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1. POS0028 DEFINING THE PREVALENCE OF UNMET NEED IN SLE: DATA FROM A LARGE MULTINATIONAL LONGITUDINAL SLE COHORT

Author

M. Nikpour, Fiona Goldblatt, Jiacai Cho, K.A. Gibson, Sean O'Neill, Zhuoli Zhang, Vera Golder, Yi-Hsing Chen, Rangi Kandane-Rathnayake, Sargunan Sockalingam, Yoshiya Tanaka, S-C Bae, Kristine P Ng, Shereen Oon, Laniyati Hamijoyo, Alberta Hoi, Tsutomu Takeuchi, Shue-Fen Luo, Yanjie Hao, Y. J. Jan Wu, Aisha Lateef, Leonid Zamora, Eric F Morand, Madelynn Chan, Zhanguo Li, N. Tugnet, C. S. Lau, Yuan An, Sandra V. Navarra, Sunil Kumar, Worawit Louthrenoo, Jun Kikuchi, B. Basnayake, Masayoshi Harigai, and Yasuhiro Katsumata

Subjects
medicine.medical_specialty, Validation study, business.industry, Immunology, Severe disease, Treatment goals, General Biochemistry, Genetics and Molecular Biology, Physician visit, Unmet needs, Rheumatology, Family medicine, Cohort, Active disease, Immunology and Allergy, Medicine, business, Bristol-Myers
Abstract

