tbuckley/cabot-search huggingface dataset:
FRI0630 Can whole body mri at baseline identify definite inflammatory arthritis patterns in undifferentiated arthritis?
Authors: JE Freeston, KS Mankia, M-A D'Agostino, R Hodgson, A Grainger, I Matsuura, N Larkman, PG Conaghan, P Emery
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> When diagnosing inflammatory arthritis (IA) early, focal joint imaging may not reflect the overall inflammatory burden/distribution. Whole body MRI (WBMRI) offers the potential to feasibly scan most joints in a single session. <h3>Objectives</h3> The aims were (i) to describe the WBMRI pattern of disease in early IA (ii) to identify patterns associated with subsequent definite IA. <h3>Methods</h3> Patients were recruited with early inflammatory joint symptoms and/or signs of IA. Clinical data included age, gender, symptom duration, CRP, HLA-B27, RF, CCP Ab and tender/swollen joint counts. Using 3T WBMRI, T2-weighted fat suppressed spine/SIJ images pre contrast and 3D VIBE Dixon images of peripheral joints and entheses post IV contrast were acquired. Images were consensus scored for inflammation/erosion at the spine, SIJ, GHJ, SCJ, wrist, MCP, PIP, hip, knee, ankle, mid/hind foot, MTP and IP joints plus shoulder, ASIS, greater trochanter, knee, Achilles and plantar fascia entheses. Subjects were clinically classified at baseline and 1 year as undifferentiated arthritis (UA), CCP+RA, CCP-RA or Spondyloarthropathy (SpA). Clinicians were unaware of the MRI findings. <h3>Results</h3> 39 patients (23 female) were recruited; mean age 43 years, median symptom duration 18 months (7, 24), TJC 5 (2,11), SJC 1 (0,3) and CRP 2 (2,2). At baseline, 14 were classified as definite disease (RA or SpA) and 25 (14 female) as UA with mean age 40 years, median symptom duration 16.5 months (9.8, 24.3), TJC 3 (1,8), SJC 0 (0,1), CRP 2 (2,2) and 3 (12%) were HLA-B27 positive. The distribution of WBMRI findings in the classified (i.e. definite IA) group was predominantly small joint and tendon-based in the CCP+ RA group, large joint based with 50% having SIJ disease in the CCP- group and similar findings in the SpA group. In the non-classified group (i.e. pUA and rUA), the distribution in pUA was both axial and peripheral, involving joints and entheses, with 25% having SIJ disease. In comparison, findings in the rUA group were similarly distributed but less frequent with no cases of SIJ disease. After 1 year of clinical/laboratory follow-up, 8 were identified as pUA, 6 rUA, 7 CCP+RA, 6 CCP-RA and 12 as SpA. Table 1 shows WBMRI disease distribution by 1 year diagnostic category. The inclusion of affected WBMRI sites in the diagnostic work-up would have appropriately classified 6 further cases of definite SpA, 3 from the pUA and 3 from the CCP-RA groups. <h3>Conclusions</h3> In the persistent UA group and CCP-RA group, WBMRI findings at baseline already showed a definite pattern of spinal disease. Therefore the use of WBMRI findings at presentation in addition to clinical assessment would allow clinicians to classify a proportion of patients earlier. <h3>Disclosure of Interest</h3> None declared
AB0852 Increased infection rate with concomitant rank ligand inhibitor denosumab and biologic therapies for rheumatic diseases: reality or illusion? experience with 40 patients over 66 months at the university of southern california
Authors: PS Chhibar, G Ehresmann
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Patients with autoimmune diseases are at increased risk of early onset osteoporosis due to multiple reasons including prolonged exposure to corticosteroids and the disease process itself in RA patients. Same patients are more likely to be on TNF inhibitors or other biologics, which causes them to be at an increased risk of infections. Denosumab, an anti-RANK ligand inhibitor, itself a biologic, used to treat osteoporosis, is associated with increased infection risk as Receptor activator of nuclear factor kappa B ligand (RANKL) is also expressed on activated T and B lymphocytes (1). It is unknown if there is an added risk of infections when TNF inhibitors/biologic agents and denosumab are used concomitantly. <h3>Objectives</h3> To determine if denosumab and biologics are associated with increased infection risk. <h3>Methods</h3> Data was collected and analyzed on 40 patients in the rheumatology clinic who had been on denosumab and TNF inhibitor/ other biologic for 66 months at the Keck Medical Center of USC. <h3>Results</h3> Patient characteristics: Mean age: 70±9.8 SD years, Gender: 98% were females, 2% Males. 