tbuckley/cabot-search huggingface dataset:
THU0437 Impact of diuretics on the urate lowering therapy in patients with gout: analysis of an inception cohort
Authors: L Ranieri, C Contero, M Andrés
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Use of diuretics is a common bystander in patients with gout, and it has been reported to impair response to allopurinol [1,2] and likely lead to treatment failure and refractoriness. However, after the introduction of new urate-lowering therapies (ULT) and treat-to-target strategies, whether this inconvenient effect of diuretics persists has not received critical attention to date. <h3>Objectives</h3> To analyze the impact of the diuretic therapy on the response to ULT in patients with gout. <h3>Methods</h3> Retrospective analysis of an inception cohort in patients with crystal-proven gout (Jan2014-Nov2016). Patients were classified according to the use of diuretics (loop and/or thiazide) at baseline. The primary outcome variables were the reduction of serum uric acid (SUA) levels and the achievement of different objectives of SUA (6, 5, and 4mg/dL); as secondary outcome variable the maximum dose of ULT was registered, as well as other clinical, analytical, and ULT-related data. A comparative analysis was performed according to the use of diuretics, using Student9s t and chi-2 tests. Also, the analysis was stratified according to the ULT used. <h3>Results</h3> The inception cohort included 225 patients with an average age of 65 years (SD 14.1), being 86.2% of them men. The median duration of gout at inclusion was 4 years (p25–75 1–10) and 21.3% presented tophi. At baseline, the median (p25–75) SUA and estimated glomerular filtration rate were 8.2 mg/dL (7.2–9.2) and 75.9 mL/min (27.2–88.3), respectively. A total of 98 patients (43.6%) were on diuretics mainly for hypertension (64.7%), heart failure (9.4%), and renal failure (5.9%). Follow-up data was available from 209 patients (92.9%), with a median 9 months of follow-up (4–14). ULT used was allopurinol in 172 patients (82.6%), febuxostat in 34 (16.5%), and benzbromarone in only 2 cases (0.9%). Regarding the baseline characteristics, patients on diuretics were older, had higher rates of females, hypertension, diabetes, and cardiovascular disease, and showed higher SUA and lower glomerular filtration rate. The table shows the outcomes comparison according to diuretic treatment, globally and stratified by type of ULT (excluding the two cases of benzbromarone). Except for a lower achievement of SUA&lt;5 in the allopurinol subgroup, no significant differences were found either globally or by type of ULT. <h3>Conclusions</h3> Despite its high rate, diuretics currently seem to not have a significant impact on the achievement of the different objectives of treatment of patients with gout. <h3>References</h3> Rheumatology; 55:1172. Br J Clin Pharmacol; 81:277. <h3>Disclosure of Interest</h3> None declared
FRI0683 Causes of death in 350 patients with systemic autoimmune rheumatic diseases (SARD)
Authors: JG Ovalles-Bonilla, O Fernández, J Martínez-Barrio, L Valor, D Hernández, I Janta, B Serrano, C Sáenz, R González, M Correyero, L García, A Lόpez, A Silva, JC Nieto, C González, I Monteagudo, FJ Lόpez-Longo
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> The major SARD have an increased mortality compared to the general population. It is well known that the main causes of death in Systemic Lupus Erythematosus (SLE) are infections (INF), cardiovascular events (CV), neoplasia (NEO) and disease activity. However, the compared mortality of Mixed Connective Tissue Disease (MCTD), Systemic Sclerosis (SSc), Poly/Dermatomyositis (PM/DM), overlap syndromes (OS), Sjögren9s syndrome (SS), Antiphospholipid syndrome (APS), systemic vasculitis (SV), and undifferentiated or incomplete