tbuckley/cabot-search huggingface dataset:
SP0056 Sustainable healthcare – it takes a village
Authors: B.A. Slusher
Journal: Annals of the Rheumatic Diseases (2018)

<h3></h3> Healthcare delivery is at a crossroads for potential paradigm change due to budget constraints, complexity of care, increasing performance measures and implementation of electronic health records. Additionally, recent reports of high levels of stress and burnout amongst healthcare providers has been linked to decreased patient safety and medical errors. Complicating matters for rheumatology, is shrinking of the available workforce. The model of interprofessional healthcare delivery holds promise as a means to improve both patient outcomes and provider wellbeing. This presentation addresses implementation of interprofessional teams in rheumatology and provides a review of successful models and guidelines for implementation. <h3>Disclosure of Interest</h3> None declared
SAT0603 Can homozygous or heterozygous mefv mutations lead to different presentation of familial mediterranean fever?
Authors: A. Aktaş, M. Karadavut, D. Üsküdar Cansu, C. Korkmaz
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Although some patients with familial Mediterranean (FMF) have heterozygous mutations for MEFV gene, there is a debate about whether heterozygosity for MEFV mutations in FMF might be responsible for disease symptoms or not. <h3>Objectives</h3> To evaluate differences between the patients with FMF having homozygos (Hom) or heterozygos (Het) MEFV mutations in terms of clinical features and severity of the disease as well as concomitant disorders. <h3>Methods</h3> We included 259 unrelated patients (female: 143, male: 116; mean age: 33.5±12 years) who were clinically diagnosed as having FMF and who met the Tell-Hashomer's diagnostic criteria. The presence of MEFV mutations was investigated in exon 2,3,5 and 10 by multiplex-PCR reverse hybridization method. All clinical manifestations and their features were revised. All the patients were questioned for the presence of concurrent disorders, and the medical records of these patients were revised retrospectively. A previous diagnosis of a concomitant disease was taken into consideration if it met the relevant criteria. <h3>Results</h3> In 12 of 259 patient, MEFV mutation analysis was not performed. No mutation was not determined in 8 FMF patients (3.2%). Hom mutation was found in 79 patients with FMF (31.9%), Het plus compound heterozygotes (cHet) in 160 FMF patients (64.7%). Early onset and early diagnosis of FMF were found in Hom group compared to Het plus cHet group (8.4 years vs 13.6 years; 23.3 years vs 28.6 years, p&lt;0.0001, respectively). The number of patients with a higher severity score was significantly higher in hom group than Het plus cHet group (p&lt;0.001). No significant difference was found between Hom and Het plus cHet group in terms of clinical features except for erysipelas like erythema (ELE) (p&lt;0.0001). Concomitant disorders were as follows: ankylosing spondylitis (AS) 24 (9.3%), amyloidosis 13 (5%), Behcet's disease 8 (3%). Amyloidosis (9 vs 4) was significantly higher in Hom group than Het plus cHet group (p&lt;0.01). <h3>Conclusions</h3> The presence of homozygous MEFV mutations in contrast to Het mutations creates a tendency for early onset of the disease, early diagnosis, frequent ELE and amyloidosis and severe disease phenotype. <h3>Acknowledgements</h3> None <h3>Disclosure of Interest</h3> None declared
OP0051 Evolution of the vascular involvement objectified by pet/tac in patients with giant cell arteritis treated with tocilizumab
