tbuckley/cabot-search huggingface dataset:
Chest Pain and Shortness of Breath After a Heart Transplant
Authors: Ersilia M. DeFilippis, Matthew Nayor, Eldrin F. Lewis
Journal: JAMA Cardiology (2017)

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SAT0096 Myocardial function improves in rheumatoid arthritis patients treated actively a magnetic resonance follow-up study
Authors: R Koivuniemi, A Kuuliala, S Kivistö, M Holmström, M Leirisalo-Repo
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Rheumatoid arthritis (RA) patients are susceptible to development of heart failure (HF). Increased HF risk is not explained by increased prevalence of coronary heart disease (CHD) or traditional cardiovascular (CV) risk factors. Chronic inflammation is suggested to play an important role. In parallel with others (1, 2), we observed RA patients with active disease to have myocardial dysfunction and local myocardial late gadolinium enhancement (LGE) indicative of fibrosis or inflammation on cardiac magnetic resonance (cMR) (3). <h3>Objectives</h3> In our patients (3), we here studied the effects of disease modifying anti-rheumatic drugs (DMARDs) on the myocardium over one-year period. <h3>Methods</h3> Fifty-eight female patients with active RA (&lt;70 years) and 22 fibromyalgia (FM) patients underwent cardiac magnetic resonance (cMR). Two RA groups existed: patients with untreated active early RA (ERA) starting conventional synthetic DMARDs (csDMARDs) or biological DMARDs (bDMARDs) and patients with chronic RA (CRA) who had inadequate response to csDMARDs and were candidates for bDMARDs. Patients with CHD, diabetes and smoking were excluded. CMR was performed to analyze LGE and ventricular function before and after one-year DMARD therapy <h3>Results</h3> Of 30 ERA patients, each started csDMARDs (77% as combination), two started also bDMARD. Of 28 CRA patients, each started bDMARD (one monotherapy). In RA patients, biventricular systo-diastolic function of the heart was impaired compared to FM (Table 2). Over the study-period, myocardial function improved (Table 2) and DAS28-CRP declined (3.5±1.1 vs 2.3±1.0; p&lt;0.001). Only RA patients had LGE, with no improvement over time (67%). <h3>Conclusions</h3> Myocardial function was impaired in RA patients with active RA compared to FM controls, although the latter group had worse classical CV risk factor profile. After one-year DMARD-treatment targeting to remission, myocardial function improved in parallel with decreasing RA activity. Inflammation seems to be deleterious to the myocardium. Tight control of RA activity may improve myocardial function. <h3>References</h3> Ntusi N, JACC Cardiovasc Imaging 2015. Kobayashi H, Arthritis Care Res 2016. Holmström M, Clin Exp Rheumatol 2016. <h3>Acknowledgements</h3> Main funding: The Finnish Medical Foundation. <h3>Disclosure of Interest</h3> None declared
FRI0226 Rituximab in rheumatoid arthritis with interstitial lung disease: a multicenter study
Authors: C Fernández-Díaz, M Martin-Lopez, M Carrasco-Cubero, D Reina-Sanz, P Rubio-Muñoz, A Urruticoechea-Arana, J Miranda-Filloy, N Vegas-Revenga, L Dominguez-Casas, M Gonzalez-Gay, R Blanco
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Anti-TNFα drugs and several conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate (MTX) have been involved in the development of Interstitial Lung Disease (ILD). <h3>Objectives</h3> Our aim was to assess the efficacy and safety of Rituximab (RTX) in RA patients with ILD. <h3>Methods</h3> Multicenter study of RA patients with ILD treated with RTX. ILD was diagnosed by high-resolution computed tomography (HRCT). RTX was used at standard dose (1 gx2 and premedication with iv Methylprednisolone for a six month interval. We assess the the following variables: a) 1-point change in the degree of dyspnea according to the Modified Medical Research Council (MMRC); b) FVC improvement ≥10%; and improvement ≥10% in DLCO; c) radiological changes in HRCT scan, and d) changes in the joint assessment measured by DAS28 score. <h3>Results</h3> We studied 18 patients (13 women /5 men) with ILD associated to RA. The mean age±SD was 62.8±11.0 years. The median [IQR] to progression of RA was 5.25 [2–12.8] years. They had received the following DMARDs previously; MTX (n=11), Leflunomide (LFN) (n=9) mycophenolate (MMF) (n=1) sulfasalazine (SSZ) (n=5), hydroxichloroquine (HCQ) (n=4), azathioprine (AZA) (n=1), gold salts (n=1), D-penicillamine (n=1), cyclophosphamide (n=1). 7 patients had previously received biological drugs. RA was seropositive in 16 cases (89%). Besides HRCT, the diagnosis of ILD was confirmed by biopsy in 4 patients. In 2 patients ILD was drug-related: MTX (n=2). RTX was prescribed as monotherapy (n=7) and combined with DMARDs (11. The DMARDs prescribed were: LFD (4), SSZ (2), MTX (3), HCQ (1), AZA (1) MMF (1). A significant improvement of the dyspnea was observed. FVC and HRCT showed an improvement in the period between 6 and 12 months. DLCO remained stable in the majority of the patients (%). DAS28 also improved. After a follow-up of 12 months, the only serious adverse effect was a severe Infection respiratory. <h3>Conclusions</h3> RTX seems to be an effective and relatively safe treatment in RA patients with ILD. However, these data should be verified in prospective and randomized studies. <h3>Disclosure of Interest</h3> None declared