Connective Tissue Disease (UCTD) is poorly described. <h3>Objectives</h3> To analyze the causes of death and the autoantibodies (AAB) profile among the SARD. <h3>Methods</h3> This was a single center, prospective and observational study. Mortality by all causes and relationship with AAB profile were analyzed in patients diagnosed of SLE, MCTD, SSc, PM/DM, OS (simultaneous or sequential criteria of 2 or more SARD), SS, APS, SV and UCTD or incomplete SARD (at least one clinical criterion of the classification criteria and a related antibody of any of the SARD). Data were obtained from the “Systemic Autoimmune Rheumatic Diseases Registry” of a tertiary referral hospital from 1986 to 2016. Patients with rheumatoid arthritis were excluded. The SARD registry counts with the institutional review board approval. <h3>Results</h3> 1750 patients were included, of whom 1453 (83%) were women. Five hundred fifty six SLE, 125 SSc, 111 PM/DM, 91 OS, 90 MCTD, 250 SS, 71 APS, 211 SV, 117 UCTD and 128 losses to follow-up, the global follow up rate was 92.7%. A global mortality of 350 (20%) cases was observed: 101 INF (28,8%), 89 CV (25,4%), 51 NEO (14,5%), 45 due to disease activity (12,8%), 41 other causes (11,7%) and 23 from unknown causes (6,5%). Table 1 shows detailed mortality causes compared by diseases. A higher mortality was associated (p&lt;0,05) with older patients (71 years, 20–96), SV (OR 3,65), male patients (OR 1,95), SSC/PM/DM (OR 1,76), MCTD (OR 1,6) and OS (OR 1,43). AAB to pANCA (OR 4,43), anti-topoisomerase I (OR 3,64), myositis-specific AAB (OR 3.0), cANCA (OR 2,19) and anticardiolipin (OR 1,89) were associated with poorer survival. A higher survival rate was observed in patients with SLE (OR 1,7), SS (OR 1,69) and UCTD (OR 15,57) (p&lt;0,05). <h3>Conclusions</h3> The main causes of death among SARD patients are CV (MCTD, SLE, and SSC), severe infections (OS, SV, and PM/DM), disease activity (APS) and neoplasia (SS). A higher mortality is observed among ANCA positive SV, anti-topoisomerase I positive SSC, MCTD, OS, anticardiolipin and myositis-specific positive patients. <h3>Disclosure of Interest</h3> None declared
In smokers with COPD, neither varenicline nor bupropion was linked to increased CV or neuropsychiatric risk vs NRT
Authors: Catherine M. Kress, Ngozi U. Obi, Allan V. Prochazka
Journal: Annals of Internal Medicine (2017)

Source Citation Kotz D, Viechtbauer W, Simpson CR, et al. Cardiovascular and neuropsychiatric risks of varenicline and bupropion in smokers with chronic obstructive pulmonary disease. Thorax. 2017 May 4. [Epub ahead of print]. 28473506
AB1050 Comparative study between ultrasonographic assessment and clinical examination in rheumatoid arthritis with optimized biological therapy and non biological treatment
Authors: R Martínez, M Fernández, E Rubio, R Menor Almagro, B Hernández, J Povedano
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> In rheumatoid arthritis (RA), patients in low activity disease or clinical remission measured by disease activity indexs can present subclinical activity by ultrasound study. The ultrasonographic inflammation in examination of joints is an important predictive value of structural damage. <h3>Objectives</h3> The aim of our study was to describe subclinical ultrasonographics activity in patients with RA in low disease activity or clinical remission, with optimized biological therapy and non biological treatment. <h3>Methods</h3> Transversal and longitudinal study describing the ultrasonographic changes in gray scale and doppler in parallel with blind clinical evaluation. We included patients with RA according to ACR/EULAR classification criteria in low activity disease or remission measured by DAS28, under optimized biological therapy at least for 6 months and non biological treatment. They