Postprandial endothelial dysfunction and CIMT after oral fat challenge in patients with type 2 diabetes mellitus with and without macrovascular disease - A preliminary study

BACKGROUND

Very few studies have reported on association of postprandial lipids and endothelial dysfunction among patients with diabetes. Whether endothelial dysfunction particularly postprandial FMD is worse in patients with T2DM with macrovascular disease compared to those without and whether this difference is related to postprandial hypertriglyceridemia (PPHTg) is unclear. Therefore, present study was aimed to assess the relationship between PPHTg and endothelial function in patients with T2DM with and without macrovascular disease.

METHOD

Endothelial dysfunction by FMD and CIMT were compared in patients with T2DM with and without macrovascular disease (n = 13 each group) and 13 age, sex and BMI matched healthy individuals after an oral fat challenge.

RESULTS

There was significant postprandial deterioration of FMD 4-hr after fat challenge in patients with diabetes (P < 0.001) as well as healthy individuals (P = 0.004). Patients with diabetes with macrovascular disease had significantly lower fasting (5.7 ± 6.1% vs. 22.7 ± 10.0% and vs. 24.7 ± 5.3%) as well as postprandial (4-hr) (3.1 ± 5.0% vs. 15.3 ± 8.1% and vs. 15.4 ± 5.7%) FMD compared to other two groups. Fasting, postprandial as well as change in FMD and CIMT in patients with diabetes correlated significantly with fasting as well as postprandial triglycerides with stronger correlation in those with macrovascular disease.

CONCLUSION

Study found significant endothelial dysfunction by FMD that shows substantial further deterioration postprandially following high fat meal in patients with diabetes with macrovascular disease compared to patients with diabetes without macrovascular disease and healthy individuals. Study also indicates that PPHTg is a contributor to endothelial dysfunction. However, more studies are required to corroborate these findings.

952 In-Patient Trauma Surgery in COVID-19 Positive Patients Carries A Significantly Higher Mortality Risk When Compared to In-Patient Covid-19 Negative Patients and Day Case Trauma Patients

Introduction

Covid-19 caused many service changes, yet Trauma surgery continued throughout. We compare mortality rates from In-Patient (IP) and Day Case (DC) trauma patients and compare the mortality rates of patients who tested positive or negative for Covid-19.

Method

We reviewed all trauma admissions that underwent surgical intervention in both our IP and DC services during 31 days from March 23^rd 2020. We recorded their sex, age, operation, Covid-19 symptoms, Covid-19 test results and mortality. The findings were compared between the groups.

Results

In total 127 patients underwent surgery (66 IP; 61 DC). There were 6 deaths (9.1%) within the IP group and 0 deaths in the DC group (p = 0.006). In the IP group 8 patients (12.1%) tested positive for Covid-19 of which 4 died (50%) compared to the remaining 58 patients (87.9%) of which 2 (3.4%) died (p < 0.001). A higher mortality rate was observed in patients with symptoms but a negative Covid-19 test (6.7%) than patients in whom a test was never indicated (2.3%).

Conclusion

Covid-19 positive patients requiring in-patient admission for trauma surgery have a significantly higher mortality rate than both in-patient admissions that were Covid-19 negative or asymptomatic and patients that were treated with Day Case Trauma surgery.

866 A Lateral Approach Is More Likely to Be Successful Than A Posterior Approach for An Injection to Reach the Subacromial Space

Background

Subacromial injections are common for diagnosis and therapy of shoulder impingement secondary to subacromial bursitis. We evaluated the likelihood of a successful subacromial injection from both the posterior and lateral injection sites.

Method

We reviewed 100 MRI scans of the shoulder and recorded measurements in both the sagittal (representative of posterior injection) and coronal (representative of lateral injection) orientations. We compared these to the lengths of standard needles.

Multiple measurements were taken:

Results

Measuring along the angle of the acromion demonstrated shorter mean distances from the lateral injection site. The distance from skin to mid-point of the acromion) provided mean values of 51.4mm for posterior and 40.1mm for lateral. A standard 40mm (green) needle would reach the midpoint of the acromion in 58% of lateral measurements and 23% from posterior.

Conclusions

Injections are more likely to enter the subacromial space from a lateral rather than a posterior entry point.

