P097 Raised inflammatory markers with unclear cause; what do they tell us? An audit of patients presenting to rheumatology service at RNHRD, Bath
Conclusion Patients with persistently elevated inflammatory markers had a higher mortality rate than the other group over 6 months. Three quarters of patients with raised inflammatory markers remain under follow up of Rheumatology team for surveillance. Patients were reviewed in Rheumatology clinics in reas onable time. Appropriate investigative modalities were considered while investigating for inflammatory disorders. Further large scale studies are required to find an association between raised inflammatory response with mortality in rheumatology patients.Disclosure M. Jamal: None.R. Peck: None.R. Sengupta: None. (Source: Rheumatology)
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P096 Pregnancy outcomes in women attending a joint obstetric and rheumatology clinic in a tertiary centre over a 2-year period
Conclusion In this cohort we report a high live birth rate and comparable rates of assisted delivery to similar cohorts. Infection and post-partum haemorrhage are maternal complications that are common, and reflect the complex clinical presentations and therapeutic regimes in these conditions. Overall this specialist clinic achieves favourable maternal and foetal outcomes in this high-risk population.Disclosure T. David: None.R. Hum: None.Y. Lau: None.S. Thornber: None.L. Simcox: None.I. Bruce: None.C. Tower: None.P. Ho: None. (Source: Rheumatology)
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P095 The impact of COVID-19 lockdown on clinical care, self-management, and mental health in patients with inflammatory arthritis
Conclusion Most patients (87%) had at least one area of clinical care affected by the lockdown. These changes in IA clinical care were associated with worse disease outcomes across all measures and greater emotional distress. In self-management, reduced physical activity was associated with worse outcomes i n all physical and mental health measures. P095 Table 1:Mean VAS (0-100) scores and percent changesPGAMarch April June/JulyMean (SD) 44.51 (23.70) 53.18 (24.67) 57.69 (25.29)Better Same WorsePercent 7.9936.6855.33[95% CI] [5.33-11.41][31.54-42.07][49.85-60.71]PainMarch April June/July42.60 (25.60) 51.11 (26.01) 56...
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P094 Incidence of clinically diagnosed Paget’s disease of bone: evidence of a continuing decline
Conclusion The incidence of clinically diagnosed Paget’s disease has continued to decrease since 1999. The reason for the decline remains unknown, though the rapidity of change points to an alteration in one or more environmental determinants.Disclosure M.J. Cook: None.S.R. Pye: None.W.G. Dixon: None.T.W. O'Neill: None. (Source: Rheumatology)
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P093 Sleep characteristics and frailty in men: the influence of testosterone
Conclusion Frailty is associated with impaired sleep quality and also sleep duration. The mechanism is unknown though cannot be explained by testosterone level.Disclosure S.D. Sharma: None.M.J. Cook: None.D. Vanderschueren: None.L. Antoniou: None.E. Gielen: None.F.C. Wu: None.T.W. O ’Neill: None. (Source: Rheumatology)
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P092 NICE biologics pathways for inflammatory arthritis exhibit regional variability due to modification by CCG’s: results from a national survey of pathways in England
Conclusion There is wide regional variation in the interpretation of NICE guidance by CCG’s resulting in many different local pathways depending on geography. Approximately 50% of pathways restricted biologics prescribing by mandating the type and sequence of biologics used, potentially compromising patie nt care and delaying treatment by requiring an IFR for a NICE approved biologic. Moreover, pathways varied as to which biologics could be used at any point of management by region as well. As exemplars of good practice, approximately 50% of CCG’s had no cap, allowing clinical freedom to prescribe the most appropriat...
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P091 Can use of high cost drugs for rare rheumatic diseases be reliably identified within routinely collected NHS data? Results from a pilot study of rituximab use in vasculitis using data from the National Disease Registration Service (NDRS) and the Registration of Complex Rare Diseases - Exemplars i n Rheumatology (RECORDER) project
Conclusion This pilot study demonstrates how the use of novel algorithms within the NDRS RECORDER project can enable the identification and registration of people with AAV and their high-cost treatment at whole-population level. Further work is now underway to study this national cohort, and to apply this m ethodology to other rare autoimmune diseases and high cost drugs.Disclosure M. Chakravorty: None.F. Pearce: Grants/research support; Recipient of research grant from Vifor Phama. Vifor Pharma had no influence on the design, interpretation or reporting of this work.M. Rutter: None.P. Lanyon: Grants/research support; ...