were sent by their usual clinician, making a random selection. They were evaluated in the same day by a rheumatologist and blind sonographer. VAS, VGP, VGM, HAQ, tender joints count, swollen joint count, CDAI, SDAI and DAS28 were evaluated. Regarding the ultrasound, were evaluated synovitis and doppler in 12 joints (wrists, second to fifth MCF and fifth bilateral MTF). The comparison between clinical examination and ultrasonography test was performed by the kappa index, with satisfactory value of &gt;0,6. <h3>Results</h3> A total of 69 patients were included, 35 with optimized biological therapy and 34 non biological treatment. The median optimization time was 12 months. The baseline characteristics only offered stadistical significance in swollen joint count and average time of disease (table 1). The concordance study between clinical joint exploration and ultrasonographic examination showed a higher kappa index in patients with optimized biological therapy: 0,52 in gray scale and 0,40 in doppler. In patients without biological therapy showed an index kappa =0.17 by the gray scale test, and kappa index =0.26 by doppler. <h3>Conclusions</h3> Our results show the existing discrepancy between the clinical examination and ultrasonographic test in patients in low disease activity/remission by DAS28, even more with the use of doppler. In the comparison of both groups we observed an increase in the difference in those who did not receive biological therapy. In patients with optimized biological teraphy, with higher swollen joint count in physical examination, kappa index was near of normality in grayscale. The detection of subclinical joint damage is often undertreated, showing ultrasound as a noninvasive technique of great help reducing joint damage. <h3>Disclosure of Interest</h3> None declared
FRI0410 Predictors of morbidity and mortality in patients with early systemic sclerosis: long-term follow-up from a single centre inception cohort study
Authors: S Panopoulos, V-K Bournia, G Konstantonis, K Fragiadiaki, PP Sfikakis, MG Tektonidou
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Several studies have investigated the predictors of morbidity and mortality in Systemic sclerosis (SSc). However long-term follow-up data from inception cohorts of early SSc patients are limited. <h3>Objectives</h3> To identify predictors of morbidity and mortality in a single centre inception cohort of early SSc patients at long-term follow-up. <h3>Methods</h3> Our inception cohort comprised SSc patients who fulfilled the American College of Rheumatology criteria, were recruited within 12 months of disease onset and followed prospectively for at least 3 years. Clinical manifestations, laboratory and lung function tests were recorded for each patient at baseline and at 3rd and 6th years of follow up. Multivariate regression analysis and Cox proportional hazard models were used to identify predictors (clinical manifestations, laboratory and lung function tests at baseline) of morbidity and mortality in SSc, respectively. <h3>Results</h3> A total of 114 patients (96 female, mean age at diagnosis 48.1±13.5 years, 53 diffuse SSc subtype) were included in the study, from January 1997 to December 2012. All patients were followed for at least 3 years and 84 patients for at least 6 years. Twenty (17.5%) of 114 patients died during a mean follow up of 101.8±48.5 months. In multivariate regression analysis predictors for major SSc outcomes at 6 years were: diffuse subtype (OR: 6.2, p=0.015), anti-scl-70 positivity (OR: 3.9, p=0.05), esophageal involvement (OR: 6.5, p=0.017) and digital ulcers (OR: 8.6, p=0.003) at baseline for the development of pulmonary fibrosis (PF). The presence of digital ulcers at baseline was a predictor for the development of arrhythmias (OR: 3.7, p=0.05) and the