384 Use of A Dry Swab During ACL Hamstring Tendon Graft Preparation May Lead to Decreased Graft Diameter at Implantation with Subsequent Rebound in Graft Diameter When Exposed to Haemarthrosis – A Porcine Tendon Study

Introduction

ACL reconstruction surgery commonly utilises a hamstring tendon graft. Grafts are normally covered with a wet swab prior to implantation. The aim of this study was to determine the variance in graft diameter when comparing the traditional wet swab to a dry swab.

Method

Flexor tendons from a selection of fresh pig trotters were isolated and prepared with a standard ACL graft preparation technique. Half of the grafts were covered with a wet swab; the other half were covered with a dry swab. Graft diameters were measured at 10-minute intervals. After 30 minutes the grafts were submerged in Hartmann’s solution to simulate the post-operative haemarthrosis, diameters were checked again after 1 hour in the solution.

Results

Use of a dry swab resulted in a 0.5mm greater reduction in diameter than the wet swab group. The dry swab group also showed an increase in diameter by 0.5mm when soaked in Hartmann’s solution, this was not seen in the wet swab group.

Conclusions

Using a dry swab produces a smaller graft diameter, this would allow smaller bone tunnels, retaining bone stock. The subsequent rebound in diameter when in solution may increase the press fit mechanism and facilitate improved integration into the bone tunnel.

890 Predictive Factors for Mortality Following Trauma & Orthopaedic Surgery in The Covid-19 Pandemic. The Manchester Equation

Introduction

Covid-19 caused many service changes including limitations on operations due to potential increased mortality risk to patients. We report our findings from Trauma & Orthopaedic (T&O) surgical mortality through this period and the effectiveness of using a scoring system (The Manchester Equation) to predict likelihood of mortality.

Method

We reviewed all T&O admissions that underwent surgical intervention during the height of the pandemic. We recorded numerous factors for each patient including mortality and Covid status. From this we created a scoring system which is the product of Covid status, Anaesthetic type, Medical co-morbidities and other medical factors and ASA Score. We then analysed the findings to determine whether the score could be predictive of mortality rate.

Results

Of 123 patients undergoing surgery 6 deaths were observed (mean score of 51.3) compared to 117 patients surviving (mean score 31.9), p = 0.001. A score of less than 32 carried a 0% chance of death whereas a score of 32 or more resulted in a 14.6% mortality rate (p = 0.01).

Conclusion

The Manchester Equation can be used to help predict the mortality rate of T&O surgery in the presence of Covid-19 and may be useful for clinical decision making and consent purposes.

Anaemia in patients with type 2 diabetes mellitus without nephropathy is related to iron deficiency

BACKGROUND AND AIMS

Iron deficiency anaemia, although well reported in diabetic nephropathy, has not been well studied in type 2 diabetes patients in the absence of nephropathy. We studied the prevalence of anaemia and iron deficiency in type 2 diabetes patients without nephropathy.

MATERIAL AND METHODS

A total of 89 patients were selected for this study. 24 h urine protein less than 500 mg was used as the criteria to rule out diabetic nephropathy. Complete hemogram, iron profile and high sensitivity C reactive protein (hs CRP) levels were performed in each patient.Functional iron deficiency (FID) was defined as serum ferritin more than 100 μg/l with serum transferrin less than 20% and total iron deficiency state was defined as serum ferritin less than 100 μg/l.

RESULTS

Fifteen patients (16.8%)had anaemia out of which 13 had total iron deficiency and one each had functional iron deficiency and normal iron status respectively. Assessment of the iron status overall showed that 49 patients had TID (55.05%), 16 had FID (17.9%)and 24 (27.05%) had normal iron status. The hs-CRP was significantly higher in those with iron deficiency.

CONCLUSIONS

The present study found a high prevalence of iron deficiency anaemia in type 2 diabetic patients even in the absence of nephropathy. Most of the diabetic subjects also displayed an iron deficiency state the cause of which needs further investigation.

SAT0319 SUBCLINICAL ATHEROSCLEROSIS IN INDIAN PATIENTS WITH SCLERODERMA – CLINICAL AND SEROLOGICAL ASSOCIATIONS

Background:

Scleroderma has been associated with increased risk of cardiovascular events, however,studies on this from India are sparse.We evaluated clinical and serological factors associated with subclinical atherosclerosis in Indian patients with scleroderma, in a cross-sectional design.