75% had RA, 10% SLE, 15% had other rheumatic diseases. 70% on TNF inhibitors, 30% on other biologics. Before Denosumab (over 2 years): cumulative infection rate 17.5%, which is 8.75 cases per 100 person-years. 9% hospitalization rate. Post Denosumab: After 12 months: No infections within the first year. After 60 months: incidence rate of infections=12.5 cases/100 person-years. After 66 months, incidence rate of infections=15.9 cases/100 person-years. Urinary tract infection (UTI) accounted for the most common infection (17.5%). No opportunistic infections, and no reactivation of latent TB found in our patients. <h3>Conclusions</h3> No infections developed within the first year, suggesting a cumulative effect of increased infection risk, if any. We cannot attribute the overall infection rate solely to the combination of denosumab and biologics as patients who developed infections either had Diabetes Mellitus, urinary incontinence, recent surgery, underlying pulmonary disease. Patients did not develop infections beyond what would be expected for their comorbidities and medications. Whether prophylactic antibiotics are indicated in patients with recurrent infections PRIOR to denosumab is uncertain, but may be a consideration in certain patients. <h3>References</h3> Cummings SR, San Martin J, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009;361:756–765. doi: 10.1056/NEJMoa0809493. <h3>Disclosure of Interest</h3> None declared
Current Practices and Attitudes Toward Cholesterol Management in Patients With Recent Acute Myocardial Infarction: A Survey of Community Physicians
Authors: Jorge L Yarzebski, Carmen Bujor, Robert J Goldberg, Frederick A Spencer, Darleen Lessard, Joel M Gore
Journal: Circulation (2001)

P41     Background: Recurrent coronary events and mortality are  associated with elevated serum cholesterol levels in patients with  acute myocardial infarction (AMI). It’s unclear what physicians’  current attitudes and practices are toward the management of high  cholesterol levels in patients with recent AMI. We carried out a survey  of practicing physicians to examine factors that influence physicians  prescription of lipid-lowering and dietary therapy in patients with  recent AMI and threshold levels of cholesterol for intervention.  Methods: Mailed questionnaire survey of general internists,  cardiologists, and family physicians practicing and/or having admitting  privileges to all Worcester (MA) metropolitan hospitals. Results: Among  the 257 responding physicians, lipid lowering therapy was more likely  to be initiated in younger patients at lower total and LDL-cholesterol  levels than in older patients. Younger physicians were more likely to  initiate dietary and lipid lowering drug therapy at lower total and  LDL-cholesterol levels. General practice physicians were more likely to  initiate dietary therapy at lower total cholesterol levels, but more  likely to initiate lipid lowering drug therapy at higher total and  LDL-cholesterol levels, than internists and cardiologists. The most  important factors reported by physicians which interfered with  patient’s use of lipid lowering drug therapy were their concerns about  medication costs, issues related to polypharmacy, and failure to  recognize the importance of lipid lowering drugs. Several physician  associated factors including provider responsibility and importance of  other cardiac drugs were associated with the more widespread use of  these medications. Conclusions: Results of this survey in a  representative sample of community physicians suggest that older  physicians are less likely to implement recommended treatment  guidelines in patients with recent AMI and high cholesterol. Additional  efforts are needed to modify potential barriers to the implementation  of effective long-term cholesterol management in patients with recent  AMI.