presence of arrhythmias at baseline for the development of pulmonary hypertension (PH) (OR: 5.4, p=0.039). Cox proportional hazard models multivariate analysis revealed that independent predictors of mortality were: male gender (HR: 3.3, p=0.023), diffuse type (HR: 8.7, p=0.004), PF at baseline (HR: 2.7, p=0.05), PH based on echocardiography at baseline (HR: 12.7, p=0.001) FVC &lt;80% (HR: 2.74, p=0.042) and DLCO &lt;60% of predicted value at baseline (HR: 2.97, p=0.019). <h3>Conclusions</h3> Results from long-term follow-up data from a single centre inception cohort indicate that diffuse SSc subtype, anti-Scl-70 positivity, esophageal involvement and digital ulcers at baseline are independent predictors for the development of PF. Male gender, diffuse subtype, PF, PH and decreased FVC and DLCO at baseline are prognostic factors of mortality. <h3>Disclosure of Interest</h3> None declared
FRI0466 Real-life performance of the asas health index in routine care of patients with spondyloarthritis
Authors: U Kiltz, T Wiatr, X Baraliakos, K Fedorov, J Braun
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> The measurement properties of the ASAS Health Index (ASAS HI) which has been developed to measure health and functioning of patients with spondyloarthritis (SpA) have been evaluated in a cohort study. Its association with structural changes has not been examined to date. <h3>Objectives</h3> To investigate the relationship between clincial data, function and health as assessed by the ASAS HI in patients with axial SpA (axSpA) and to study the influence of structural spinal changes on this instrument. <h3>Methods</h3> Patients fullfilling ASAS classification criteria for axSpA were recruited prospectively. Information was collected on clinical assessments (ASAS HI, NRS pain, BASDAI, ASDAS, BASFI, BASMI), laboratory parameters and spinal x-rays. Images were scored using mSASSS by two independent readers. The relationship between ASAS HI and other health outcomes was evaluated by Spearman correlation. <h3>Results</h3> A total of 150 patients (57 nr-axSpA and 93 AS patients) were included: 68.7% male, mean (SD) age 46.4 (14.1), symptom duration 18.7 (13.5) and diagnosis since 11.4 (11.8) years, and HLA-B27 positive in 82.0%. Values of clinical assessments were ASAS HI 7.4 (4.1), BASDAI 4.7 (2.3), ASDAS 2.7 (1.1), BASMI 3.3 (1.8), pain 5.7 (2.7), and BASFI 4.7 (2.6). Elevated CRP levels were found in 34.8% of the patients. Radiographs of the sacroiliac (SI) joint and the spine were available in 138 patients, 38.0% of which had syndesmophytes and 7.5% had a bamboo spine. The median (IQR) mSASSS value was 4.3 (IQR 1.0–22.1) in AS und 0.2 (IQR 0.0–1.4) in nr-axSpA patients. Patients received a treatment with NSAIDs (62.7%), DMARDs (20.9%) and/or biologics (49.4%). Significant correlation of ASAS HI was found for BASFI (r=0.8), BASDAI (r=0.7), ASDAS (r=0.5) and BASMI (r=0.5, and, all p&lt;0.05). No correlations were found for ASAS HI and radiographic damage (mSASSS r=0.2, occurrence of syndesmophytes r=0.01, occurrence of bamboo spine r=0.2) and CRP levels (r=0.07). Stratifying patients by symptom duration (cut-off 3 years) did not affect these results. <h3>Conclusions</h3> Established measures of function and spinal mobility correlate well with the ASAS HI in patients with axSpA. The influence of structural changes as measured by mSASSS on the ASAS HI was limited in this study, probably due to relatively low mSASSS scores at baseline,. Further study in more and more severe patients is needed to study the association of physical activity, spinal mobility, function and radiographic damage in axSpA. <h3>Disclosure of Interest</h3> None declared
AB0195 Is there an association between periodontitis and levels of anti-citrullinated peptides antibodies in rheumatoid arthritis?