AB0798 Amtolmetin guacil-effective and good safe nonsteroidal anti-inflammatory drug in knee osteoarthritis patients with dyspepsia
Authors: E Tsvetkova, L Denisov, E Nasonov
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Objectives</h3> To investigate the efficacy and tolerability of amtolmetin guacil (AMG; Niselat®, Dr. Reddy9s Laboratories Ltd, India) versus previous therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with knee osteoarthritis (OA) and signs of dyspepsia. <h3>Methods</h3> The open-label observational study included 220 patients aged 30–65 years who suffered from knee OA and intense pain during NSAID intake and had symptoms of dyspepsia in the absence of contraindications to the use of AMG. Among the comorbidities that generally occurred in 68% of the patients, there was a preponderance of hypertension (42%), lower extremity varicose veins (6.4%), and diabetes mellitus (6%). Treatment efficacy was evaluated using three domains of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), by also taking into account pain intensity and general health assessment on the visual analogue scale. A Severity of Dyspepsia Assessment (SODA) scale was used to rate dyspepsia. <h3>Results</h3> AMG had a marked analgesic effect confirmed by 40% or more pain reduction thatoccurred in 72.5% of the patients. The high analgesic effect of AMG was confirmed by a statistically significant (p&lt;0.001) reduction in the WOMAC index (pain and stiffness) and by an increase in functional activity. Therewas a significant decrease in painless and painful signs of dyspepsia, as well as positive changes in the measures“overall assessment of dyspepsia severity” (p&lt;0.001) and “satisfaction with treatment”. Overall assessment ofAMG tolerability was only positive: excellent (33%), good (56%), and satisfactory (11%). There were no seriousadverse events (AE). AE were graded as moderate and mild in 8 and 82% of cases, respectively. AE were recordedin 7.7% of the patients. AMG had a marked analgesic effect confirmed by 40% or more pain reduction that occurred in 72.5% of the patients. The high analgesic effect of AMG was confirmed by a statistically significant (p&lt;0.001) reduction in the WOMAC index (pain and stiffness) and by an increase in functional activity. There was a significant decrease in painless and painful signs of dyspepsia, as well as positive changes in the measures “overall assessment of dyspepsia severity” (p&lt;0.001) and “satisfaction with treatment”. Overall assessment ofAMG tolerability was only positive: excellent (33%), good (56%), and satisfactory (11%). There were no serious adverse events (AE). AE were graded as moderate and mild in 8 and 82% of cases, respectively. AE were recorded in 7.7% of the patients. <h3>Conclusions</h3> The findings suggest that AMG offers good prospects for knee OA treatment. <h3>Acknowledgements</h3> Otteva A.N., Dubikov A.I., Yakupova S.P., Ivanova O.N., Korshunov N.I., Vaisberg A.R., Abyshev R.A., Tartynov A.V. <h3>Disclosure of Interest</h3> None declared
THU0337 Classification of antineutrophilic cytoplasmic antibody-associated vasculitis and clinical impact and outcome
Authors: S Deshayes, A Aouba, K Kathy, D Mariotte, T Lobbedez, N Martin Silva
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have overlapping manifestations. Classifications based on clinical criteria or ANCA specificity have emerged to individualize homogenized group of patients in terms of clinical forms and outcomes. <h3>Objectives</h3> The aim of our study was to retrospectively re-evaluate the clinical impact and outcome of our monocentric AAV patients9 cohort, according to classifications based on clinical criteria and/or ANCA specificity. <h3>Methods</h3> A retrospective monocentric study carried out in Caen university hospital led to identify proteinase-3 (PR3) or myeloperoxidase (MPO)-ANCA AAV patients (via an ELISA technique), respectively from March 1997 to June 2016, and from September 2011 to June 2016. Patients with eosinophilic granulomatosis with polyangiitis were excluded. AAV