Authors: D. Prieto-Peña, J. Loricera, J. Martín-Varillas, M. Calderón-Goercke, J. Nárvaez, E. Aurrecoechea, I. Villa, S. Castañeda, C. Gómez-Arango, A. Mera, E. Pérez-Pampín, V. Aldasoro, N. Álvarez-Rivas, N. Fernández-Llanio, M. Álvarez-Buergo, L. Marena-Rojas, F. Sivera, E. Galíndez-Agirregoikoa, R. Solans-Laqué, S. Romero-Yuste, I. Martínez-Rodríguez, I. Banzo, V. Calvo-Río, N. Palmou-Fontana, B. Atienza-Mateo, J. Hernández, M. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Giant cell arteritis (GCA) is a large-vessel vasculitis which can involve the aorta and/or its major branches. Tocilizumab (TCZ) seems to be effective in giant cell arteritis (GCA).<sup>1–4</sup> <h3>Objectives</h3> Our aim was to assess if the clinical and analytical improvement yielded in patients with GCA treated with TCZ is accompanied by a reduction of the vascular inflammation evaluated by PET/CT. <h3>Methods</h3> Study of 36 patients who had a baseline and follow-up PET/CT from a multicenter series of 134 patients with GCA in treatment with TCZ. The evolution of the vascular involvement objectified by PET/CT was assessed. In addition clinical efficacy, analytical improvement (acute phase reactants) and the reduction of corticosteroid dose was studied. <h3>Results</h3> The 36 patients (28 women and 8 men) had an mean age of 69.83±8.66 years. After TCZ onset, a rapid and maintained clinical improvement was observed (table 1). In addition, during the first twenty-four months of follow-up, C-reactive protein decreased from 2.4 [0.9–6.8] to 0.1 [0.0–0.5] mg/dL and the erythrocyte sedimentation rate from 41.5 [16.7–58.5] to 4 [2–12.5] mm/1 st hour. On the other hand, the levels of haemoglobin experienced an increase from 12.3 [11.3–13.0] to 13.3 [13.0–13.9] g/dL. The median dose of prednisone decreased from 12.5 [9.4–26.2] to 0.0 [0.0–0.0] mg/day. However, the decrease in F18-fluordeoxyglucose uptake in the PET/CT study was not as evident. <h3>Conclusions</h3> Although TCZ seems to be an important therapeutic agent in the treatment of GCA, achieving a rapid and sustained clinical and analytical improvement, the decrease in vessel inflammation assessed by F18-fluordeoxyglucose uptake seems to take a slower course. <h3>References</h3> [1] Loricera J, et al. Tocilizumab in giant cell arteritis: Multicenter open-label study of 22 patients. Semin Arthritis Rheum2015;44:717–723. [2] Loricera J, et al. Tocilizumab in refractory aortitis: Study on 16 patients and literature review. Clin Exp Rheumatol2014;32(3 Suppl 82):S79–89. [3] Loricera J, et al. Use of positrón emission tomography (PET) for the diagnosis of large-vessel vasculitis. Rev Esp Med Nucl Imagen Mol2015;34:372–377. [4] Loricera J, Blanco R, Hernández JL, et al. Tocilizumab in patients with Takayasu arteritis: A retrospective study and literature review. Clin Exp Rheumatol2016;34(3 Suppl 97):S44–53. <h3>Disclosure of Interest</h3> None declared
SAT0483 Female sexual dysfunction in patients with systemic sclerosis
Authors: B. Hermankova, M. Spiritovic, H. Smucrova, S. Oreska, H. Storkanova, K. Pavelka, J. Vencovsky, L. Senolt, R. Becvar, M. Tomcik
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Systemic sclerosis (SSc) is a chronic autoimmune disease leading to various physical and psychological impairments including sexual dysfunction. <h3>Objectives</h3> To assess sexual functions/quality of life and pelvic floor function in female SSc patients compared to age-/sex-matched healthy controls (HC), and to analyse the potential impact of disease activity, fatigue, physical activity and depression. <h3>Methods</h3> In total, 41 women with SSc (mean age: 50.9, disease duration: 5.8 years, lcSSc/dcSSc: 18/23, mRSS: 13.6, ESSG activity index: 2.5), who fulfilled the ACR/EULAR 2013 criteria, and 41 healthy controls (mean age: 50.9) without rheumatic diseases filled in 12 well-established and validated questionnaires assessing sexual function/quality of life, pelvic floor function, fatigue, physical activity and depression. Full names of questionnaires are listed in the table 1. Data are presented as mean ±SEM. <h3>Results</h3> Compared to HC, patients with SSc had significantly higher prevalence and greater severity of sexual dysfunction (FSFI, BISF-W: in all subscales as well as total scores), dysfunction of pelvic floor (PISQ-12, PFIQ7), and worse sexual quality of life (SQol-F) (table 1). Worse scores in SSc patients were associated with higher disease activity [ESSG activity index: SQol-F (r=−0.364,p=0.0443), PFIQ7-gynaecological subscale (r=0.492,p=0.0036)], greater fatigue [all three questionnaires FSS/FIS/MAF correlated negatively with FSFI, BISF-W], more severe depression [BDI-II: FSFI (r=−0.553,p=0.0002), BISF-W (r=−0.514,p=0.0007), PFIQ7 (r=0.495,p=0,0010)], deteriorated quality of life [SHAQ: FSFI (r=−0.536,p=0.0003), BISF-W (r=−0.563,p=0.0001), SQol-F (r=−0.338,p=0.0382), PISQ-12 (r=0.563,p=0.0051), PFIQ7 (r=0.380,p=0.0142)], and worse ability to perform physical activities [HAP: FSFI (r=0.407,p=0.0082), BISF-W (r=0.409,p=0.0078)]. <h3>Conclusions</h3> Women with SSc reported significantly impaired sexual function, sexual quality of life and pelvic floor function than age-matched healthy controls. Worse scores in SSc were associated with disease activity, physical activity, fatigue, depression and quality of life. <h3>Acknowledgements</h3> Supported by AZV-16- 33574A and MHCR 023728. <h3>Disclosure of Interest</h3> None declared
