tbuckley/cabot-search huggingface dataset:
AB0857 Problems of diagnostics and prophylaxis of glucocorticoid-induced osteoporosis in real clinical practice
Authors: S Yakupova, R Demidov
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Oral glucocorticoids (GC) are used in different medicine fields and appear as risk factors of glucocorticoid-induced osteoporosis (GIO). <h3>Objectives</h3> The aim is to estimate the frequency of use of prophylaxis of OP, use drugs that are approved for GIO and also an awareness of GIO of patients with prolonged intake of GC. <h3>Methods</h3> 50 patients (10 men and 40 women), taking GC, took part in research. 30 patients (60%) were from rheumatology department, 5 patients (10%) from pulmonology department, 5 patients (10%) from gastroenterology department, 10 patients (20%) from nephrology department of Republic Clinical Hospital. Mean age of patients - 48,84±14,03 years (from 26 to 73). The following signs were estimated: clinical data, osteoporosis risk factors, instrumental tests (X-ray, densitometry). FRAX assessment of fracture risk was performed, the questionnaires of patients9 awareness of GIO was completed. <h3>Results</h3> The duration of intake GC – 5,93±4,86 years. Minimal dose of GC per day (if receiving prednisone) – 7.5 mg; maximal dose – 60 mg. 10-year risk of major osteoporotic fractures by FRAX, adjusted according to GC dose - 18,11±11,01. 32 patients (64%) were given recommendations for changing lifestyle and diet for GIO prophylaxis, 40 patients (80%) - recommendations for intake of calcium and vitamin D medications, but only 31 patients (62%) followed recommendations and started the intake of calcium medications. From the said number of patients only 14 patients (45,2%) used appropriate daily dose of calcium and vitamin D. Drugs that are approved for GIO were have to be prescribed for 18 patients, but only 6 patients (33,3%) underwent treatment, principally bisphosphonates. Only half of them underwent densitometry after starting the therapy. 72,2% patients with GIO used calcium and 30,7% were taking appropriate daily dose of calcium and vitamin D. 70% rheumatologic patients knew about GIO and in 90% cases calcium and vitamin D drugs were recommended. Only 50% of patients from non-rheumatologic departments knew about GIO and in 65% cases calcium and vitamin D drugs were recommended. <h3>Conclusions</h3> Clinical recommendations in real clinical practice are rarely fulfilled. Less than 60% patients were taking calcium and vitamin D, which are recommended for all patients, who started the GC therapy; only 33% of patients received osteoporosis therapy, only half of them underwent densitometry. Patients are insufficiently informed about necessity of changing lifestyle and diet for GIO prophylaxis. Education for patients taking GC and training for rheumatologic and non-rheumatologic specialties are necessary. <h3>Disclosure of Interest</h3> None declared
Determinants of diaphragm thickening fraction during mechanical ventilation: an ancillary study of a randomised trial
Authors: Emmanuel Vivier, Ferran Roche-Campo, Laurent Brochard, Armand Mekontso Dessap
Journal: European Respiratory Journal (2017)

Ultrasonography of the diaphragm is the subject of a growing interest in the intensive care unit (ICU) setting [1–6]. Observing the diaphragm in its zone of apposition allows measurement of its thickness and computation of its thickening fraction (TFdi), which depends on diaphragmatic activity [3] and reflects the diaphragm work of breathing [1]. A recent study showed that the TFdi correlated well with the endotracheal pressure variation generated by phrenic stimulation [6]. This index was also proposed for clinical evaluation of diaphragm weakness to detect ventilator-induced diaphragmatic dysfunction (VIDD) and predict difficult weaning [3, 4]. However, it remains unclear whether increased thickening in this setting only reflects a better intrinsic diaphragmatic strength, or if it also suggests enhanced work of breathing in response to increased cardiorespiratory workload. Furthermore, some authors suggested that VIDD could be thought as the "respiratory" manifestation of a global neuromuscular weakness [4, 7], but its relationship with ICU-acquired limb weakness is not straightforward [5]. The present study had a dual objective: first, to explore the correlation between ICU-acquired limb weakness (as assessed by the Medical Research Council (MRC) score) and diaphragm thickening (as assessed by TFdi); second, to assess the association of clinical variables with TFdi during mechanical ventilation. Diaphragm thickening does not correlate with ICUAW; it is influenced by cardiopulmonary load and residual sedation <http://ow.ly/6TC130e6G3Q>
