, all cases were treated successfully with immunosuppressive drugs and cytotoxic agents such as etoposide were used only in one case. <h3>Disclosure of Interest</h3> None declared
SAT0043 Factors affecting the need for orthopaedic surgery in patients with rheumatoid arthritis. results from 1010 patients diagnosed with ra from 1972-2009
Authors: B-TS Fevang, AM Fenstad, ON Furnes, TW Nystad
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Surgery still comprises a necessary part of treating RA patients, when medication fail to prevent joint destruction. Orthopaedic corrective procedures are considered a reliable and objective proxy for a destructed joint, and is an important outcome measure in RA. <h3>Objectives</h3> To investigate how patient characteristics, time of diagnosis and treatment affect the need for orthopaedic surgery in patients with rheumatoid arthritis (RA). <h3>Methods</h3> We reviewed the medical history of 1544 patients diagnosed with RA at Haukeland University Hospital in Bergen, Norway from 1972 to 2009, of which 1010 (mean age 57, 69% women) were included in the study. Relevant orthopaedic procedures were obtained from the Norwegian Arthroplasty Register and the hospital9s administrative patient records. 693 procedures (joint synovectomies 22%, arthrodeses 21%, prostheses 41% and forefoot procedures 12%) were performed in 315 patients. Survival analyses were completed to evaluate the impact of age, sex, radiographic changes and year of diagnosis, on the risk of undergoing surgery. <h3>Results</h3> Patients diagnosed in 1972–1985 and 1986–1998 had a relative risk (RR) of 2.4 and 2.2 (p&lt;0.001) respectively, of surgery compared to patients diagnosed in 1999–2009. Radiographic changes at diagnosis and female sex were also significant risk factors. Disease activity at baseline did not affect the outcome. Anti-rheumatic medication was significantly different in the three time periods. <h3>Conclusions</h3> Patients with early years of diagnosis had greatly increased risk of having an RA related procedure performed. This is probably due to the year of diagnosis being a proxy for the type and intensity of medical treatment. <h3>References</h3> Goodman SM. Rheumatoid Arthritis Therapy and Joint-replacement Surgery: Are We Making a Difference? J Rheumatol. 2016;43:833–5. <h3>Disclosure of Interest</h3> None declared
Violent crime at GP surgeries is on the rise, figures show
Authors: Gareth Iacobucci
Journal: BMJ (2017)

GPs and their staff are increasingly facing violence, harassment, and threatening behaviour in their surgeries, an investigation by The BMJ has found.

Crime figures obtained from police forces across the UK show a 9% rise in the overall number of recorded crimes committed on the premises of GP surgeries and health centres over the past year (from 1974 in 2015-16 to 2147 in 2016-17). This is in line with a 10% increase in the overall number of recorded crimes in England and Wales last year,1 the largest annual rise for a decade.

The figures obtained by The BMJ show a 5% increase in recorded assaults at GP surgeries and health centres (from 324 in 2015-16 to 339 in 2016-17), a 34% rise in cases of harassment (from 41 to 55), and a 90% surge in public order offences such as threatening behaviour (from 169 to 321) (fig 1⇓). There was also a small rise in sexual offences (from 73 to 75 …