Objectives:

To compare carotid intima-medial thickness (CIMT, mean value of both carotids) as a measure of subclinical atherosclerosis (SCA) between patients with scleroderma (n=61) fulfilling 2013 ACR/EULAR criteria, and healthy controls (n=41).

- To compare clinical (body mass index – BMI, waist-hip ratio – WHR, fasting lipid profile) and serological factors (microparticles, endothelial microparticles, inflammatory cytokines associated with increased cardiovascular risk) between patients with scleroderma and healthy controls.

- To identify factors associated with SCA in scleroderma patients.

Methods:

Subclinical atherosclerosis(SCA) was defined by presence of carotid plaques, or increased CIMT >2 standard deviations compared with Indian reference standards for age and sex. Total microparticles (TMP) were measured of plasma after ultracentrifugation as per previously described protocol using microbeads of 3 μm size (TMP were of size 0.1-1 μm); of these, microparticles positive for CD31 and CD142 were endothelial microparticles (EMP). Serum cytokines (IL-1, IL-6, TNF-α, IL-17) were measured by ELISA using manufacturer instructions. Linear regression was used to identify the determinants of CIMT in scleroderma. Binomial logistic regression was used to identify factors associated with subclinical athersclerosis in scleroderma.

VariablePatients with scleroderma (n=61)Healthy controls (n=41)p valueAge37.8 ± 11.9235.37 ± 6.690.2375Gender (M:F)11:506:350.6516Diabetes/Hypertension/Tobacco use1/2/00/0/0NSBody mass index (kg/m2)20.11 ± 3.8224.38 ± 4.45<0.0001Waist-hip ratio0.86 ± 0.110.89 ± 0.070.1251Total cholesterol (mg/dL)142.5 ± 30.7147.3 ± 39.50.4948Triglycerides (mg/dL)99.4 ± 37121.4 ± 460.0087HDL cholesterol (mg/dL)46.9 ± 4.946.1 ± 4.20.4029LDL cholesterol (mg/dL)93.6 ± 10.593.3 ± 7.50.8520VLDL cholesterol (mg/dL)19.9 ± 7.424.7 ± 9.70.0057Carotid intima-medial thickness (mm)0.68 ± 0.100.53 ± 0.03<0.0001Total microparticles (per±L)12913 ± 24936272 ± 1533<0.0001Endothelial microparticles (per±L)2623 ± 1032829 ± 439.5<0.0001Serum IL-1±(pg/mL)38.19 ± 13.4631.38 ± 18.290.0326IL-6 (pg/mL)176.6 ± 85.74128.9 ± 53.610.0020IL-17 (pg/mL)56.3 ± 20.4553.89 ± 20.510.5611TNF±(pg/mL)49.65 ± 26.7142.09 ± 30.410.1879

Results:

Despite lower BMI, triglycerides and VLDL cholesterol, CIMT was significantly higher in patients with scleroderma. Patients with scleroderma had significantly higher total microparticles and endothelial microparticles in plasma, and serum IL-1± and IL-6 (Table 1). On multivariable regression, age was the only significant determinant of CIMT. 28 (45.9%) patients had SCA; 13 (21.3%) had carotid plaques. Patients with SCA had higher proportion of males (9/28 in those with SCA vs 2/33 in those without SCA). Binomial logistic regression did not identify any other significant predictors of SCA.

Table 1

Comparison between patients with scleroderma and healthy controls

Serum IL-1± (pg/mL)38.19 ± 13.4631.38 ± 18.290.0326IL-6 (pg/mL)176.6 ± 85.74128.9 ± 53.610.0020IL-17 (pg/mL)56.3 ± 20.4553.89 ± 20.510.5611TNF± (pg/mL)49.65 ± 26.7142.09 ± 30.410.1879

Conclusion:

Patients with scleroderma had significant burden of subclinical atherosclerosis, which could not be explained by traditional or novel cardiovascular risk factors.

References:

[1]Psarras A, Soulaidopoulos S, Garyfallos A, Kitas G, Dimitroulas T. A critical view on cardiovascular risk in systemic sclerosis. Rheumatol Int. 2017 Jan; 37(1):85-95.