Accuracy of comprehensive PCR analysis of nasopharyngeal and oropharyngeal swabs for CT-scan-confirmed pneumonia in elderly patients: a prospective cohort study
Authors: V. Prendki, B. Huttner, C. Marti, A. Mamin, P.E. Fubini, M.P. Meynet, M. Scheffler, X. Montet, J.P. Janssens, J.L. Reny, L. Kaiser, N. Garin, J. Stirnemann
Journal: Clinical Microbiology and Infection (2019)

ObjectivesWe aimed to assess the accuracy of PCR detection of viruses and bacteria on nasopharyngeal and oropharyngeal swabs (NPS) for the diagnosis of pneumonia in elderly individuals.MethodsWe included consecutive hospitalized elderly individuals suspected of having pneumonia. At inclusion, NPS were collected from all participants and tested by PCR for the presence of viral and bacterial respiratory pathogens (index test, defined as comprehensive molecular testing). Routine diagnostic tests (blood and sputum culture, urine antigen detection) were also performed. The reference standard was the presence of pneumonia on a low-dose CT scan as assessed by two independent expert radiologists.ResultsThe diagnosis of pneumonia was confirmed in 127 of 199 (64%) included patients (mean age 83 years, community-acquired pneumonia in 105 (83%)). A pathogen was identified by comprehensive molecular testing in 114 patients (57%) and by routine methods in 22 (11%). Comprehensive molecular testing was positive for viruses in 62 patients (31%) and for bacteria in 73 (37%). The sensitivity and specificity were 61% (95% CI 53%–69%) and 50% (95% CI 39%–61%) for comprehensive molecular testing, and 14% (95% CI 82%–21%) and 94% (95% CI 86%–98%) for routine testing, respectively. Positive likelihood ratio was 2.55 for routine methods and 1.23 for comprehensive molecular testing.ConclusionComprehensive molecular testing of NPS increases the number of pathogens detected compared with routine methods, but results are poorly predictive of the presence of pneumonia. Hence, comprehensive molecular testing is unlikely to impact clinical decision-making (NCT02467192).Clinical Trials RegistrationNCT02467192.
SAT0156 Association between cumulative methotrexate dose, non-invasive scoring system and hepatic fibrosis detected by fibroscan in rheumatoid arthritis patients receiving methrotrexate.
Authors: R. Lertnawapan, S. Chonprasertsuk, S. Siramolpiwat
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Methotrexate (MTX) is recommended by recent ACR and EULAR guideline as a first-line drug for RA. Liver fibrosis, which occurs as long-term side effect is one of the most concerns. <h3>Objectives:</h3> To find the association between clinical parameters, cumulative MTX dosage, liver fibrosis scoring systems and the presence of liver fibrosis assessed by transient elastography (TE; Fibroscan®). <h3>Methods:</h3> Rheumatoid arthritis, prescribed MTX, patients had been evaluated of liver fibrosis with TE. Two subgroups of patients were compared: non-fibrosis and fibrosis (TE &gt;7 kPa). Univariate and multivariate logistic regression analysis were performed to identify factors associated with liver fibrosis. <h3>Results:</h3> One hundred and eight patients were recruited. Twenty-nine patients (26.8%) were classified by transient elastography as liver fibrosis cases. The multivariate analysis demonstrated only the statistically significant of the association in BMI (OR=1.217; 95%CI 1.048–1.414; P=0.010); fatty liver (OR=2.318; 95%CI 0.584–9.189; P=0.232); ALT (OR=1.044; 95%CI=1.003–1.087; P=0.036) and cumulative MTX dosage (OR 1.001; 95%CI 1.000–1.001; P=0.001). <h3>Conclusions:</h3> Liver fibrosis measured with Fibroscan was associated with cumulative MTX. RA patients with metabolic syndrome including high BMI, IFG, fatty liver had higher risk of MTX-induced hepatic fibrosis. RA patients with high cumulative MTX dose, especially patients with concurrent metabolic syndrome should be cautiously monitored for liver fibrosis. <h3>Disclosure of Interest:</h3> None declared