Background:The recent prospectively validated definition of the lupus low disease activity state (LLDAS) allows characterisation of patients not achieving a treatment goal, providing impetus for an analysis of unmet needs in SLE using formal definitions. Other recently described definitions of high disease burden include disease activity over time, high disease activity status (HDAS) episodes, and the combination of high disease activity, serological activity and glucocorticoid (GC) use (HDAS+SA+GC).Objectives:To determine the prevalence of formal categories of unmet need, and the association of these with adverse outcomes, in SLE.Methods:Data from a 13-country longitudinal SLE cohort (ACR/SLICC criteria) were collected between 2013 and 19 using standard templates. Unmet need was defined as (i) patients never attaining LLDAS defined as in Golder et al., 2019 [1], (ii) having persistently active disease (time adjusted mean SLEDAI-2K (AMS) > 4), (iii) ever exhibiting high disease activity status (HDAS; SLEDAI-2K ≥10[2]), or (iv) ever exhibiting all of SLEDAI≥10, serological activity, and glucocorticoid use (HDAS+SA+GC)[3]. Health-related quality of life (HRQoL) was assessed using SF36 (v2) surveys and damage accrual using SLE Damage Index (SDI).Results:3,384 SLE patients were followed for 30,313 visits over median [IQR] 2.4 [0.4, 4.3] years. 53% of all visits were not in LLDAS; 813 patients (24%) never achieved LLDAS during observation. Median AMS was 3.0 [1.4, 4.9] and 34% of patients had AMS > 4 throughout the study. 25% of patients had at least one episode of HDAS, representing 8% of visits. 702 patients (21%) had at least one episode of HDAS+SA+GC, representing 8% of visits. Each of never-LLDAS, AMS>4, ever-HDAS, and ever-HDAS+SA+GC were associated with significantly greater number of physician visits, higher mean glucocorticoid dose, lower HRQoL and higher mortality. 31%, 58% and 83% of never-LLDAS, AMS>4, and ever-HDAS patients respectively were also HDAS+SA+GC on at least one occasion.Conclusion:Data from a multinational longitudinal SLE cohort indicate that unmet need, defined by LLDAS-never, AMS>4, HDAS, or HDAS+SA+GC, is prevalent in SLE, and that these definitions are associated with poor outcomes.References:[1]Golder, V., et al., Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study. The Lancet Rheumatology, 2019. 1(2): p. e95-e102.[2]Koelmeyer, R., et al., High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus. Lupus Sci Med, 2020. 7(1).[3]van Vollenhoven, R.F., et al., Belimumab in the treatment of systemic lupus erythematosus: high disease activity predictors of response. Annals of the Rheumatic Diseases, 2012. 71(8): p. 1343-1349.Acknowledgements:The APLC acknowledges all the Data Collectors and Patients for their valuable contributions to research.Disclosure of Interests:Rangi Kandane-Rathnayake: None declared, Worawit Louthrenoo: None declared, Alberta Hoi Consultant of: Abbvie and GSK, Grant/research support from: AstraZeneca, GSK, BMS, Janssen, and Merck Serono, Vera Golder: None declared, Yi-Hsing Chen Speakers bureau: Pfizer, Novartis, Abbvie, Johnson & Johnson, BMS, Roche, Lilly, AstraZeneca, Sanofi, MSD, Guigai, Astellas, Inova Diagnostics, UCB, Agnitio Science Technology, United Biopharma, Thermo Fisher, Consultant of: Pfizer, Novartis, Abbvie, Johnson & Johnson, BMS, Roche, Lilly, AstraZeneca, Sanofi, MSD, Guigai, Astellas, Inova Diagnostics, UCB, Agnitio Science Technology, United Biopharma, Thermo Fisher, Gilead, Grant/research support from: Pfizer, Norvatis, BMS, Abbevie, Johnson & Johnson, Roche, Sanofi, Guigai, Roche, Boehringer