AB0288 Laboratory markers of inflammation and serum nicotinamide phosphoribosyltransferase level in rheumatoid arthritis patients
Authors: Y Akhverdyan, B Zavodovsky, J Polyakova, L Seewordova, I Zborovskaya, T Rogatkina
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Objectives</h3> To study relationship between serum levels of nicotinamide phosphoribosyltransferase and laboratory markers of inflammation in patients with rheumatoid arthritis (RA). <h3>Methods</h3> We determined nicotinamide phosphoribosyltransferase level in sera of 140 patients with RA (96 women and 44 men) by indirect enzyme-linked immunosorbent assay (RaiBiotech, cat No. EIA-VIS-1). The control group consisted of 20 women and 10 men aged 22 to 55 years without complaints of pain in the joints throughout life. The mean duration of disease was 5.94±0.37 years. <h3>Results</h3> We divided all RA patients into 2 groups: one group (118 patients) with elevated levels of nicotinamide phosphoribosyltransferase serum (more than 3.9 ng/ml) and second group (22 patients) - with normal range. In each of the two groups, the levels of CRP and ESR were determined. Patients with elevated levels of Nampt had the following laboratory parameters (M±m): ESR – 37.83±1,57, CRP – 56.09±3,73 (rate - less than 5.0 mg/l). The second group had following data: ESR 22.46±0,56, CRP 21,65±1.38. Thus, patients with elevated levels of nicotinamide phosphoribosyltransferase had significantly higher concentrations of ESR and CRP (p&lt;0,001). <h3>Conclusions</h3> There is the relationship between the level of nicotinamide phosphoribosyltransferase serum and laboratory markers of inflammation in RA (CRP and ESR). The data indirectly confirm the hypothesis that increased levels of nicotinamide phosphoribosyltransferase in RA patients is associated with disease activity. <h3>Disclosure of Interest</h3> None declared
Classification, Epidemiology, and Global Burden of Cardiomyopathies
Authors: William J. McKenna, Barry J. Maron, Gaetano Thiene
Journal: Circulation Research (2017)

In the past 25 years, major advances were achieved in the nosography of cardiomyopathies, influencing the definition and taxonomy of this important chapter of cardiovascular disease. Nearly, 50% of patients dying suddenly in childhood or adolescence or undergoing cardiac transplantation are affected by cardiomyopathies. Novel cardiomyopathies have been discovered (arrhythmogenic, restrictive, and noncompacted) and added to update the World Health Organization classification. Myocarditis has also been named inflammatory cardiomyopathy. Extraordinary progress accomplished in molecular genetics of inherited cardiomyopathies allowed establishment of dilated cardiomyopathy as mostly cytoskeleton, force transmission disease; hypertrophic–restrictive cardiomyopathies as sarcomeric, force generation disease; and arrhythmogenic cardiomyopathy as desmosome, cell junction disease. Channelopathies (short and long QT, Brugada, and catecholaminergic polymorphic ventricular tachycardia syndromes) should also be considered cardiomyopathies because of electric myocyte dysfunction. Cardiomyopathies are easily diagnosed but treated only with palliative pharmacological or invasive therapy. Curative therapy, thanks to insights into the molecular pathogenesis, has to target the fundamental mechanisms involved in the onset and progression of these conditions.
AllergoOncology: Opposite outcomes of immune tolerance in allergy and cancer
Authors: E. Jensen‐Jarolim, H. J. Bax, R. Bianchini, S. Crescioli, T. R. Daniels‐Wells, D. Dombrowicz, E. Fiebiger, H. J. Gould, S. Irshad, J. Janda, D. H. Josephs, F. Levi‐Schaffer, L. O′Mahony, G. Pellizzari, M. L. Penichet, F. Redegeld, F. Roth‐Walter, J. Singer, E. Untersmayr, L. Vangelista, S. N. Karagiannis
Journal: Allergy (2017)

Abstract While desired for the cure of allergy, regulatory immune cell subsets and nonclassical Th2‐biased inflammatory mediators in the tumour microenvironment can contribute to immune suppression and escape of tumours from immunological detection and clearance. A key aim in the cancer field is therefore to design interventions that can break immunological tolerance and halt cancer progression, whereas on the contrary allergen immunotherapy exactly aims to induce tolerance. In this position paper, we review insights on immune tolerance derived from allergy and from cancer inflammation, focusing on what is known about the roles of key immune cells and mediators. We propose that research in the field of AllergoOncology that aims to delineate these immunological mechanisms with juxtaposed clinical consequences in allergy and cancer may point to novel avenues for therapeutic interventions that stand to benefit both disciplines.
