tbuckley/cabot-search huggingface dataset:
AB0083 Single nucleotide polymorphisms in lep – 2548 g&gt;a and lepr + 668 a&gt;g in rheumatoid arthritis mexican mestizos are associated with age at diagnosis, disease activity and anti-ccp antibodies
Authors: E Gomez-Bañuelos, E Chavarria-Avila, K Arrona-Rios, L González-Rosas, J Aguilar-Arreola, S Duran-Barragan, H Avila-Armengol, F Corona-Meraz, A Saldaña-Millan, R-E Navarro-Hernandez, M Vázquez-Del Mercado
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> The role of adipose tissue in RA pathogenesis has been acknowledged since the high frequency of dyslipidemia and insulin resistance in these patients. Leptin, a pleiotropic adipokine, has been associated with inflammation markers and articular damage in RA and the anti-citrullinated protein antibodies. Notwithstanding, these findings have not been constant across different populations. These points towards that single nucleotide polymorphism (SNP) in leptin and its receptor might influence the participation of this adipokine in RA pathogenesis. <h3>Objectives</h3> To determine the association of the SNPs <i>LEP</i> -2548 G&gt;A and <i>LEPR</i> 668 A&gt;G with adiposity, metabolic and inflammation markers in RA patients. <h3>Methods</h3> We enrolled 116 patients with RA (ACR 1987) matched with 133 control subjects by age, gender, and body mass index (BMI). Subjects were evaluated for fat mass and skinfold thickness. Also, serum glucose, insulin, lipid profile, serum leptin (sLep), soluble leptin receptor, TNFa. In patients with RA we evaluated disease activity and anti-CCP. Genotypes of <i>LEP</i> -2548 G&gt;A and <i>LEPR</i> 668 A&gt;G were determined by PCR-RFPL using <i>HhaI</i> and <i>MspI</i> restriction enzymes. <h3>Results</h3> There was no difference in genotypes distribution of LEP -2548 G&gt;A and <i>LEPR</i> 668 A&gt;G between RA and control. <i>LEPR</i> 668 G allele was associated with higher anti-CCP titers and disease activity score compared to <i>LEPR</i> 668A/A homozygotes, 4.2±1.7 vs. 3.46±1.2 <i>P</i>=0.012. <i>LEP</i> -2548A allele was associated with younger age of RA diagnosis vs. G/G homozygotes, 35.9±11.5 vs. 41.8±13.9 years old (<i>P</i> =0.045). OR for diagnosis before 40 years old was 2.7 (CI95% 1.04 – 7.45). <h3>Conclusions</h3> <i>LEP</i> -2548 G&gt;A is related with a younger age at diagnosis of RA and <i>LEPR</i> 668 G/G was associated with increased anti-CCP titers and disease activity. This suggests that there is an additive effect between chronic inflammation of RA and obesity were leptin may favor humoral immune response against citrullinated proteins and influence the severity of RA. In preobese and obese patients with RA anti-CCP (+) there is an increased sLep production. <i>LEP</i> -2548 G&gt;A is related with a younger age at diagnosis of RA and <i>LEPR</i> 668 G/G was associated with increased anti-CCP titers and disease activity. These suggests that there is an additive effect between chronic inflammation of RA and obesity were leptin may favors humoral immune response against citrullinated proteins and influence the severity of RA. <h3>Disclosure of Interest</h3> None declared
Meeting the information and budgetary requirements of primary care groups Commentary: Accurate information may be difficult to produce
Authors: J. Gilley, A. Majeed
Journal: BMJ (1999)

# Meeting the information and budgetary requirements of primary care groups {#article-title-2}

Primary care is experiencing another wholesale reorganisation as the government's “new NHS” is implemented. The intention is to bring general practitioners and other healthcare professionals together at a local level to assess the needs of their shared populations and to ensure that resources are allocated to meet those needs. The mechanisms chosen for England (primary care groups) and Wales (local health groups) have more in common than those for Scotland (primary care trusts and local health care cooperatives). The differences among the three countries represent a worrying fragmentation of “national” health service structures. Primary care groups (PCGs) are not voluntary; all general practitioners are members of a primary care group. Shadow groups started operating at the end of October 1998and go live in April 1999.