Verna Wright: father of the spondyloarthropathies
Authors: Philip S Helliwell
Journal: Annals of the Rheumatic Diseases (2019)

Verna Wright arrived in Leeds in 1956, having qualified in Liverpool. At that time there were few ‘official’ rheumatologists as care for arthritis was delivered by general physicians or physical medicine specialists. His interest in psoriatic arthritis was kindled by the patients admitted to the regional rheumatic disease hospital in Harrogate—the Royal Bath Hospital. When he went to the USA for a spell (to follow his interest in biomechanics) he asked one of the senior nurses in Harrogate to make a list of all patients admitted with psoriasis and arthritis in his absence. On his return he had his first cohort—it was as simple as that. He was not the first to notice the characteristic features of psoriatic arthritis, there was an early description by Alibert1, and Bauer et al in the USA very carefully described the salient features in an article in 1941.2 However, Verna Wright’s contribution was to make careful clinical and radiographic observations of a large cohort of patients, an advantage of working in a regional centre where patients came from all over the North of England. Together with John Moll, he recognised that other arthritides shared common …
The anti‐inflammatory potency of biologics targeting tumour necrosis factor‐α, interleukin (<scp>IL</scp>)‐17A,<scp>IL</scp>‐12/23 and<scp>CD</scp>20 in hidradenitis suppurativa: an<i>ex vivo</i>study
Authors: A.R.J.V. Vossen, C.B. Ardon, H.H. Zee, E. Lubberts, E.P. Prens
Journal: British Journal of Dermatology (2019)

Biologics targeting inflammatory mediators can achieve clinical improvements in hidradenitis suppurativa (HS). However, their clinical efficacy shows great interpatient variability in daily practice.To investigate the anti-inflammatory potency of a selection of currently available biologics and prednisolone for the treatment of HS in an ex vivo skin culture system using lesional HS biopsies.Lesional skin samples from 10 patients with HS and skin samples from five healthy controls were cultured ex vivo and exposed to prednisolone or biologics targeting tumour necrosis factor (TNF)-α, interleukin (IL)-17A, IL-12/23p40 or CD20 (adalimumab, infliximab, secukinumab, ustekinumab and rituximab, respectively). Real-time quantitative polymerase chain reaction and cytokine bead arrays were used to measure the inhibitory effect of the biologics on cytokines and antimicrobial peptides (AMPs).The relative mRNA expression of all tested cytokines and AMPs was significantly downregulated by all anti-inflammatory agents (P < 0·001). The protein production of the proinflammatory cytokines TNF-α, interferon γ, IL-1β, IL-6 and IL-17A was significantly inhibited by adalimumab, infliximab, ustekinumab, prednisolone (all P < 0·001) and rituximab (P = 0·0071), but not by secukinumab (P = 0·0663). On both mRNA and protein levels, adalimumab, infliximab and prednisolone reduced the levels of a broader mix of individual cytokines than secukinumab, ustekinumab and rituximab. Moreover, a significant inhibitory effect on mRNA expression levels of inflammatory markers in healthy control skin was observed only for TNF-α inhibitors (P < 0·001) and prednisolone (P = 0·0015).This ex vivo study suggests that TNF-α inhibitors and prednisolone are the most powerful inhibitors of proinflammatory cytokines and AMPs in HS lesional skin, which concurs with our clinical experience in patients with HS.
Abstract 14786: Protein Kinase G mediates Hyperoxia-Induced Vascular Changes in Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension
Authors: Keng Jin Lee, Gina A Kim, Joann M Taylor, Franz Hofmann, Kathryn N Farrow
Journal: Circulation (2014)

Introduction: Bronchopulmonary dysplasia (BPD) is a complication of prematurity and is often associated with pulmonary hypertension (PH). Protein Kinase G (PKG) is a kinase that phosphorylates mult...