AB0777 Characteristics of amyloid a deposition in psoriatic arthropathy and in rheumatoid arthritis – a comparative postmortem clinicopathologic study of 161 rheumatoid and 12 psoriatic arthritis patients
Authors: M Bély, Ά Apáthy
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> The aim of this study was to determine the prevalence and extent of amyloid A deposition on different tissue structures in various organs of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients. <h3>Methods</h3> AAa was detected in 34 (21.1%) (females: 29, average age: 64.3 years, range: 83–32, onset of RA: 48.6, average disease duration: 15.7 years; males: 5, average age: 51.2 years at death, range: 88–19, onset of RA: 41.3, average disease duration: 14.8 years) of 161 RA, and in 2 (16%) female: 2, average age: 57.5 years, range: 63–52, onset of PsA: 47.5, average disease duration: 11.0 years) of 12 PsA patients. RA and PsA were diagnosed clinically according to the criteria of the American College of Rheumatology (ACR) [1,2]. Amyloid deposits on different tissue structures [arteriole, small artery, medium size artery, venule, small vein, medium size vein, interstitial collagen fiber, reticulin fiber (collagen IV), basal laminas, nerve, renal glomerulus] of 6 organs [heart, lungs, liver, kidney, skin and brain] were determined histologically. The extent of amyloid A deposits was evaluated by semi-quantitative, visual estimation on a 0 to 3 plus scale, based on the number of involved tissue structures per light microscopic field [3]. The prevalence and extent of amyloid A deposits on different tissue structures were compared by Student (Welch) t-probe. <h3>Results</h3> The average prevalence (in %) and the average extent of amyloid A deposits (absolute value) on different tissue structures of analyzed 6 organs in RA and PsA patients are summarized in Table. <h3>Conclusions</h3> The difference between average prevalence (<i>p</i>&lt;0.388) and average amount (<i>p</i>&lt;0.444) of amyloid A deposits/structures in RA and PsA patients was not significant. The prevalence and extent of amyloiod A deposits on different tissue structures of analyzed organs changed parallel in RA or PsA patients except for collagen IV and interstitial collagen. The reverse prevalence and extent of amyloid A deposits on collagen IV and interstitial collagen fibers between RA or PsA patients may be due to structural (qualitative) changes of collagen IV resulting in its increased affinity of amyloid A in PsA patients. Qualitative change of collagens in systemic sclerosis patients has been demonstrated [4]. <h3>References</h3> Arnett FC et al: Arthritis Rheum. 1988; 31(3):315–24. PMID: 3358796. Helliwell PS, Taylor WJ: Classification and diagnostic criteria for psoriatic arthritis. Ann Rheum Dis 2005;64:ii3-ii8 doi:10.1136/ard.2004.032318. Bély M, Apáthy Άgnes: Clinical pathology of rheumatoid arthritis. 1–440 pp. Akadémiai Kiadό, Budapest 2012 http://www.akkrt.hu. Istok R et al: Pyridinoline in fibrotized tissues of patients with systemic sclerosis. Annals Rheum Dis 1999; 58(Suppl. 1):192. <h3>Disclosure of Interest</h3> None declared
SAT0130 Evaluation of the factors related with risk of falling and fear of falling in patients with rheumatoid arthritis
Authors: S Unsal Delialioglu, G Kilinc Kamaci, S Ozel, F Yurdakul, H Bodur
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> People with rheumatoid arthritis (RA) have an increased risk of falls (1,2). The identification of predictive and potentially modifiable risk factors is essential for the development of effective falls prevention strategies (3). <h3>Objectives</h3> The aim of the study is to determine the relationship between falling risk and falling fear with balance, lower extremity muscle strength, functional status, disease activity and pain in patients with Rheumatoid Arthritis (RA) <h3>Methods</h3> A total of 124 patients (92 females, 32 males) who were diagnosed with RA according to the American College of Rheumatology (ACR) diagnostic criteria were included in the study. The fear of falling was assessed by the Fall Efficacy Scale (FES-I) and the shortened form (Short FES-I). Disease activity was assessed using the Disease Activity Score-28 (DAS28), the functional status was assessed with Health Assessment Questionnaire (HAQ). While lower extremity muscule strenght was determined using Chair Stand Test, Four Balance Test was used to determine the balance. The pain