Their three main areas of responsibility include the development of primary care, the commissioning of secondary care services, and a quality agenda delivered under the umbrella of clinical governance. Only level 1and 2groups will exist from 1999; primary care trusts, described by one civil servant as “PCGs in long trousers,” with their wider remit to include community health services, will not start until 2000.Current NHS community trusts, together with primary care groups, will be able to bid to progress to primary care trusts. Level 1groups will have a largely “advisory” role in the commissioning of secondary care services. Level 2groups, in contrast, will take charge of at least 40% of their unified budget to purchase secondary care services. The government's stated aims for all levels are similar: tackling variations in quality of care and distributing NHS cash more fairly. “The healthcare needs of populations, including the impact of deprivation, will be the driving force in determining where the cash goes.”1 Few will argue with these aims, but clearly any redistribution exercise will mean winners …
AB0271 T2t adherence measurement tool performance in rheumatoid arthritis
Authors: R Garcia Salinas, MP Girard Bosch, MV Martire, P Arturi, S Magri
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> The purpose of the T2T approach in RA is to achieve remission or LDA according to results from objective activity measurements. This strategy has proven clinical benefits, however objective adherence T2T measurement tools are lacked in daily practice. <h3>Objectives</h3> To evaluate the setting, usage of a T2T adherence measure: T2T70 and T2T100, and its association with sustained low disease activity (LDAS) as a measure of outcome. <h3>Methods</h3> Prospective study, consecutive patients with RA diagnosis (ACR/EULAR 2010) and follow-up between 1 and 24 months were included. Data from electronic medical record (EHR) were collected. Demographic variables, characteristics of the disease and treatment were recorded. The following T2T characteristics were defined and collected from each patient: number of visits, visits where treatment was adjusted, CDAI measurements, use of ultrasound to measure disease activity and achievement of LDA. Sustained LDA (LDAS) was defined when the patient had 2 or more records of that consecutive state of activity. Measures of adherence to T2T were defined as follows: T2T-70, when therapeutic decisions were accompanied by the measurement of activity by 70% and the interval between visits did not exceed 6 months; And T2T-100, when 100% of the decisions were accompanied with the activity measurement and the interval between each visit did not exceed 6 months. Statistical analysis: a descriptive analysis of the variables was performed and Chi2 test (categorical) and Student or MannWhitney test (continuous) were applied. For multivariate logistic regression analysis we considered as dependent variable LDAs. <h3>Results</h3> 96 patients were included, with a mean follow-up of 15 months (DS 7.8), equivalent to 120.6 patients/year. Eighty percent of the patients were women, mean age 53.7 years (SD 13), disease duration 36 months (RIC, 12–52), 64% had early diagnosis, 85% and 75% positive For FR and ACPA, respectively. According to T2T characteristics, 526 visits were recorded, 270 were treatment adjustment and 208 (78%) of them were performed according to the CDAI value. The frequency of LDAS was 20% (IC95: 12–30). The frequency of T2T-70 compliance was 62.5% (IC95: 52–72) and T2T-100 was 42% (IC95: 32–52). Compliance with T2T-70 and T2T-100 presented a statistically significant association to the achievement of LDAS in the uni and multivariate analysis (p: 0.000). Compliance with T2T-70 and T2T-100 was associated with a shorter time course of disease; And T2T-70 also showed association with early diagnosis. <h3>Conclusions</h3> T2T-70 and T2T-100 adherence were 62% and 42%, respectively, patients who met these criteria reached more LDAS. The early diagnosis and shorter time to disease evolution at baseline were variables that were variables that were associated with more compliance of these tools. <h3>Acknowledgements</h3> Dra Josefina Marcos. <h3>Disclosure of Interest</h3> None declared
SP0092 The vicious circle of educational level and risk of poverty in rheumatoid arthritis - results of a cross-sectional multicenter study in germany
Authors: M Zaenker
Journal: Annals of the Rheumatic Diseases (2017)