[2]Jung C, Drummer K, Oelzner P, Figulla HR, Boettcher J, Franz M, et al. The association between endothelial microparticles and inflammation in patients with systemic sclerosis and Raynaud’s phenomenon as detected by functional imaging. Clin HemorheolMicrocirc. 2015; 61(3):549-557.

Acknowledgments:

Supported by IRA(Indian Rheumatology Association) Research Grant to DP Misra.

Disclosure of Interests:

None declared

AB1169 RHEUMATOLOGY PATIENT PERCEPTION OF CARDIOVASCULAR RISKS: A SURVEY AT A TEACHING HOSPITAL

Background:

It is well known that individuals with rheumatological conditions are at an increased risk for developing cardiovascular diseases (CVS) and they are the most common cause of mortality. However, there is still lack of awareness about the CVS risk among Rheumatology patients. We carried out a patient survey to assess their awareness and perception of CVS risk associated with their condition. We also assessed if the health professionals attending to these patients gave adequate education to the patients regarding the CVS risk.

Objectives:

To study awareness about CVS risks among rheumatology patients

Methods:

This was a prospective cross sectional survey where in multiple-choice questionnaires were distributed to consecutive patients attending rheumatology clinic. The questionnaire contained 18 questions including demographics, diagnosis, medications and their awareness of cardiovascular risks associated with their underlying rheumatic conditions. We also explored as patient attempted any Primary preventive measures for reducing the CVS risk.

Results:

We collected data of 57 patients with 47% of patients were above 60 years of age with Female: Male ratio of 3:1. Rheumatoid arthritis was the most common diagnosis (60%) with others including AS (22%), SLE(5%). 32% of patients had been suffering from inflammatory disorder for >10 years and 44% believed their disease was still not fully controlled. 37% had family history of heart diseases.

More than half of the patients (56%) were unaware of cardiovascular risks associated with their condition and 65% overall reported that they were not personally informed about these risks by the treating health professionals. When we analysed the newly diagnosed patients (<5years) 64% were unaware about the CVS risks which is higher compared to patients with diagnosis of >5 years. We tried to explore any ethnic differences, however the number is too small to compare. We noted that around 60% of white British with rheumatological diagnosis were not aware of CVS risk in our group. When further asked about the primary preventive measures, only 23% engage in exercise, 21% have made diet changes, 12% take aspirin, 16% have quit smoking and only 5% quit alcohol.

Conclusion:

This was a small pilot study to look at the patient awareness of CVS risks associated with rheumatological conditions. Clearly there is lack of awareness among patients about CVS risks. Furthermore, most of the patients reported they were not educated about the risks from the health professionals. Majority do not engage in any kind of primary preventive measure for heart diseases. It is crucial that the health professionals actively educate patients regarding the CVS risks and the various methods through which these can be prevented. We believe patient-targeted educational programmes and behavioural interventions can be incorporated for holistic patient management.

References:

[1]John, Holly et al. Inflammatory arthritis as a novel risk factor for cardiovascular disease European Journal of Internal Medicine, Volume 23, Issue 7, 575 – 579

Disclosure of Interests:

Nibha Jain: None declared, Anukripa Manivannan: None declared, Aswin Mahesh: None declared, Arumugam Moorthy Speakers bureau: Abbvie, Novartis,UCB,MSD

AB0694 IS THERE ANY HETEROGENEITY OF SPONDYLOARTHRITIS DISEASE MANIFESTATIONS BETWEEN TWO ETHNIC SUBGROUPS?:A MULTICENTRE INTERNATIONAL COMPARATIVE STUDY BETWEEN INDIA AND UK

Background:

Pathogenesis of Spondyloarthritis (SpA) multifactorial and remains unclear. Various hypothesis have been postulated genetics, HLAB27, IL17, Gut microbiome and Biomechanical stress. Many of these factors can be attributed to ethnic background and environment. HLAB27 accounts for 20–25 % of total heritability and 40% of genetic risk while <10% of HLA-B27 carriers in general population develop SpA1. Higher faecal calprotectin levels in SpA compared to control point towards microscopic gut inflammation2. Thus dietary habits and geographical factors can influence pathogenesis of disease. We looked in clinical manifestations of SpA patients of two very different ethnic background Caucasians and Indians from UK and India to shed more light in understanding the disease

Objectives:

To study any differences in the clinical manifestations of SpA patients of two ethnic groups

To compare outcome measure (BASDAI and ASDAS) between Caucasians and Indians

To study the difference in disease activity between Indian patients and British Asians

Methods:

Multicentre observation study where data of SpA patients attending rheumatology clinics from two major teaching hospitals collected. In India data collected from Sheth VS Hospital and NHL Medical College, Gujarat and in United Kingdom from University Hospitals Leicester, NHS trust. Leicester has a multi-ethnic demography wherein almost 30%3of population is of south Asian ethnicity, making this study unique.