THU0681 Baseline ESSDAI/DAS scores in 8061 patients with primary sjÖgren syndrome: characterization of systemic disease
Authors: P Brito-Zerόn, N Acar-Denizli, M Zeher, A Rasmussen, X Li, C Baldini, J-E Gottenberg, D Danda, L Quartuccio, G Hernandez-Molina, AA Kruize, S-H Park, M Kvarnström, S Praprotnik, D Sene, A Alunno, R Solans, T Mandl, Y Suzuki, M Rischmueller, G Nordmark, G Fraile, P Wiland, H Bootsma, T Nakamura, V Valim, R Giacomelli, R Seror, V Devauchelle-Pensec, B Hofauer, M Bombardieri, V Trevisani, D Hammenfors, A Minniti, SG Pasoto, J Morel, S Retamozo, TA Gheita, F Atzeni, C Vollenveider, X Mariette, M Ramos-Casals
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Objectives</h3> To characterize and quantify systemic involvement at diagnosis in a large international cohort of patients with primary Sjögren9s syndrome (SS). <h3>Methods</h3> The Big Data Sjögren Project was formed in 2014 to take a “high-definition” picture of primary SS at diagnosis by merging international databases (9302 consecutive patients from 21 countries of the 5 continents). The main features (including ESSDAI/DAS) at diagnosis were analysed. <h3>Results</h3> Baseline ESSDAI was available in 8061 patients (93% female, mean age 53yrs). The mean ESSDAI score at diagnosis of the entire cohort was 6.4±7.9. In 1498 patients (19%), score at diagnosis was 0, while 681 (8%) presented with high activity in at least one domain. The main systemic features at diagnosis were biological (51%), articular (38%), haematological (24%) and glandular (22%). Low DAS was reported in 4480 (56%) patients, moderate DAS in 2483 (31%) and high DAS in 1098 (14%) patients. The mean baseline ESSDAI was higher the younger the patient was (p&lt;0.001), higher in White patients (6.9 vs 5.1, p&lt;0.001), males (8.4 vs 6.2, p&lt;0.001), those with positive ocular (6.7 vs 4.9, p&lt;0.001) or oral (6.8 vs 6.2, p=0.016) tests, and those with ANA (6.9 vs 4.5, p&lt;0.001), RF (7.5 vs 5.8, p&lt;0.001) and anti-Ro/La antibodies (7.2 vs 4.4, p&lt;0.001). Logistic regression identified as independent variables White ethnicity (OR 3.07), abnormal ocular tests (OR 2.14), ANA (OR 1.67) and Ro/La autoantibodies (OR 2.78). <h3>Conclusions</h3> This is the largest series of patients with primary SS in whom the ESSDAI score has been evaluated. Primary SS is undeniably a systemic disease even at the time of diagnosis, with nearly 80% of patients showing an ESSDAI score &gt;0. <h3>Disclosure of Interest</h3> None declared
AB0697 Impact of the baseline bath ankylosing spondylitis radiology hip index on the structural hip joint progression after tnfα blocking therapy in spondyloarthrities patients
Authors: K Maatallah, M Sahli, I Mahmoud, W Hamdi, O Saidane, M Kchir, R Tekaya, L Abdelmoula
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> One of the major goals of treatment of spondyloarthrites (SpA) is to prevent or slow the radiographic damage.The results of clinical trials raised expectations that TNFi are effective not only on clinical and biological parameters of the disease but may also have structural effect. <h3>Objectives</h3> We assessed whether the baseline Bath Ankylosing Spondylitis Radiology (BASRI) hip index had effect on structural hip progression under TNFα blockers in SpA patients with hip disease. <h3>Methods</h3> This was a multicentric longitudinal study including SpA patients (ASAS2009) with hip disease under TNF α blockers. Anteroposterior X-rays of the pelvis obtained at baseline were compared with X-rays obtained after 5 years [3–10] of continuous TNF α blockers treatment. Radiographic progression of the hip was evaluated by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h), scoring system (min 0 = no change, 1 = focal joint space narrowing, 2 = circumferential joint space narrowing &gt;2 mm, 3 = circumferential joint space narrowing ≤2 mm or bone-on-bone apposition of &lt;2 cm and max 4 = bone deformity or bone-on-bone apposition of ≥2 cm) and the hip joint space width (assessed by the average of measurements at three distinct sites between the acetabulum and femoral head)[1]. The median progression of the hip joint space was chosen as cut-off to define the structural evolution, it was 0.3mm. A good response of the hip was defined by a stabilization or a decrease of the hip joint space less than 0.3 mm (RH+).A poor response was defined by a decrease of the hip joint space &gt;0.3mm (RH-). <h3>Results</h3> 48 patients were included (81% male). The average age was 40.7±11years. The mean age at the onset of the disease was 25.8±10 years. Hip involvement was bilateral in 77% of cases. At baseline, the mean BASRI hip index was 2±0.8. The BASRI hip score was 1 in 26%, 2 in 51%, 3 in 18% and 4 in 5% of patients. The average of hip joint space width at baseline was 3.4±1.2mm. Infliximab was the most prescribed TNFα blocker (48%) followed by Etanercept (37.5%) and Adalimumab (14.5%).After 5years, the mean BASRI hip index remained stable 2±0.8, the BASRI hip score was 1 in 23%, 2 in 50%, 3 in 14% and 4 in 13% (p=ns). The variation of hip joint space width was-0.294 mm (p=ns). 