This lecture will provide an overview on the dimensions of poverty in general and describe methods of assessing the risk of poverty in patients with rheumatoid arthritis (RA). Based on results of a cross-sectional multicenter study of RA-patients from outpatient-clinics in Brandenburg and Saarland, Germany, this talk will give a rationale for how patients with RA are threatened by poverty due to treatment-related expenses, disability and early retirement compared to the general population. It will be highlighted, that the equalized disposable income of RA patients is significantly lower than in general population and RA patients share a doubled risk of poverty, even in social-welfare well-secured countries such as Germany. Further, the talk will demonstrate that both lower educational level and socio-economic state are associated with more severe disease course of RA and various underlying mechanisms will be discussed. <h3>Disclosure of Interest</h3> M. Zaenker Consultant for: Celgene, Hospira, MSD, Roche
Abstract 15574: TELEmedicine for Monitoring of Patients With Mechanically Assisted Circulatory Support Out of hospital: TELEMACO Project
Authors: Vincenzo Tarzia, Chiara Cavalli, Lorenzo Bagozzi, Jonida Bejko, Tomaso Bottio, Biancarosa Volpe, Gino Gerosa
Journal: Circulation (2016)

Introduction:  Telemedicine allows patient assessment and monitoring to facilitate healthcare at a distance. LVAD patients are a particular population in whom the outcome depends on adherence to the mechanical regimen, close medical follow-up and acceptance of a life that is far from normal (batteries, driveline, alarms).   Hypothesis:  Telemonitoring systems (TS) and network’s psychological support (NPS) could improve quality of life and mental distress in patients with LVAD and their caregivers.   Methods:  TS includes electrocardiograms, pulse-oxymeter, body-weight analysis and real-time INR. NPS was performed weekly with the patients and caregivers separately. Quality of life and psychological assessment, including SF-36, SCL-90-R, STAI-Y, BDI-II, was administered to the patients and their caregivers at the beginning, during and at the end of the study. CBI was administered only to the caregiver.   Results:  Between May 2015 and May 2016, 12 patients with LVAD and the respective caregivers were enrolled. In 9 cases the implant strategy was bridge to transplant and in 3 cases was destination therapy. The mean time monitoring was 7 months. All patients and their caregivers were adherent to the study protocol, performing daily transmission of medical data and total participation to psychological support. There was no home fatal complications; one patient died in hospital (due to independent cause by the project); 6 patients were successfully transplanted and 5 patients are still on going. Quality of life increased significantly in LVAD patients and caregivers in SF-36. Regarding mental distress as measured on the SCL-90, we observed a clinically significant improvement both in patients (p    Conclusions:  In LVAD population, TS and NPS has proved to be safe and effective and allow immediate control by breaking down the distances. Moreover, direct contact with the doctors and psychological support have improved the quality of life and decreased the typical mental distress of these patients and their caregivers.
FRI0497 What choices do rheumatologist make in escalating dmard therapy in early psa?
Authors: J Luime, I Tchetverikov, K Wervers, A Gerards, M Kok, C Appels, H van Groenendael, W vd Graaff, L-A Korswagen, J Veris, M Hazes, M Vis
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Psoriatic arthritis (PsA) is a multifaceted disease. <h3>Objectives</h3> We aimed to evaluate change in medication over time guided by joints, skin, enthesis, low back pain and dactylitis in newly diagnosed PsA patients <h3>Methods</h3> Newly diagnosed PsA patients were included in the Dutch Early south-west Psoriatic Arthritis cohoRt (DEPAR) study between August 2013 and March 2016. Initial drug treatment and escalation of therapy were described for all patients. Drivers of treatment changes in the first year were evaluated by mixed ordered ordinal regression with outcome treatment change and variables joints (66/68 count), skin (PASI), entheses (LEI and MASES), dactylitis (LDI) and axial disease (BASDAI) <h3>Results</h3> 323 patients had had baseline assessment in March 2016. Their average age was 50.0 years (SD 13.8) and 49% were male. 80% patients had arthritis (19% monoarthritis, 39% oligoarthritis and 23%polyarthritis), 9% had an enthesitis subtype, 2% axial disease and 9% dactylitis. Initial treatment consisted of methotrexate (MTX) (52%), in 7% of other synthetic disease modifying antirheumatic drugs (sDMARDs) and due to treatment of psoriasis 3% biologicals. Within the different phenotypes MTX was most frequently started in polyarthritis (84%) followed by oligoarthritis (63%), monoarthritis (33%) and other phenotypes (5%). At 12 months 70% (n=148) stayed on the initial drug. Of those switched, 9 started MTX, within the initial MTX users (n=74) almost equal percentages stopped, switched to metoject or biological (4%). A smaller percentage (2%) switch to leflunomide. Changes in medication were driven by swollen joint count and the presence of dactylitis (Table 1) <h3>Conclusions</h3> MTX was initiated in about half of the early PsA patients. The majority of patients were kept on the initial treatment strategy in first year. Failure on initial drug led to variation in subsequent drugs with additional start of other sdmards, switch subcutaneuous MTX, to other sdmards or to biological dmards. Treatment change was driven by Swollen Joint Count and presence of Dactylitis. Skin, Enthesis and Axial disease did not play a role in escalating treatment. <h3>Disclosure of Interest</h3> None declared