Baseline demographic and clinical data was collected. Clinical and outcome measures compared to see any heterogeneity in disease manifestations. SPSS software used

Results:

Total 200 patients analysed with 148 Indians and 52 Caucasians. The Indian cohort was subdivided into British Asians (second generation Indians) and those form Gujarat, India

We found Indian subgroups were younger with shorter disease duration. Comparison in Table 1

Table 1.CaucasianIndianPAge45.9±1231±12<0.001M:F34:193:10.74TDI years9.6 ±5.93.5± 5.2<0.001BASDAI4.05±2.173.1±1.70.002ASDAS2±0.82.4±1.20.02CRP12.8±23.624±12<0.001HLAB2767%26%<0.001Uveitis25%12%0.02IBP78%90%0.03Enthesitis21%60%<0.001Peripheral Arthritis19%36%0.02Dactylitis2%10%0.07Psoriasis10%20%0.1IBD2%5%0.35Comparing British Asians to Indians, Gujarat no significant difference in clinical parameters. (Table 2)British AsianIndianPBASDAI5.16±2.763.1±1.70.006ASDAS2.53±1.32.4±1.20.74CRP15.2 ±15.424±12<0.001

Conclusion:

We found Caucasians had more HLAB27 positivity and extra-articular manifestation of uveitis however the Indian population has more enthesitis and peripheral arthritis. Enthesitis is initiated during a mechano-sensation and the cultural difference including style of footwear could probably be one of the factors explaining our findings inflammatory back pain has been reported to be higher in Indians compared to Caucasians which could be due to life style

The fact that ASDAS CRP behaves similarly in Indian patients across the two countries and is more when compared to Caucasians might point towards overall higher burden of disease in Indian population

To our knowledge this is a first study comparing clinical manifestations of SpA between Indians and Caucasians

References:

[1]Brown MAet al. Susceptibility to ankylosing spondylitis in twins: the role of genes, HLAand environment.Arthritis Rheum 1997;40: 1823–8

[2]J Simione, et al. Fecal Calprotectin, GutInflammation and SpA Archives of Medical Research. 2019;50:41-46

[3]http://www.ons.gov.uk/census

Disclosure of Interests:

Nibha Jain: None declared, Sapan Pandya: None declared, Puja Srivastava: None declared, Prashant Chotalia: None declared, Arumugam Moorthy Speakers bureau: Abbvie, Novartis,UCB,MSD

AB0953 CANNABINOIDS: FRIEND OR FOE OR A BYSTANDER?

Background:

Cannabinoids has recently gained popularity for use in chronic pain. There is a lot of inquisitiveness among our patients wherein health care professionals are asked about its efficacy, side effects and sometimes even ask for a prescription! As there is paucity of data and research about its use in rheumatology, patient reported outcome(PROM) can guide ahead in expanding our knowledge and experience.

Objectives:

To study usage of cannabinoids by rheumatology patients

To study awareness among primary physicians regarding Cannabinoid usage in rheumatology.

Methods:

Cross sectional survey with two arms. Arm 1 Information from patients attending tertiary rheumatology clinic,including perception regarding the use of Cannabinoids.

Arm 2 consisted of collecting data via web-based survey with20-question from 100 GPs of Leicestershire. Questions on demographics, perspectives on and knowledge of cannabinoid use. Statistical analysis SPSS software.

Results:

Arm1 Total 102 rheumatology patients with 60%were females and 45% secondary education. 48% were unemployed. 75% Caucasians, 18% Asians. RA most common diagnosis followed by OA and FMS. 40 % depression and anxiety in addition to Rheumatic disease. 94% reported ongoing pain with 6-8 on a VAS scale. 79% were satisfied with their current therapy. 65% had heard about complementary medicine and 15% reported using cannabinoids.