HRT tablets are associated with blood clot risk—but not patches, creams, or gels
Authors: Zosia Kmietowicz
Journal: BMJ (2019)

Women who take hormone replacement therapy (HRT) as tablets have a higher risk of serious venous thromboembolism (VTE) than those not taking oral HRT, although cases are very rare, a large study in The BMJ has found. Patches, gels, and creams did not increase a woman’s chance of VTE.1

While the study was observational and cannot establish cause, the researchers from the University of Nottingham said that their findings “provided a more …
AB1007 Seasonal variations of 25-hydroxyvitamin d3 levels and its relation to parathyroid hormone levels
Authors: M.A. Teran Tinedo, P. Cristina
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To analyse the relationship between 25-hydroxyvitamin-D3 and parathyroid hormone levels and to determine its variation between the different seasons of the year. <h3>Methods</h3> An observational descriptive study was carried out, collecting and analysing 25-hydroxyvitamin-D3 (25OH-D3) and parathyroid hormone (PTH) serum levels of patients from .<sup>January to December of 2017</sup> The frequencies distribution analysis of both variables was compared and Pearson's correlation coefficient (PCC) was used to analyse linear relationship between them. The results were classified by date in four seasons: winter, spring, summer, and autumn, assessing the mean seasonal oscillations of each variable and calculating correlation in each case. Different levels of 25OH-D3 were evaluated in order to identify differences in the grade of correlation. <h3>Results</h3> Serum samples from 6265 patients were recollected. 59% of the patients had 25OH-D3 levels lower than 25 ng/ml. Pearson's correlation coefficient between both variables was −0.159 (p&lt;0.01). The mean values of 25OH-D3 were calculated for each seasonal period, establishing a mean level of 23 ng/ml for winter, 25 ng/ml for spring, 31 ng/ml for summer and 29 ng/ml for autumn. Regarding PTH levels, the mean values for each season were 108 pg/ml, 101 pg/ml, 86 pg/ml and 84 pg/ml from winter to autumn respectively. PTH/Vitamin D correlation was also assessed for each period: Pearson's correlation coefficient during winter was −0.08(p&lt;0.01), for spring −0.249(p&lt;0.01), for summer −0,21(p&lt;0.01) and for autumn −0,19(p&lt;0.01). At last, correlation calculated with deficiency levels of 25OH-D3 (&lt;30 ng/ml) was −0.18(p&lt;0.01), and with levels inferior than 10 ng/ml was −0.12(p&lt;0.01). <h3>Conclusions</h3> Linear correlation between levels of 25OH-D3 and PTH could not be established in our study, not even using levels classified as vitamin D deficiency. 25OH-D3 levels tended to increase from winter to summer whereas PTH levels decreased inversely during these seasons, without any linear correlation. <h3>Disclosure of Interest</h3> None declared
THU0379 Coronary artery disease in sle: a case-controlled angiographic study
Authors: T. Chazal, M. Kerneis, P. Guedeney, J. Haroche, A. Mathian, P. Ruffat, F. Cohen-Aubart, G. Montalescot, Z. Amoura
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Coronary artery disease (CAD) is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients.<sup><sup>1</sup></sup> Whether SLE is a cardiovascular risk factor <i>per se</i> remains controversial. <h3>Objectives</h3> This study was conducted to determine the clinical and angiographic characteristics of SLE patients with CAD and to compare them to those of control non-SLE patients with CAD. <h3>Methods</h3> All SLE patients who underwent a coronary angiography procedure in our tertiary centre between 2005 and 2016 were enrolled in the study. Those without significant atherosclerosis (stenosis &gt;50%) were excluded. Each SLE patient was matched by sex and age at catheterization with seven non-SLE controls with significant CAD. Angiographic characteristics were reviewed by two independent cardiologists. <h3>Results</h3> Among the 73 SLE patients who underwent coronary angiography, 28 patients had at least one significant coronary atherosclerotic lesion. The SLE patients were predominantly female (75%, median age of 55.7 years) with a long-standing disease duration (median SLE duration of 20.5 years). Ten patients (35%) had renal involvement, and 9 patients (32%) had antiphospholipid syndrome. The patients with SLE had fewer cardiovascular risk factors (1.6 vs 2.1, p=0.01) than the controls, including lower body mass index (23.8 kg/m² vs 24.98 kg/m², p=0.03), less frequent family history of coronary artery disease (3.5% vs 18%, p=0.049) and less diabetes (7% vs 22%, p=0.07) than controls. However, SLE patients were more likely to have chronic kidney failure (35% vs 20%, p=0.07) and to need hemodialysis (17% vs 2%, p=0.001). The SLE patients more often had multivessel disease (50%). <h3>Conclusions</h3> While they have fewer cardiovascular risk factors, patients with SLE experience more severe CAD than non-SLE patients, suggesting that SLE, associated conditions or the treatments themselves play key roles in the development of atherosclerosis.<sup><sup>2</sup></sup> <h3>References</h3> [1] Lee YH, Choi SJ, Ji JD, Song GG. Overall and cause-specific mortality in systemic lupus erythematosus: an updated meta-analysis. Lupus2016Jun;25(7):727–734. [2] Schoenfeld SR, Kasturi S, Costenbader KH. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review. Semin Arthritis Rheum2013Aug;43(1):77–95. <h3>Disclosure of Interest</h3> None declared