AB0010 Lilrb3 expression on t cells correlates with disease activity in ra
Authors: A Holz, T Witte, RE Schmidt
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Leukocyte immunoglobulin-like receptors (LILR) participate in the generation of immunological tolerance (1,2). LILRB3 can be expressed on T cells and is an inhibiting receptor (3). <h3>Objectives</h3> We wanted to study LILR expression on T cells in RA compared to SLE and controls. <h3>Methods</h3> Heparinised human blood from blood donors was obtained from the Institute of Transfusion Medicine, Medical School Hannover (Germany). Blood samples from RA (DAS28 &lt;3.2 n=11; DAS28&gt;3.2 n=8) and SLE patients (n=9) were obtained from Outpatients` Clinic of the Department of Rheumatology and Immunology after informed consent. PBMCs were stained with LILRA2 (Biolegend, APC), LILRB3 (Biolegend, PE), CD3 (Biolegend, APC-Cy 7), CD4 (BD, PerCP-Cy5.5), CD8 (Biolegend, V500), CD25 (Biolegend, PE/Cy5), CD28 (Biolegend, Pacific Blue). Results were compared to isotype controls. Statistical analyses and figures were made with GraphPad Prism, ANOVA and the Mann-Whitney Test. <h3>Results</h3> The percentage of both CD4+ and CD8+ T cells expressing LILRB3 was significantly higher in both inactive as well as active RA compared to controls or SLE (See Fig. 1) (p=0.0397 ANOVA: RA all vs. SLE vs. controls). Within the group of RA patients, the percentage of LILRB3 expressing T cells was highest in active compared to inactive (DAS28&lt;3.2) RA (p=0.0287). LILRA2 was not expressed on T cells. <h3>Conclusions</h3> Expression of LILRB3 correlates with disease activity of RA and is decreased after successful treatment with DMARDS or biologicals. Since LILRB3 is an inhibiting receptor the increased expression in active RA may be a counterregulation to reduce disease activity. <h3>References</h3> Anderson KJ, Allen RL. Regulation of T-cell immunity by leucocyte immunoglobulin-like receptors: innate immune receptors for self on antigen-presenting cells. Immunology 2009 May;127(1):8–17. Thomas R, Matthias T, Witte T. Leukocyte immunoglobulin-like receptors as new players in autoimmunity. Clin Rev Allergy Immunol 2010 Apr;38(2–3):159–162. Brown D, Trowsdale J, Allen R. The LILR family: modulators of innate and adaptive immune pathways in health and disease. Tissue Antigens 2004 Sep;64(3):215–225. <h3>Acknowledgements</h3> We thank the StrucMed program for the support, and Katja Kniesch for technical assistance. <h3>Disclosure of Interest</h3> None declared
FRI0629 Magnetic resonance imaging (MRI) inflammation of the feet demonstrates subclinical inflammatory disease in cutaneous psoriasis patients without clinical arthritis
Authors: AJ Mathew, P Bird, A Gupta, RE George, D Danda
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Up to 40% of patients with cutaneous psoriasis may develop psoriatic arthritis (PsA). Early detection of PsA by advanced imaging techniques results in better response to therapy. There are very few studies evaluating the MRI appearance in feet of patients with psoriasis and PsA. <h3>Objectives</h3> This study sought to evaluate inflammation at the small joints of feet in a subset of psoriasis patients without clinical arthritis, using an office-based extremity MRI (eMRI) as compared to the findings in overt PsA patients. <h3>Methods</h3> Patients with psoriasis were recruited from Dermatology and Rheumatology clinics of a tertiary care institution in southern India were divided into those without arthritis (PsO) and PsA groups. All consenting patients underwent non-contrast eMRI of the right foot. Demographic and physical examination details were recorded. PsO patients completed the early arthritis in psoriasis (EARP) questionnaire. Two trained readers scored the MRI inflammation (synovitis, tenosynovitis, osteitis) using a modification of the PsAMRI scores (PsAMRIS). <sup>1</sup> Inter-reader agreement was assessed in a random subset of 42 cases using intra-class correlation coefficient (ICC). Proportion of patients with any sign of MRI inflammation was noted. Mann-Whitney U test was used to compare inflammation scores of PsO with PsA patients. Clinical variables were compared with inflammation scores for any association. <h3>Results</h3> A total of 83 patients (30 PsA and 53 PsO) with 75% males and mean age of 42.2±11.6 years were included. ICC for all three variables between the