Most common form Cannabinoids oil 60% followed by smoking 20%. 56% reported using >3 months and majority 72% use daily. Median age 55 years. 88% users Caucasians. Mean disease duration 6.25 years among users indicates chronicity of disease has a direct proportion in usage. All users had ongoing pain of 7 on VAS. 87% believed it helps them managing pain effectively with a pain free state. On an average spends between 50-100 pounds per week. More than half believe cannabinoids should be available as a prescription drug in NHS and 30% interested to know more about it.

In Arm 2 consisting of Primary care physicians, response rate 50%. Average clinical experience 5 years. Only 20% heard about usage of complementary medicine by rheumatology patient. Most replied that 10% of their patients use Cannabinoids for pain management. Most did not believe use of cannabinoids benefited the patients. Only 4% recommend its usage. 25% think it should be available as prescription. 40% experienced patients asking about cannabinoids during appointment. 88% of respondents did not know much about cannabinoid usage in rheumatology and have never prescribed it in their practice.

Conclusion:

Cannabinoids widely used by the rheumatology patients with PROM favouring its efficacy for control of chronic pain. Preclinical data suggest that cannabinoids might have a therapeutic potential RA1, OA, FMS2. Clinical data regarding cannabinoid treatment for rheumatic diseases are scarce, therefore, recommendations concerning cannabinoid treatment cannot be made. All patients who reported using it suffered from moderate to severe chronic pain. Thus main indication of usage was pain rather than recreational purpose. Although a small survey it clearly highlights lack of knowledge among primary physicians. These results emphasise the need for further research regarding the benefits and risks of cannabinoids in rheumatology.

References:

[1]RichardsonD. etal Characterisation ofthe cannabinoid receptor system in synovial tissue andfluid in patients with OA and RA Arthritis Res.Ther. 10, R43 (2008).

[2]Walitt, B etal Cannabinoids for fibromyalgia. Cochrane DatabaseSyst. Rev. 7, CD011694 (2016).

Disclosure of Interests:

Nibha Jain: None declared, Neelima Reddy: None declared, Arumugam Moorthy Speakers bureau: Abbvie, Novartis,UCB,MSD

C00006 PSYCHOLOGICAL IMPACT OF COVID 19 PANDEMIC ON PATIENTS WITH RHEUMATOLOGICAL DISORDERS - A WEB BASED CROSS-SECTIONAL MULTICENTRE SURVEY

Background:

The COVID-19 pandemic has resulted in uncertainty and negative psychological outcomes for patients with autoimmune rheumatic diseases for several reasons.1The anxiety is due to “underlying conditions” that are expected to increase the risk of infection and / or severe complications. Patients with rheumatological disorders fall into this group as they are believed to be immunosuppressed due to disease or the treatment. It is essential to understand the level of anxiety among the rheumatic disease patients at the current situation of COVID-19.

Objectives:

To study difference in Anxiety score (Mean/Avg Score) among following groups-underlying rheumatic disease, age, gender, marital status, educational status, employment status, medications, those who were on steroids/not, those who are Biologicals / Not.

Methods:

A web-based cross-sectional multi-centre survey was done across 5 rheumatology centres in India. The study duration was between 9th May and 16th May 2020.The questionnaire included consent, demographic details, medication history, opinion about tele rheumatology services and anxiety score measured by Beck Anxiety Inventory (BAI)2.

Results:

The survey was sent to 2987 patients, there were 933 responses and 581 were complete (Male =175). Complete responses were considered for data analysis. Most respondents were less than 50 years of age (70.6%). Rheumatoid arthritis (RA) was the most frequent (50.6%) diagnosis followed by other conditions. Most of the patients (43%) were on combination DMARD therapy, 12.7% of patients were on biological drugs and 23.9% of patients were on glucocorticoids. Statistically significant higher anxiety scores were observed in females, patients suffering from fibromyalgia, patients on glucocorticoids and biological agents. There was no difference in the anxiety scores with regard to age, educational status, and employment status.Difficulty in meeting rheumatologists and getting medications was expressed by 327 (56.2%) and 73 (29.7%) respondents respectively. Majority of respondents (86.6 %) agreed/strongly agreed regarding use of telemedicine to access health care during the crisis.