29 patients were RH+. The BASRI hip index 2±0.8 and 2.1±0.9 in RH+ and RH- patients respectively with no statistically significant difference. <h3>Conclusions</h3> According to our study the structural hip joint progression under TNFα blockers is not influenced by the baseline BASRI hip index. <h3>References</h3> Konsta M,Sfikakis PP, Bournia VK, Karras D, Iliopoulos A.Clin Rheumatol (2013) 32:1229–1232. <h3>Disclosure of Interest</h3> None declared
SAT0108 Clinical significance of anti-actin antibodies in autoimmune inflammatory rheumatic diseases
Authors: I Ayadi, L Laadhar, M Kallel-Sellami
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Anti-actin antibodies (AAA) are well-described as the major component of smooth muscle autoantibodies (microfilament antibodies). They are specially detected in patients with chronic active hepatitis (CAH) and celiac disease (CD). AAA have also been found less frequently in various other autoimmune disorders including systemic lupus erythematosus (SLE), Sjogren9s syndrome, and myasthenia gravis, as well as in primary biliary cirrhosis and alcoholic liver disease. <h3>Objectives</h3> to study clinicobiological characteristics of patients with AAA in autoimmune inflammatory rheumatic diseases (AIRD). <h3>Methods</h3> From January to December 2016, we have collected all cases of patients with AAA presenting for symtomatology of AIRD. The presence of AAA was detected fortuitously by indirect immunofluorescence (IIF) in accordance with its characteristic fluorescence pattern in HEp2 cells (BioRad<sup>©</sup>). The specificity for F-actin was confirmed by IIF on rat liver-kidney-stomach sections (Biosystem®) and/or Immunodot (Euroimmun®). Coeliac disease related antibodies were performed in all patients with AAA. <h3>Results</h3> Six patients were included: 5 women and a man with a mean age of 43.5 years. AIRD have been suspected in these patients and the mean clinical features were inflammatory polyarthralgia and fever. AIRD was diagnosed in three cases: One patient presented with SLE and two others with rheumatoid arthritis (RA). Hepatic function was disturbed with elevated serum ALT and AST activities in one case higly suspected of CAH. CD was diagnosed in one case. The sixth patient had positive antinuclear antibodies, hypocomplementemia and anti-Ro52, anti-SSB and anti-DFS antibodies associated with FR but didn9t fulfilled SLE criteria. The immunological tests showed anti-nuclear antibodies among all patients with high titre and anti-DNA antibodies in SLE and CAH patients respectively. One RA patient had anti-Ro60 antibodies. <h3>Conclusions</h3> During our study, AAA were found fortuitously in AIRD. This association is rarely described in the literature. Hepatic involvement can be seen during AIRD. Nevertheless, a CAH and CD associated shouldn9t be disregarded. <h3>References</h3> Diagnostic value of anti-actin antibodies in a French multicenter study. P.Chretien-Leprince et al; Ann N Y Acad Sci. 2005;1050:266–73. Smooth-muscle antibodies in rheumatoid arthritis. I.Andresen et al; Acta Pathol. Microbiol. Scand. 1980;88: 131–135. <h3>Disclosure of Interest</h3> None declared
OP0101 Risk of opportunistic infections in patients with rheumatoid arthritis initiating abatacept: analysis of all available clinical trial data
Authors: T Simon, T Gelarden, E Nkhoma, M Zhou, S Banerjee, K Winthrop
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Opportunistic infections (OI) during treatment with abatacept (ABA) have been previously reported but are lacking a comprehensive analysis. <h3>Objectives</h3> To present the overall incidence rates of OI and herpes infections observed in patients (pts) receiving ABA using combined clinical trial data. <h3>Methods</h3> OI adverse events were summarized from 16 clinical trials (both placebo-controlled and cumulative abatacept exposure); all pts randomized to placebo were on a non-biologic DMARD. Incidence rates (per 100 person-years [p-y]) were calculated by the number of pts experiencing the first event divided by the total number of p-y of exposure. The p-y of exposure was censored at the time of the first event, death, discontinuation or end of study. Random effects