Ingelheim, UCB, MSD, Astra-Zeneca, Astellas, Gilead, Shue Fen Luo: None declared, Yeong-Jian Jan Wu Speakers bureau: Pfizer, Lilly, Novartis, Abbvie, Aisha Lateef: None declared, Jiacai Cho: None declared, Laniyati Hamijoyo Speakers bureau: Pfizer, Novartis, Abbot, Chak Sing Lau Shareholder of: Pfizer, Sanofi, and Janssen, Sandra Navarra Speakers bureau: Pfizer, Johnson & Johnson, Novartis, Astellas, Grant/research support from: Astellas, Johnson & Johnson, Leonid Zamora: None declared, Zhanguo Li Speakers bureau: Eli, Lilly, Novartis, GSK, AbbVie, Paid instructor for: Pfizer, Roche, Johnson., Consultant of: Lilly, Pfizer, Grant/research support from: Pfizer, Yuan An: None declared, Sargunan Sockalingam Speakers bureau: Pfizer, Roche, Novartis, Grant/research support from: Roche and Novartis, Yasuhiro Katsumata Speakers bureau: Chugai Pharmaceutical Co., Ltd., Glaxo-Smithkline K.K., and Sanofi K.K., masayoshi harigai Speakers bureau: AbbVie Japan GK, Ayumi Pharmaceutical Co., Boehringer Ingelheim Japan, Inc.,Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GlaxoSmithKline K.K., Kissei Pharmaceutical Co., Ltd., Pfizer Japan Inc., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., Consultant of: AbbVie, Boehringer-ingelheim, Bristol Myers Squibb Co., Kissei Pharmaceutical Co.,Ltd. and Teijin Pharma., Grant/research support from: AbbVie Japan GK, Asahi Kasei Corp., Astellas Pharma Inc., Ayumi Pharmaceutical Co., Bristol Myers Squibb Co., Ltd., Chugai Pharmaceutical Co., Daiichi-Sankyo, Inc.,Eisai Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Kayaku Co., Ltd., Sekiui Medical, Shionogi & Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Teijin Pharma Ltd., Yanjie Hao: None declared, Zhuoli Zhang Speakers bureau: Norvatis, GSK, Pfizer, Jun Kikuchi: None declared, Tsutomu Takeuchi Speakers bureau: AbbVie AYUMI Pharmaceutical Corp. Bristol-Myers Squibb Chugai Pharmaceutical Co, Ltd. Daiichi Sankyo Co., Ltd. Eisai Co., Ltd. Eli Lilly Japan, Gilead Sciences, Inc. Mitsubishi-Tanabe Pharma Corp. Pfizer Japan Inc. Sanofi K.K., Consultant of: Astellas Pharma, Inc. Chugai Pharmaceutical Co, Ltd. Eli Lilly Japan, Mitsubishi-Tanabe Pharma Corp., Grant/research support from: AbbVie, Asahikasei Pharma Corp. Chugai Pharmaceutical Co, Ltd. Mitsubishi-Tanabe Pharma Corp. Sanofi K.K., BMDB Basnayake: None declared, Fiona Goldblatt: None declared, Madelynn Chan Speakers bureau: AbbVie, Novartis, Consultant of: Pfizer, Eli-Lilly, Kristine Ng Speakers bureau: Abbvie, Novartis, Janssen, Sang-Cheol Bae: None declared, Shereen Oon: None declared, Sean O’Neill Consultant of: GSK, Kathryn Gibson Speakers bureau: UCB, Consultant of: Novartis, Janssen, Grant/research support from: Novartis, Sunil Kumar: None declared, Nicola Tugnet: None declared, Yoshiya Tanaka Speakers bureau: Daiichi-Sankyo, Eli Lilly, Novartis, YL Biologics, Bristol-Myers, Eisai, Chugai, Abbvie, Astellas, Pfizer, Sanofi, Asahi-kasei, GSK, Mitsubishi-Tanabe, Gilead, Janssen, Grant/research support from: Abbvie, Mitsubishi-Tanabe, Chugai, Asahi-Kasei, Eisai, Takeda, Daiichi-Sankyo, Mandana Nikpour Speakers bureau: Actelion, GSK, Janssen, Pfizer, UCB, Paid instructor for: UCB, Consultant of: Actelion, Boehringer Ingelheim, Certa Therapeutics, Eli Lilly, GSK, Janssen, Pfizer, UCB, Grant/research support from: Actelion, Astra Zeneca, BMS, GSK, Janssen, UCB, Eric F. Morand Speakers bureau: AstraZeneca, Paid instructor for: Eli Lilly, Consultant of: AstraZeneca, Amgen, Biogen, BristolMyersSquibb, Eli Lilly, EMD Serono, Genentech, Janssen, Grant/research support from: AstraZeneca, BristolMyersSquibb, Eli Lilly, EMD Serono, Janssen.