Conclusion:

The findings of the study revealed that anxiety is a major concern in patients with autoimmune rheumatic diseases. Fibromyalgia patients and those who were on glucocorticoids and biological drugs were found to have more anxiety levels compared to other groups of patients. In such periods of public health crises, telemedicine is a great tool for patients to access healthcare without fear of going to hospital. There is a need to intensify the awareness and address the mental health issues of rheumatology patients during this COVID-19 pandemic.

References:

[1]Pope, J.E. What Does the COVID-19 Pandemic Mean for Rheumatology Patients?. Curr Treat Options in Rheum (2020).https://doi.org/10.1007/s40674-020-00145-y.

[2]Oh H, Park K, Yoon S, Kim Y, Lee SH, Choi YY, et al. Clinical utility of beck anxiety inventory in clinical and nonclinical Korean samples. Front Psychiatry.2018;9:666.https://doi.org/10.3389/fpsyt.2018.00666

Disclosure of Interests:

None declared

AB1030 IgG4-RELATED DISEASE: A RETROSPECTIVE CLINICAL CASE SERIES FROM A TERTIARY CARE CENTRE IN INDIA

Background:

IgG4-related disease (IgG4-RD) is an often unrecognized, rare fibro-inflammatory condition that can involve various organ systems.

Objectives:

The aim of this study was to identify the different clinical patterns of this disease in a single centre in North India.

Methods:

70 patients were diagnosed on the basis of published diagnostic criteria for IgG4-RD. Patients’ presenting complaints, epidemiological profiles, laboratory, radiological and histological findings along with the treatment and outcomes were collated and analyzed from 2011 – 2019.

Results:

In a total of 70 patients who were diagnosed with the disease, the ratio of female to male ratio was 1:1. The mean age of patients was 41.4 years. Involvement of orbits and peri-orbital tissues was highest (52.9%) due to large number of referrals from ophthalmology services. 13% of patients had multiple organ involvement. Patients with involvement of retroperitoneal tissues and lymph nodes were 8.5% and 5.7%, respectively. Increased serum IgG4 levels were found in 74.3% of the patients. Histopathological examinations of the affected organs were performed in 44 (62.85%) patients and a diagnosis of possible (38.57), probable (32.85%) and definite (28.57%) IgG4-RD was made. Majority of the patients (94.3%) required immunosuppressive medications along with corticosteroids. Azathioprine was the most commonly used (72.8%) immunosuppressive medication. Rituximab was used in17.1% of the patients, of whom one had multisystem involvement.

Conclusion:

This study depicts the most common patterns of organ involvement along with the epidemiological, laboratory, histological, radiological data and response to treatment, in IgG4-RD, with a definite ophthalmology referral bias, in a tertiary care centre in North India.

References:

[1]Stone JH, Zen Y, Deshpande V. IgG4-related disease. N Engl J Med 2012; 366(6):539-51.

[2]Khosroshahi A, CarruthersMN, Deshpande V, Unizony S, Bloch DB, Stone JH. Rituximab for the treatment of IgG4-related disease: lessons from 10 consecutive patients. Medicine 2012; 91(1):57-66.

Table 1.

Clinical and laboratory characteristics

CharacteristicsNumber of patients (N=70)Age (years)41.4Age group in years, n (%) >5024 (34.28) <5046 (65.71)Sex, n (%) Male36 (51.42) Female34 (47.22) ESR (mm/hr)24.37 CRP (mg/dL)12.31 Serum IgG (mg/dL)1214.2 Serum IgE (IU/L)587.2Type of IgG4 related disease, n (%) Definite20 (28.57) Probable23 (32.85) Possible27 (38.57)

Data represented as mean, unless otherwise specified.

CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; Ig, immunoglobulin.

Table 2.

Distribution of patients according to organ involvement.

Organ involvementNumber (%)Orbital and periorbital37(52.9)Retroperitoneum6 (8.5)Laryngotracheal tissue4 (5.7)Aorta and branches4 (5.7)Lymph nodes3(4.2)Paranasal sinus2 (2.8)Paravertebral tissue2 (2.8)Pancreas2 (2.8)Lung and bronchus2 (2.8)Eye (Scleritis)1 (1.4)Prevesical Mass1 (1.4)Ear polyp1 (1.4)Small Bowel1 (1.4)Primary sclerosing cholangitis1 (1.4)Musculoskeletal1(1.4)Submandibular gland1(1.4)Central nervous system1 (1.4)Multisystem involvement9 (12.86%)Figure 1.