intensity was determined using 10 cm Visual Analogue Scale-Pain (VAS-pain). <h3>Results</h3> The mean age of the patients is 54.75±10.96 years, the mean duration of illness is 14.10±10.99 years. A statistically significant relationship was found between FES-I, Short FES-I scores and HAQ (respectively r:0,776, p:0,000; r:0,783, p:0,000), VAS rest (r:0.397, p:0,000; r:0,405, p:0,000), VAS motion (r:0.542, p:0,000; r:0,519, p:0,000), DAS28 values (r:0.216, r:0.181; r:0,260, p:0,004). There was a significant negative correlation between FES-I, Short FES-I scores and Chair Stand Test (respectively r:-0.644, p:0,000; r:-0.652, p:0,00), Four Balance Test (r:-0.597, p:0,000; r:-0.611, p:0,00). There was a statistically significant correlation between the number of falls in the last year and age, duration of illness, HAQ, DAS28, VAS scores (p&lt;0,05) <h3>Conclusions</h3> The risk of falling and fear of falling is associated with balance, lower extremity muscle strength, disease activity, functional status, and pain in patients with RA. Therefore; the risk of falling and fear of falling should be determined and necessary measures must be taken in patients with RA. <h3>References</h3> Böhler C, Radner H, Ernst M, Binder A, Stamm T, Aletaha D, Smolen JS, Köller M. Rheumatoid arthritis and falls: the influence of disease activity. Rheumatology (Oxford). 2012 Nov;51(11):2051–7. Armstrong C, Swarbrick CM, Pye SR, O9Neill TW. Occurrence and risk factors for falls in rheumatoid arthritis Ann Rheum Dis. 2005 Nov;64(11):1602–4. Stanmore EK, Oldham J, Skelton DA, O9Neill T, Pilling M, Campbell AJ, Todd C. Risk factors for falls in adults with rheumatoid arthritis: a prospective study. Arthritis Care Res (Hoboken). 2013 Aug;65(8):1251–8. <h3>Disclosure of Interest</h3> None declared
FRI0530 Efectiveness of an orthogeriatric fracture liaison service compared with standard care
Authors: A Naranjo, S Conde Fernández, S Ojeda, S Rodríguez, L Hernández Torres, I Bernardos, I Rodríguez, V Kraev, C Carballo Hernández, P Laynez
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Our fracture liaison service (FLS) for outpatients has reported to maintain 73% of the patients on antiresorptive 2 years after the fracture. For hip fracture we are concerned about the low capture rate (27%). <h3>Objectives</h3> To analyze the efectiveness of a FLS for inpatients with hip fracture compared with standard care. <h3>Methods</h3> Observational study carried out in two hospitals, one with a FLS (Hospital Negrin) and the other one with standard orthogeriatric care (Hospital Candelaria). The reference population &gt;65 y from H.Negrin and H.Candelaria are 63,382 and 63,249 inhabitants respectively. We included patient &gt;65 y with fragility hip fracture ocurred between 1th March 2016 and 31th July 2016. Severe dementia, non-fragility fractures and those patients who died during hospital admittance were excluded. All patients underwent hemogram and biochemistry. The densitometry was not performed on any patient. The only difference between hospitals was a dedicated nurse from the FLS H.Negrin who visited inpatients twice a week, interviewed patients, gave education and applied a treatment protocol to be started by Primary Care. Data recorded were: age, sex, previous fractures and previous treatment for osteoporosis, including calcium, vitamin D, bisphosphonates, denosumab and teriparatide. We also collected the treatment that was included in the discharge report and treatment six month later (checking the electronic prescription). <h3>Results</h3> We included 185 patients (105 from Hospital Candelaria and 80 from Hospital Negrin), mean age 82 y (Table). The percentage of patients receiving a bisphosphonate or equivalent before hospital admittance was similar in both hospitals. However, the percentage after discharge rose by 91% in the hospital with FLS and remain 8% in the hospital with standard care. After six months, 75% of patients from FLS and 15% of patients with standard care had a treatment. <h3>Conclusions</h3> The implementation of an orthogeriatric FLS lead to an increase in treatment for osteoporosis compared with standard care and similar to our outpatient FLS model. The ideal approach to secondary fracture prevention is a FLS model of care in an integrated health care network, overseen by a nurse coordinator. <h3>References</h3> Naranjo A et al. Osteoporos Int. 2015;11:2579–85. <h3>Disclosure of Interest</h3> None declared