meta-regression was performed across the trials to estimate the frequency of OI after adjusting for between-study heterogeneity. OI were identified using a pre-specified list in the setting of biologic therapy for patients with RA. Criteria for consideration were based on type, location of the infection and causing organism. Excluded from the list were non-specific infections caused by organisms considered to be opportunistic, but common in the general population. <h3>Results</h3> A total of 7044 pts with RA with ∼21,330 p-y of ABA exposure were included in the cumulative randomized trial data (Table). The frequency of OI was 64% lower among pts treated with ABA vs placebo. After adjusting for heterogeneity across studies, the frequency (95% CI) of OI remained lower for the ABA group (0.15% [0.06, 0.42] vs the placebo group (0.48% [0.22, 1.04]). <h3>Conclusions</h3> Abatacept-treated pts had a lower incidence rate of OI compared with placebo. The OI and herpes infection incidence rates in the cumulative data are similar or lower to those reported in the literature.<sup>1–3</sup> <h3>References</h3> Curtis JR, et al. Ann Rheum Dis 2016;75:1843–7. Yun H, et al. Arthritis Care Res (Hoboken) 2015;67:731–6. Winthrop KL, et al. Ann Rheum Dis 2015;74:2107–16. <h3>Disclosure of Interest</h3> T. Simon Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, T. Gelarden Employee of: Alpha Consulting, E. Nkhoma Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, M. Zhou Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, S. Banerjee: None declared, K. Winthrop Consultant for: Pfizer, AbbVie, Bristol-Myers Squibb, UCB, Roche/Genentech, Amgen, Galapagos, Lilly
Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke
Authors: Jeffrey L. Saver, John D. Carroll, David E. Thaler, Richard W. Smalling, Lee A. MacDonald, David S. Marks, David L. Tirschwell
Journal: New England Journal of Medicine (2017)

Whether closure of a patent foramen ovale reduces the risk of recurrence of ischemic stroke in patients who have had a cryptogenic ischemic stroke is unknown.
AB1094 Association between use of traditional chinese medicine and medication adherence among chinese-american rheumatology patients
Authors: K Sun, H Tian, YJ Chang, L Lee, JC Leng, LA Mandl
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Chinese-Americans (CA) are a fast-growing US immigrant group with high utilization of Traditional Chinese Medicine (TCM) and worse SLE and RA outcomes than Caucasians (1,2). The effect of TCM use on adherence to prescribed western medications for systemic rheumatic diseases is unknown. <h3>Objectives</h3> To evaluate whether TCM use is associated with adherence to western medicines prescribed for systemic rheumatic diseases among CA patients. <h3>Methods</h3> Patients with systemic rheumatic diseases were recruited from 2 rheumatology clinics that serve a predominantly CA immigrant population. Inclusion criteria were speaking Mandarin or English and having medication(s) prescribed by the rheumatologist. TCM use, adherence, Patient-Reported Outcomes Measurement Information System (PROMIS) domains, and other variables were assessed using validated instruments available in English and Chinese. Adherence was classified as high or medium/low based on the 8-item Morisky Medication Adherence Scale (3). Medication complexity was assessed using the Medication Regimen Complexity Index (MRCI) (4); higher score indicates more complexity. <h3>Results</h3> 177 enrolled, mean age 54 (range 20–97), 62% female, 73% ≤high school education, 75% Medicaid (subsidized insurance), and only 18% spoke English. Diagnoses were RA (43%), SLE (17%), SpA (16%), Sjogren9s (8%), gout/CPPD (6%), and other (10%). 49% reported TCM use in the past year, most commonly <i>tuina</i> massage (48%), acupuncture (47%), and herbs (39%). 27% reported high adherence. Table 1 shows significant univariate associations with high adherence. In multivariate analysis adjusting for all variables in Table 1, only TCM use (OR 2.6, p=0.027) and higher MRCI (OR 1.1, p=0.019) were associated with high adherence. <h3>Conclusions</h3> Among poorly integrated and low socioeconomic status CA rheumatology patients, TCM use was statistically significantly associated with high adherence to western medication, as was higher MRCI. TCM use does not appear to represent an alternate but rather complementary approach to disease management in these patients. Future studies should evaluate whether TCM use is associated with disease activity and outcomes over time. <h3>References</h3> Barton JL, et al. Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university-affiliated clinics. Arthritis Care Res 2011;63:1238–1246. Mok MY, Li WL. Do Asian patients have worse lupus? Lupus 2010;19:1384–1390. Morisky DE, et al. Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. J Clin Hypertens 2008;10:348–354. George J, et al. Developmennt and Validation of the Medication Regimen Complexity Index. Ann Pharmacoepidemiol 2004;38:1369–1376. <h3>Disclosure of Interest</h3> None declared