were classified between granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA), and limited or severe forms according to respectively European Medicines Agency vasculitis algorithm and WGET group. Categorical variables were reported as percentages and compared using Chi<sup>2</sup> or Fisher9s tests according to expected frequencies. Continuous variables were expressed as means and analyzed using Student9s t-test. Associations between survival, or relapse free survival, and AAV classifications were evaluated by the log-rank test. A p-value &lt;0.05 was considered to be statistically significant. <h3>Results</h3> A total of 150 GPA/MPA were included. As expected, ear-nose throat involvement were significantly higher in PR3-ANCA vs MPO-ANCA, and GPA vs MPA (p&lt;0.001). Survival was significantly higher in anti-MPO GPA but relapse-free survival was lower, compared to anti-MPO MPA (p=0.038 and p=0.015, respectively), without difference in treatments. Relapse-free survival was lower in GPA, compared to MPA (p&lt;0.001). Among GPA patients, there was significantly more deaths in PR3 than MPO patients (p=0.02), but without significant difference between ANCA types for all other considered criteria, including survival (p=0.06). <h3>Conclusions</h3> The clinicopathological classification appeared as the strongest criteria for distinguish homogeneous forms and prognosis of AAV. Besides their diagnostic value, ANCA may not exhibited further great interest, especially in GPA. <h3>Disclosure of Interest</h3> None declared
AB0231 Physician visual analog scale estimates for damage are higher than for inflammation in patients with osteoarthritis and also in patients with rheumatoid arthritis at all levels of clinical severity according to rapid3
Authors: I Castrejon, J Chua, JA Block, T Pincus
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> A visual analog scale (VAS) to estimate the patient9s global status (DOCGL) often is the most efficient of all 7 RA core data set measures to distinguish active from control treatments in clinical trials<sup>1</sup>. DOCGL is designed to assess inflammatory activity, but it may be influenced variably in different doctors by irreversible joint damage and/or distress. Therefore, 3 additional 0–10 VAS have been developed to estimate levels of inflammation, damage, and distress that may impact DOCGL. <h3>Objectives</h3> To analyze 4 estimates for overall global, inflammation, damage and distress according to 4 RAPID3 (routine assessment of patient index data) severity categories in patients with RA or OA. <h3>Methods</h3> Patients seen at one academic clinical setting are assigned 4 0–10 VAS estimates: overall DOCGL, inflammation (reversible), damage (irreversible), and distress (symptoms explained by neither inflammation nor damage, eg, fibromyalgia). All patients complete a self-reported MDHAQ questionnaire as part of routine care. The MDHAQ includes 0–10 scores for physical function (FN), pain (PN), patient global estimate (PATGL), compiled into a 0–30 RAPID3. Patients with a primary diagnosis of RA or OA according to their rheumatologists were included. The percentage of RA and OA patients in each RAPID3 severity category was compared according to mean DOCGL and the 3 subscale estimates using chi-square and ANOVA. <h3>Results</h3> The study included 232 patients with RA and 274 with OA. Patients with OA were older than RA patients (66.5 versus 57.3, p&lt;0.001) and had higher scores for RAPID3 (14.4 vs 11.7, p&lt;0.001). A higher percentage of patients with OA had high RAPID3 severity compared with RA patients (66% vs 48%, p&lt;0.001) (Table). DOCGL and each subscale estimate were higher according to each of 4 RAPID3 categories from remission to high severity in RA and OA (Table). The level of inflammation was higher in RA than in OA, but estimates for damage higher in OA than RA. However, estimates for damage were higher than for inflammation in RA in each RAPID3 category. <h3>Conclusions</h3> Physician VAS for inflammation, damage, and distress may supplement the overall physician global estimate as quantitative physician estimates of reversible findings, irreversible findings, and distress to support clinical management decisions. Estimates of joint damage are higher in OA than in RA, although higher than estimates of inflammation in both RA and OA, in patients in all 4 RAPID3 severity categories. <h3>References</h3> Pincus T, et al. Clin Exp Rheumatol 2014; 32 (Suppl. 85): S47-S54. <h3>Disclosure of Interest</h3> I. Castrejon: None declared, J. Chua: None declared, J. Block: None declared, T. Pincus Shareholder of: Health Report Services, Inc
AB0640 Does mixed connective tissue disease without anti-u1rnp exist?