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P059 Wellbeing and shielding of patients with rheumatic disease on biologic therapy during the early COVID-19 pandemic: a single centre experience
Conclusion This study gives initial insights into the behaviours and concerns of patients with autoimmune and inflammatory disease on biologic therapy during the first wave of COVID-19 in the UK. Wellbeing and disease management have considerably suffered for many individuals. Further understanding patient experience may help guide restructuring of rheumatology services in next phase of the UK pandemic.Disclosure L.M. Carter: None.H. Irvine: None.A. D ’Cunha Kamath: None.A. Sahni: None.P. Hanna: None.N. Rahimi: None.K. Bhamra: None. (Source: Rheumatology)
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P058 Persistence of neutrophil abnormalities in COVID-19 convalescence
Conclusion Circulating neutrophils in acute COVID-19 have an altered phenotype and comprise immature and activated cells. This altered phenotype persisted in convalescence and may contribute to the persistence of symptoms and an increased susceptibility to subsequent infections. Future work will aim to inve stigate the functional implications of these findings.Disclosure T.O. Williams: None.V. K ästele: None.E.R. Mann: None.S.B. Knight: None.M. Menon: None.C. Jagger: None.S. Khan: None.J.E. Konkel: None.T.N. Shaw: None.M. Rattray: Consultancies; M.R. has a paid consultancy with AstraZeneca.L. Pearmain: None.A. Horsley...
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P057 What is the course of SARS-CoV-2 infection in people with autoimmune conditions on immunomodulators in comparison to people without autoimmune disease?
Conclusion People with and without autoimmune disease presented with similar symptoms of COVID-19. In our sample, subjects with autoimmune disease were less likely to be hospitalised or require respiratory support. Serology revealed no difference in antibody titres against SARS-CoV-2 in participants with an d without autoimmune disease. P057 Table 1:A comparison of the clinical features of COVID-19 in patients with and without autoimmune diseaseParticipants with autoimmune disease (n = 26)Participants without autoimmune disease (n = 26)Average age5855Male to female ratio10:1610:16EthnicityWhite 50%Black 23%Asian 27%Whi...
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P056 Recurrent ACE-inhibitor induced angioedema in a patient with long COVID-19 syndrome
Conclusion Bradykinin affects vascular permeability and results in vasodilatation, when patients take an ACE inhibitor there is a slower rate of bradykinin degradation and therefore this accumulation results in ACE inhibitor induced angioedema. SARS-CoV-2 binds to the ACE2 receptors. ACE2 is thought to coun terbalance ACE in the renin-angiotensin system, it is theorised that the potential downregulation of ACE2 by the presence of bound SARS-CoV-2 may therefore potentiate angioedema in susceptible individuals. At present we cannot confirm this proposed relationship and global current consensus supports the ongoing use of ...
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P042 A rare case of constrictive pericarditis with co-existing positive COVID-19: probable autoimmune or immunoglobulin related disease
Conclusion We report a case of constrictive pericarditis with COVID-19, although this remained a differential among the co-existed immunoglobulin and autoimmune syndrome. Appropriate imaging, biomarkers and histology investigations need to be considered for rapid evaluation and escalation of treatment. Card iac manifestations are an important feature of COVID- 19. Further research is required to guide the management plans for similar cases.Disclosure Z. Alkutobi: None.G. Ansari: None.A. Nandagudi: None. (Source: Rheumatology)
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P041 Alemtuzumab-related haemophagocytic lymphohistiocytosis: negotiating the cytokine storm
Conclusion HLH is an under-recognised complication of alemtuzumab therapy. Severe HLH requires both cytokine storm-directed treatment and identification/treatment of the trigger. Here, HLH was refractory to first line therapy (steroids and IVIG) and required immune modulation. The combination of alemtuzumab -induced immune dysregulation and sepsis were likely triggers, rather than Gadolinium. Supportive regional and national MDT input were required to guide therapy, especially as the patient wished to avoid etoposide (a standard refractory-HLH therapy) to preserve fertility. MDT working enabled early d ischarge with clos...
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P040 An unusual case of giant cell arteritis
Conclusion GCA is an uncommon diagnosis in younger and non-Caucasian patients. Thorough investigation through ultrasound and biopsy helped increase our diagnostic confidence in this unusual case. Rheumatologists must be alert to atypical presentations in order to deliver prompt and potentially sight-saving treatment.Disclosure J. Ellis: None.K. Austin: None.S. Emerson: None. (Source: Rheumatology)
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
P039 Muscle wasting & amp; weakness: a rare presentation of sarcoidosis
Conclusion Symptomatic myopathy is present in only 0.5-2.5% of sarcoidosis patients. This unique case highlights the heterogeneity of this disease and the vital role different diagnostic modalities play in achieving the correct diagnosis. It is also pertinent that the lymphadenopathy, found incidentally via imaging, led to the diagnosis. Although notoriously a diagnosis of exclusion, this case emphasises the importance of considering sarcoidosis even in the absence of respiratory symptoms, a raised ACE or hypercalcaemia.Disclosure C. Tomlinson: None.A. Khan: None.D. Mukerjee: None.N. Bhadauria: None. (Source: Rheumatology)
Source: Rheumatology - April 26, 2021 Category: Rheumatology Source Type: research