Right eye proptosis

Figure 2.

CT abdomen showing hydronephrosis due to retroperitoneal fibrosis

Disclosure of Interests:

None declared

A phase 3 study evaluating the safety and efficacy of a pediatric dose of mometasone furoate with and without formoterol for persistent asthma

OBJECTIVES

Asthma affects over 6 million children in the United States alone. This study investigated the efficacy and long-term safety of mometasone furoate-formoterol (MF/F) and MF monotherapy in children with asthma.

MATERIALS AND METHODS

This phase 3, multicenter, randomized controlled trial evaluated metered-dose inhaler twice daily (BID) dosing with MF/F 100/10 µg or MF 100 µg in children, aged 5 to 11 years, with a history of asthma for greater than or equal to 6 months and confirmed bronchodilator reversibility, who were adequately controlled on inhaled corticosteroid/long-acting beta-agonist combination therapy for greater than or equal to 4 weeks. After a 2-week run-in on MF 100 µg BID, eligible patients received 24 weeks of double-blind treatment and were followed for safety up to 26 weeks. The primary efficacy endpoint was the change from baseline in AM postdose 60-minute AUC %predicted FEV1% across 12 weeks of treatment.

RESULTS

A total of 181 participants received at least one dose of MF/F (n = 91) or MF (n = 90). MF/F was superior to MF across the 12-week evaluation period, with a treatment advantage of 5.21 percentage points (P < .001). Superior onset of action with MF/F over MF was achieved as early as 5 minutes postdose on day 1. Overall, approximately 50% of participants experienced one or more treatment-emergent adverse events, with fewer occurring in the MF/F group.

CONCLUSIONS

In children 5 to 11 years of age with persistent asthma, the addition of F to MF was well tolerated and provided significant, rapid, and sustained improvement in lung function compared with MF alone.

Frequent Versus Infrequent Bathing in Pediatric Atopic Dermatitis: A Randomized Clinical Trial

BACKGROUND

Studies evaluating bathing frequency in pediatric atopic dermatitis (AD) are limited. Parents of children with AD often receive conflicting information, leading to frustration and confusion.

OBJECTIVE

To evaluate efficacy of twice-daily soaking baths, followed by immediate application of an occlusive moisturizer (ie, soak-and-seal [SS]), versus twice-weekly SS baths, in the acute management of pediatric AD.

METHODS

We conducted a randomized, single-blind, crossover-controlled trial comparing frequent versus infrequent SS baths, in children 6 months to 11 years of age with moderate-to-severe AD. Children were randomized 1:1 into 2 groups: group 1 underwent twice-weekly SS baths, for 10 minutes or less, over 2 weeks ("dry method" [DM]) followed by twice-daily SS baths, for 15 to 20 minutes, over 2 weeks ("wet method" [WM]). Group 2 did the inverse. Patients received the same moisturizer, cleanser, and low-potency topical corticosteroid (TCS). Primary outcome was AD severity evaluated using the SCORing Atopic Dermatitis (SCORAD) index. Caregiver assessment of AD severity (Atopic Dermatitis Quickscore [ADQ]), quality of life, Staphylococcal aureus colonization, skin hydration, moisturizer, and TCS usage were assessed.

RESULTS

Of the 63 children screened, 42 fulfilled inclusion criteria and were randomized. Forty (95%) completed the study. WM decreased SCORAD by 21.2 compared with DM (95% confidence interval [CI], 14.9-27.6; P < .0001). Secondary analysis showed a greater than 30% SCORAD improvement for WM versus DM (McNemar's χ² = 8.83, df = 1, P = .0030). SCORAD correlated with ADQ (r = 0.66), and ADQ also showed significant improvement with WM decreasing ADQ by 5.8 (95% CI, 1.8-9.7). No other secondary endpoints showed significance.

CONCLUSIONS

As an acute treatment intervention, WM is superior to DM at improving disease severity in moderate-to-severe pediatric AD.