readers was very good (&gt;0.8). There was no statistical difference between the median eMRI inflammatory scores in PsA and PsO patients (p=0.493). Evidence of inflammation was present in 64% and 67% patients in the PsO and PsA groups, respectively (Table 1). Higher NAPSI scores were associated with presence of MRI inflammation (p=0.022). <h3>Conclusions</h3> This study corroborates a high proportion of psoriasis patients with subclinical disease of the small joints of foot. Patients with nail involvement had a higher risk of subclinical disease. The cohort is being assessed longitudinally to determine the clinical utility of MRI feet in predicting subsequent development of PsA in patients with psoriasis. <h3>References</h3> Glinatsi D, Bird P, et al. Validation of the OMERACT psoriatic arthritis magnetic resonance imaging score (PSAMRIS) for the hand and foot in a randomized placebo-controlled trial. J Rheumatol 2015;42:2473–9. <h3>Acknowledgements</h3> This project is being funded by the APLAR and Christian Medical College, Vellore research board. <h3>Disclosure of Interest</h3> None declared
Targeting the Correct Population When Designing Transitional Care Programs for Medicare Patients Hospitalized With Heart Failure
Authors: Faraz S. Ahmad, Ramsey M. Wehbe, Preeti Kansal, Hannah A. Jackson, Allen S. Anderson, Clyde W. Yancy, R. Kannan Mutharasan
Journal: JAMA Cardiology (2017)

Yonathan Freund, MD, PhD; Marine Cachanado, MSc; Quentin Delannoy, MD; Said Laribi, MD, PhD; Youri Yordanov, MD, PhD; Judith Gorlicki, MD; Tahar Chouihed, MD, PhD; Anne-Laure Féral-Pierssens, PhD; Jennifer Truchot, MD, PhD; Thibaut Desmettre, MD, PhD; Celine Occelli, MD; Xavier Bobbia, MD, PhD; Mehdi Khellaf, MD, PhD; Olivier Ganansia, MD; Jérôme Bokobza, MD; Frédéric Balen, MD; Sebastien Beaune, MD, PhD; Ben Bloom, MD, PhD; Tabassome Simon, MD, PhD; Alexandre Mebazaa, MD, PhD
FRI0703 New incident cases of rheumatoid arthritis, psoriatic arthritis and polymyalgia rheumatica in a city of central italy: results of the campo-re study
Authors: A De Socio, FM Perrotta, E Lubrano
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> few studies reported the incidence of rheumatic disease in Italy using the most recent classification criteria. <h3>Objectives</h3> The aim of the CAMPO-RE study was to assess the new incidence cases of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Polymyalgia Rheumatic (PMR) attending a primary rheumatologic outpatient9s clinic of new institution, integrated in the community of Campobasso, a small town in the centre of Italy. <h3>Methods</h3> Campobasso has a population of 49,501 inhabitants (1st January 2016) and Public Health is managed from a single health authority in the entire area. In Italy, all citizens are registered with a National Health System of General Practitioner Physicians (GPP). Between 1st June 2014 to 31st May 2016 all consecutive adult patients, sent by GPP of the municipality of Campobasso with any diagnosis of musculoskeletal symptoms/signs complains were evaluated in a single rheumatology outpatient clinic of our Academic Unit, that represent the first and unique reference for the GPP about rheumatic diseases in the territory. Subjects were classified using the EULAR criteria for RA, the CASPAR criteria for PsA and the 2012 ACR classification criteria for PMR. New incident cases were calculated using the number of cases as the numerator and population based on 1st January census of the municipality of Campobasso as the denominator. <h3>Results</h3> 1003 adult patients, sent by GPP with articular or musculoskeletal complains were visited in our clinic. Of these, 409 patients inhabitants of the municipality of Campobasso were evaluated for the study. During the 2-years study period we diagnosed 18, 19 and 12 new cases of RA, PsA and PMR respectively, with a new incident cases rate of 18.18, 19.19 and 12.12/100,000/year on the whole population of Campobasso municipality. Age-related incident cases were also calculated (table 1). <h3>Conclusions</h3> The results of our study could contribute to better define the new incident cases of these rheumatic disease classified with the new classification criteria. The incidences of RA, PsA and PMR seem to be similar to those reported in previous study<sup>1–3</sup>. <h3>References</h3> Alamanos Y, Voulgari PV., Drosos AA. Incidence and Prevalence of Rheumatoid Arthritis, Based on the 1987 American College of Rheumatology Criteria: A Systematic Review. Semin Arthritis Rheum 2006;36:182–8. Catanoso M, Pipitone N, Salvarani C. Epidemiology of psoriatic arthritis psoriasis. Reumatismo 2012;64:66–70. Raheel S, Shbeeb I, Crowson CS, Matteson EL. Epidemiology of Polymyalgia Rheumatica 2000–2014 and Examination of Incidence and Survival Trends over 45 Years: A Population Based Study. Arthritis Care Res (Hoboken) 2016; [Epub ahead of print]. <h3>Disclosure of Interest</h3> None declared