Authors: B Rodríguez-Lozano, J González Febles, F Sánchez Alonso, JL Rodríguez Garnier, S Dadlani, Y Barrios, M Sanz Alonso, F González Díaz
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Positivity of anti-citrullinated peptides antibodies (ACPA) indicates severity in Rheumatoid Arthritis (RA). There is evidence for chronic periodontitis (PD) in RA autoimmune response by periodontopathogenic bacteria such as <i>P.gingivalis</i>, through citrullination of L-arginine. <h3>Objectives</h3> 1.To determine whether there is an association between PD and its severity with ACPA(+).2.To assess relationship between PD and ACPA titres.3.To identify association between certain periodontal parameters and ACPA titres and their possible cutoff points. <h3>Methods</h3> Observational, cross-sectional study RA patients ≥18 with ≥4 teeth, no tooth cleaning, antibiotic intake 6 months before.Socio-demographic and anthropometric variables, annual dental prophylaxis and comorbidities.Serum ACPA detection:Ab IgG against CCP2 (ELISA)Eurodiagnostica:positive≥25; ACPA titres stratification:Low (25–75), moderate (76–300) and high (&gt;300). Periodontal parameters: plaque index (PI), bleeding on probing (Bop), probing pocket depth,clinical attachment level (CAL). CAL loss was categorized according to European Workshop 2005 (Tonetti):T level0 (absence), TL1 (mild), TL2 (severe). Statistical analysis:t-student, Kruskal Wallis, Chi- squared tests by Stata program 13.1. <h3>Results</h3> 187 RA patients included (table 1),ACPA determined in 168 patients: 67.86% (+) with similar titres distribution: low 18%, moderate 26%, high 23%. PD:182 patients (97.3%):TL1 52.4%,TL2 44.9%. Although prevalence of severe PD/ACPA(+) was higher compared to PD/ACPA(-) (69.2% vs 30.7%), there was no association between PD and ACPA positivity/titres. Regarding the association with periodontal parameters, there was tendency of association between ACPA(+) and number of periodontal pockets ≥5mm (NPP),OR 1.02 (95% CI 0.9–1.04) adjusted. There was a gradient effect, where NPP increased as ACPA titles increased, which was significant for high ACPA titres (p≤0.05,OR 1.03 95% CI 1.0–1.05). When ACPA(+) was related to %PI and BoP, a strong association was observed for PI, OR 10.32 (p&lt;0,026), and only a tendency for BoP (p&lt;0.062). With cutoff points of 8% PI and 65% BoP, a risk for ACPA(+) was detected with an OR 2.19 and OR 2.45, respectively. <h3>Conclusions</h3> 1.Despite higher prevalence of severe PD in ACPA(+) patients, we found no association between the presence of PD and ACPA positivity nor with serum titres. 2. On analysis of ACPA titres in relation to the severity of the periodontal parameters, there was a "gradient" risk, where NPP increased as ACPA titres increased, which was significant for high ACPA titres.3. Risk cutoff points for ACPA(+) were 8% for PI and 65% for BoP. <h3>Disclosure of Interest</h3> None declared
OP0278-PARE The french patient's association (AFLAR: french league against rheumatism) has generated the french national alliance against osteoarthritis and the first general convention of osteoarthritis in france: a campaign to create a national lobbying tool to improve the management of osteoarthritis
Authors: L Grange, F Rannou, F Berenbaum, C Roques, F Srour, C Delaunay, P Niemczynsky, C Dreux, P Richette, P-A Joseph, C Cochet, J Giraud, F Alliot Launois, C Gérard
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> OA suffers from a lack of interest and not considered serious enough by Health authorities taking into account the burden of the disease. AFLAR has fostered dynamics by creating a structure called the National Alliance against OA, includes national experts, patients and health professionals (HP). A initiative of this group has been to organize the first General Convention for OA. <h3>Objectives</h3> Its main challenge was to provide a list of actions that could potentially change the face of the disease and improve the visibility of OA along with the needs and demands from French patients. <h3>Methods</h3> 10 regional roundtables (with HP, patients and health institutions, around five topics) has been launched with discussions and debates and enabled the production of patient-related proposals in order to improve their care and information. <h3>Results</h3> 79 proposals have been selected and submitted to an online vote