Biotin tagging of MeCP2 in mice reveals contextual insights into the Rett syndrome transcriptome
Authors: Brian S Johnson, Ying-Tao Zhao, Maria Fasolino, Janine M Lamonica, Yoon Jung Kim, George Georgakilas, Kathleen H Wood, Daniel Bu, Yue Cui, Darren Goffin, Golnaz Vahedi, Tae Hoon Kim, Zhaolan Zhou
Journal: Nature Medicine (2017)
Antiretroviral therapy in pregnant women living with HIV: a clinical practice guideline
Authors: Reed A C Siemieniuk, Lyubov Lytvyn, Jinell Mah Ming, Rhonda Marama Mullen, Florence Anam, Teresia Otieno, Gordon H Guyatt, Graham P Taylor, Claudia Beltrán-Arroyave, Patrick Mbah Okwen, Ruth Nduati, John Kinuthia, Henry Namme Luma, Haresh Kirpalani, Arnaud Merglen, Olufunmilayo A Lesi, Per Olav Vandvik, Thomas Agoritsas, Susan Bewley
Journal: BMJ (2017)

Approximately 1.4 million women living with HIV become pregnant every year. Most women use antiretroviral therapy, to reduce the risk of vertical transmission or for personal health reasons. Using the GRADE framework according to the BMJ Rapid Recommendation process, we make recommendations for optimal choice of combination antiretroviral regimen considering patient values and preferences, the balance of desirable and undesirable outcomes, their uncertainty, and practical issues. We suggest a zidovudine and lamivudine-based regimen over one that includes tenofovir or emtricitabine (weak recommendation). We recommend alternatives over the combination of tenofovir, emtricitabine, and lopinavir/ritonavir (strong recommendation).
SAT0447 Prevalence of radiographic sacroiliitis in patients with psoriatic arthritis and the clinical, analytical and demographic factors associated to its appearance
Authors: C Lόpez-Medina, S Leόn-Idougourram, MD Lόpez-Montilla, L Bautista-Aguilar, L Ladehesa-Pineda, E Collantes-Estévez
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> To date, published studies suggest that a significant proportion of patients with Psoriatic Arthritis (PsA) present asymptomatic sacroiliitis; that is to say, an inflammatory back pain (IBP) absence. This fact could result in the underdiagnosis of axial involvement in these patients (1). <h3>Objectives</h3> To evaluate the prevalence of radiographic sacroiliitis in patients with PsA and to determine its association with clinical, analytical and demographic factors. <h3>Methods</h3> A cross-sectional, observational, and unicentre study in which clinical, analytical and demographic data from 359 patients belonging to a PsA monographic consultation were analyzed. All patients met the CASPAR criteria. The presence of sacroiliitis in the sacroiliac x-ray image was used as a dependent variable, formerly evaluated by a trained Rheumatologist. Likewise, independent variables related to arthropathy, cutaneous involvement and sociodemographic characteristics of the patients were used as well. A descriptive analysis and two logistic regressions (univariate and multivariate), were performed to associate radiographic sacroiliitis to different covariates. <h3>Results</h3> Out of the 359 patients, 214 (59.6%) were men with a mean time of PsA evolution of 10.05±11.6 years. The x-ray image performed showed sacroiliitis in 127 patients (35.4%). Univariate analysis showed that radiographic sacroiliitis is related (p&lt;0.05) to gender (men), psoriasic paternal family history, IBP, positive HLA-B27 antigen and psoriatic cutaneous involvement greater than 25%. The multivariate analysis showed that radiographic sacroiliitis in these patients is predominantly associated to the presence of IBP, the positive HLA-B27 antigen and gender (men). However, sacroiliitis is not not associated to the onset age of PsA (p&gt;0.05). <h3>Conclusions</h3> The prevalence of radiographic sacroiliitis in our population is 35.4%, higher than in other series due to the fact that the sacroiliac x-ray images were performed on all patients, regardless of the clinic. The radiographic sacroiliitis in patients with PsA is related to the presence of IBP, HLA-B27 antigen and gender. However, the time of evolution of arthropathy and the onset age of PsA are not related to sacroiliac radiographic involvement. <h3>References</h3> Jadon DR, Sengupta R, Nightingale A, et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis. Ann Rheum Dis 2016;0:1–7. <h3>Disclosure of Interest</h3> None declared