Authors: J Martínez-Barrio, E Estrada, JG Ovalles-Bonilla, L Valor, D Hernández-Flόrez, T Río del, I Janta, JC Nieto Gonzalez, B Serrano, R Benítez González, C Sáenz Tenorio, L García-Montoya, M Correyero, A Silva, A Lόpez-Cerόn, C Gonzalez, I Monteagudo, FJ Lόpez-Longo
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Mixed Connective Tissue Disease (MCTD) is a systemic autoimmune rheumatic disease (SARD) characterized by clinical manifestations of systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and polymyositis (PM) and the presence of anti-U1-RNP antibodies. <h3>Objectives</h3> To determine whether there are patients with symptoms of MCTD in the absence of anti-U1-RNP antibodies. <h3>Methods</h3> This was a monocentric, prospective, observational study of patients with SARD. All patients diagnosed of MCTD according to Kasukawa and/or Alarcόn-Segovia9s criteria, SLE, SSc, PM, overlap syndromes (simultaneous or sequential criteria of 2 or more SARD), Sjögren9s syndrome, Antiphospholipid syndrome, systemic vasculitis and undifferentiated or incomplete SARD (at least one clinical criterion of the classification criteria and a related antibody of any of the SARD) were included in the "Autoimmune Systemic Rheumatic Diseases Registry" of the Hospital General Universitario Gregorio Marañon Rheumatology Department from 1986 to 2012. The registry includes 2406 patients diagnosed with SARD. Patients with rheumatoid arthritis were excluded. Patients with clinical MCTD criteria were divided into seropositive (MCTD, with anti-U1RNP) and seronegative (possible MCTD, without anti-U1RNP). The registry counts with the local Institutional Ethics Board approval. <h3>Results</h3> A total of 692 patients were recruited, 608 women (87.9%). Seventy (70, 10.1%) patients were classified as seropositive and 75 (10.8%) as seronegative by Kasukawa9s criteria. Sixty-two (62, 8.9%) patients were classified as seropositive and 54 (7.8%) as seronegative according to Alarcόn-Segovia9s criteria. There were no significant differences in age at disease onset, age at diagnosis or disease duration (p&gt;0.05) between seropositive and seronegative patients. Seropositive patients with Kasukawa9s criteria presented more frequently: lymphadenopathy, malar rash, leukopenia, Raynaud9s phenomenon, muscle weakness and increase of muscle enzymes (Table 1). By Alarcόn-Segovia9s criteria, patients who developed myositis were more frequent in the seropositive group (p=0.007, OR 3.25, 95% CI, 1.44–7.32). <h3>Conclusions</h3> Some patients with SARD manifestations fulfill MCTD clinical criteria, both Kasukawa9s and Alarcόn-Segovia9s, in the absence of anti-U1-RNP antibodies from the onset of the disease and throughout its evolution (seronegative MCTD). The frequency of seronegative MCTD was similar to the frequency of seropositive MCTD. Patients with seropositive MCTD presented more frequently manifestations of SLE (lymphadenopathy, malar rash and leukopenia) when using Kasukawa9s criteria and of PM when using both criteria. <h3>Disclosure of Interest</h3> None declared
FRI0761-HPR Chronic widespread pain prevalence in the general population: a systematic review &amp; meta-analysis
Authors: P Andrews, M Steultjens, J Riskowski
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Chronic widespread pain (CWP) is a worldwide health problem and a significant contributor to disability. Understanding the impact of individual-dependent (e.g., gender) and contextual-dependent (e.g., survey method, latitude) factors have on CWP prevalence may provide a foundation population-based strategy for addressing CWP. <h3>Objectives</h3> To determine a general population worldwide estimate of CWP prevalence and to examine the individual and contextual-dependent factors related to CWP prevalence. <h3>Methods</h3> A systematic review was undertaken using seven databases. Along with data extracted from the manuscripts, additional contextual data including WHO development status and region, human development index (HDI; measure of socioeconomic position), GINI coefficient (measure of inequality), and latitude were added. Methodological