in order to be prioritized. Among the 5 topics addressed by the regional roundtables, cross-cutting issues were identified and 9 fields of action emerged. The final proposals were synthesized in a White Paper document and presented to the national Senate assembly. After it was broadcast to the health and public authorities in a prospect of lobbying. see in the image. <h3>Conclusions</h3> Although the impact of this initiative is not yet measurable, we think that it should improve the awareness of the decision-makers on the burden of the disease and provide concrete ideas to governmental and non-governmental policy makers in order to improve the quality of life of OA patients. <h3>Acknowledgements</h3> L. Euller-Ziegler F. Blanchet F. Beroud CE Bouvier D.Romain Bertholon, SANOIA,SNMR,CFMR. With support of Genévrier, Pierre Fabre, Expanscience Rottapharm Meda laboratory, SOFMER, CONMK &amp; AFLAR <h3>Disclosure of Interest</h3> None declared
Gene expression profiling of multiple myeloma cell lines after treatment with 5-aza-2′deoxycytidine and Trichostatin A
Authors: Gerwin Heller, Michael Auer, Barbara Ziegler, Sonja Seidl, Martin Bilban, Christoph C. Zielinski, Johannes Drach, Sabine Zöchbauer-Müller
Journal: Cancer Research (2005)

913   Multiple myeloma is a B-cell neoplasm which ranks as the second most frequently occurring hematologic malignancy. Epigenetic silencing of cancer-related genes is an important mechanism in the pathogenesis of multiple myeloma. We therefore performed a genome wide analysis using cDNA microarray to detect global changes in gene expression in the multiple myeloma cell lines U266 and MM1 induced by the DNA methyltransferase inhibitor 5-aza-2′-deoxycytidine (AzaC) and the histone deacetylase inhibitor trichostatin A (TSA). The increase of expression was defined as ≥ 2-fold change in expression compared to untreated cells. In the cell line U266 we found 83 genes out of 22283 probe sets with an increase in expression after AzaC treatment and 110 genes with an increase in expression in AzaC/TSA-treated cells compared to untreated cells. The expression of 46 genes was up-regulated in AzaC-treated MM1 cells and in 112 genes after treatment with the AzaC/TSA combination. Among these genes there are several putative tumor suppressor genes including  PFN1  ( Profilin1 ),  NME4 ,  ST14 ,  PYCARD ,  DLEU1  and  p57 . The expression of 6 and 28 genes was found to be up-regulated in both cell lines after AzaC and AzaC/TSA treatment, respectively. Selected genes will now be analyzed for their expression and methylation pattern in bone marrow aspirates from multiple myeloma patients. In conclusion, our results demonstrate that AzaC and AzaC/TSA reactivate the expression of by epigenetic mechanisms silenced genes. Reactivation of these genes using DNA methyltransferase inhibitors and histone deacetylase inhibitors may play a role in the future treatment of multiple myeloma patients.
Response by Lindahl et al to Letter Regarding Article, “Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease”
Authors: Bertil Lindahl, Tomasz Baron, David Erlinge, Nermin Hadziosmanovic, Anna Nordenskjöld, Anton Gard, Tomas Jernberg
Journal: Circulation (2017)
Red flag screening for low back pain: nothing to see here, move along: a narrative review
Authors: Chad E Cook, Steven Z George, Michael P Reiman
Journal: British Journal of Sports Medicine (2017)

Screening for red flags in individuals with low back pain (LBP) has been a historical hallmark of musculoskeletal management. Red flag screening is endorsed by most LBP clinical practice guidelines, despite a lack of support for their diagnostic capacity. We share four major reasons why red flag screening is not consistent with best practice in LBP management: (1) clinicians do not actually screen for red flags, they manage the findings; (2) red flag symptomology negates the utility of clinical findings; (3) the tests lack the negative likelihood ratio to serve as a screen; and (4) clinical practice guidelines do not include specific processes that aid decision-making. Based on these findings, we propose that clinicians consider: (1) the importance of watchful waiting; (2) the value-based care does not support clinical examination driven by red flag symptoms; and (3) the recognition that red flag symptoms may have a stronger relationship with prognosis than diagnosis.