reporting quality was assessed using the STROBE checklist [1]. Meta-analyses were conducted to determine global CWP prevalence, and individual- and contextual-dependent factors were evaluated using meta-regression analyses. <h3>Results</h3> Thirty studies across 20 countries (630,654 participants) met the inclusion criteria. Studies varied in CWP diagnostic criteria, survey method, and reporting quality. Study CWP sample prevalence ranged from 1.4–24.0%, with CWP in men ranging from 1.1–15.3%, while in women it ranged from 1.7–22.1%. Estimated overall CWP prevalence was 9.4% (7.6–11.3%). By gender, the global CWP prevalence estimate in women was significantly higher than for men (10.9% [8.1–13.7%] v 6.7% [4.5–8.8%], p≤0.01; Table). A meta-regression of the contextual factors showed the HDI was related to CWP prevalence (p=0.002), while other measures such as survey type, methodological reporting quality and GINI index showed no significant effect. <h3>Conclusions</h3> Globally CWP affects one in ten individuals within the general population, with women more likely to experience CWP than men. HDI was noted to be the socioeconomic factor related to CWP prevalence, with those in more developed countries having a lower CWP prevalence than those in less developed countries. There was a lack of data from countries with a lower socioeconomic position, and further CWP data in these areas can help determine if there are socioeconomic effects associated with CWP prevalence and can refine the CWP prevalence estimate. <h3>References</h3> Poorolajal, J., et al., Epidemiology and health, 2011. 33. <h3>Disclosure of Interest</h3> None declared
Weight and Metabolic Outcomes 12 Years after Gastric Bypass
Authors: Ted D. Adams, Lance E. Davidson, Sheldon E. Litwin, Jaewhan Kim, Ronette L. Kolotkin, M. Nazeem Nanjee, Jonathan M. Gutierrez, Sara J. Frogley, Anna R. Ibele, Eliot A. Brinton, Paul N. Hopkins, Rodrick McKinlay, Steven C. Simper, Steven C. Hunt
Journal: New England Journal of Medicine (2017)

Few long-term or controlled studies of bariatric surgery have been conducted to date. We report the 12-year follow-up results of an observational, prospective study of Roux-en-Y gastric bypass that was conducted in the United States.A total of 1156 patients with severe obesity comprised three groups: 418 patients who sought and underwent Roux-en-Y gastric bypass (surgery group), 417 patients who sought but did not undergo surgery (primarily for insurance reasons) (nonsurgery group 1), and 321 patients who did not seek surgery (nonsurgery group 2). We performed clinical examinations at baseline and at 2 years, 6 years, and 12 years to ascertain the presence of type 2 diabetes, hypertension, and dyslipidemia.The follow-up rate exceeded 90% at 12 years. The adjusted mean change from baseline in body weight in the surgery group was -45.0 kg (95% confidence interval [CI], -47.2 to -42.9; mean percent change, -35.0) at 2 years, -36.3 kg (95% CI, -39.0 to -33.5; mean percent change, -28.0) at 6 years, and -35.0 kg (95% CI, -38.4 to -31.7; mean percent change, -26.9) at 12 years; the mean change at 12 years in nonsurgery group 1 was -2.9 kg (95% CI, -6.9 to 1.0; mean percent change, -2.0), and the mean change at 12 years in nonsurgery group 2 was 0 kg (95% CI, -3.5 to 3.5; mean percent change, -0.9). Among the patients in the surgery group who had type 2 diabetes at baseline, type 2 diabetes remitted in 66 of 88 patients (75%) at 2 years, in 54 of 87 patients (62%) at 6 years, and in 43 of 84 patients (51%) at 12 years. The odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus nonsurgery group 1 and 0.09 (95% CI, 0.03 to 0.29) for the surgery group versus nonsurgery group 2 (P<0.001 for both comparisons). The surgery group had higher remission rates and lower incidence rates of hypertension and dyslipidemia than did nonsurgery group 1 (P<0.05 for all comparisons).This study showed long-term durability of weight loss and effective remission and prevention of type 2 diabetes, hypertension, and dyslipidemia after Roux-en-Y gastric bypass. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).