Published
2021
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2. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro

Author

S. Karrar, X. Shiwen, J. Nikotorowicz-Buniak, D. J. Abraham, C. Denton, R. Stratton, R. Bayley, K. A. Kite, E. Clay, J. P. Smith, G. D. Kitas, C. Buckley, S. P. Young, L. Ye, L. Zhang, J. Goodall, H. Gaston, H. Xu, P. M. Lutalo, Y. Zhao, L. Meng Choong, S. Sangle, J. Spencer, D. D'Cruz, O. J. Rysnik, K. McHugh, P. Bowness, L. Rump-Goodrich, D. Mattey, O. Kehoe, J. Middleton, A. Cartwright, C. Schmutz, A. Askari, D. H. Gardner, L. E. Jeffery, K. Raza, D. M. Sansom, M. Fitzpatrick, G. Wallace, S. Young, J. Shaw, H. Hatano, A. Cauli, J. L. Giles, A. Mathieu, S. Kollnberger, S. Webster, L. Ellis, L. M. O'Brien, T. J. Fitzmaurice, A. Nazeer Moideen, L. Evans, L. Osgood, A. Williams, S. Jones, C. Thomas, V. O'Donnell, M. Nowell, L. Ouboussad, S. Savic, L. J. Dickie, J. Hintze, C. H. Wong, G. P. Cook, M. Buch, P. Emery, M. F. McDermott, S. A. Hardcastle, C. L. Gregson, K. Deere, G. Davey Smith, P. Dieppe, J. H. Tobias, E. Dennison, M. Edwards, J. Bennett, D. Coggon, K. Palmer, C. Cooper, D. McWilliams, A. Young, P. D. Kiely, D. Walsh, H. J. Taylor, I. Harding, J. Hutchinson, I. Nelson, A. Blom, J. Tobias, E. Clark, J. Parker, M. Bukhari, K. Jayakumar, P. Kiely, J. Diffin, M. Lunt, T. Marshall, J. Chipping, D. Symmons, S. Verstappen, J. Bluett, J. Bowes, P. Ho, N. McHugh, D. Buden, O. Fitzgerald, A. Barton, J. R. Glossop, N. B. Nixon, R. D. Emes, P. T. Dawes, W. E. Farrell, D. L. Mattey, I. C. Scott, S. Steer, S. Seegobin, A. M. Hinks, S. Eyre, A. Morgan, A. G. Wilson, L. Hocking, P. Wordsworth, J. Worthington, A. Cope, C. M. Lewis, S. Guerra, B. A. Ahmed, D. Abraham, C. Fonseca, J. Robinson, J. Taylor, L. Haroon Rashid, E. Flynn, J. Isaacs, J. H. Barrett, B. Kingston, M. Ahmed, J. R. Kirwan, R. Marshall, K. Chapman, R. Pearson, C. Heycock, C. Kelly, M. Rynne, V. Saravanan, J. Hamilton, A. Saeed, R. Coughlan, J. J. Carey, Z. Farah, W. Matthews, C. Bell, S. Petford, L.-M. Tibbetts, K. M. J. Douglas, W. Holden, J. Ledingham, M. Fletcher, R. Winfield, Z. Price, K. Mackay, C. Dixon, R. Oppong, S. Jowett, E. Nicholls, D. Whitehurst, S. Hill, A. Hammond, E. Hay, K. Dziedzic, C. Righetti, M. Lebmeier, V. L. Manning, M. Hurley, D. L. Scott, E. Choy, L. Bearne, E. Nikiphorou, S. Morris, D. James, E. C. Wong, J. Long, A. Fletcher, S. Holmes, P. Hockey, M. Abbas, C. Chattopadhyay, J. Flint, M. Gayed, K. Schreiber, S. Arthanari, M. Nisar, M. Khamashta, C. Gordon, I. Giles, J. Robson, A. Kiran, J. Maskell, N. Arden, A. Hutchings, A. Emin, D. Culliford, B. Dasgupta, W. Hamilton, R. Luqmani, H. Jethwa, D. Rowczenio, H. Trojer, T. Russell, J. Loeffler, P. Hawkins, H. Lachmann, I. Verma, A. Syngle, P. Krishan, N. Garg, S. P. McGowan, D. T. Gerrard, H. Chinoy, W. E. Ollier, R. G. Cooper, J. A. Lamb, L. Taborda, P. Correia Azevedo, D. Isenberg, K. M. Leyland, A. Judge, D. Hunter, D. Hart, M. K. Javaid, M. H. Edwards, A. E. Litwic, K. A. Jameson, D. Deeg, J. Cushnaghan, A. Aihie Sayer, D. Jagannath, C. Parsons, L. Stoppiello, P. Mapp, S. Ashraf, D. Wilson, R. Hill, B. Scammell, C. Wenham, P. Shore, R. Hodgson, A. Grainger, J. Aaron, L. Hordon, P. Conaghan, Y. Bar-Ziv, Y. Beer, Y. Ran, S. Benedict, N. Halperin, M. Drexler, A. Mor, G. Segal, A. Lahad, A. Haim, U. Rath, D. M. Morgensteren, M. Salai, A. Elbaz, V. G. Vasishta, E. Derrett-Smith, R. Hoyles, K. Khan, A. Ezeonyeji, G. Takhar, V. Ong, L. Loughrey, L.-A. Bissell, E. Hensor, G. Abignano, A. Redmond, F. Del Galdo, F. C. Hall, A. Malaviya, S. Baker, A. Furlong, A. Mitchell, A. L. Godfrey, M. Ruddlesden, A. Hadjinicolaou, M. Hughes, T. Moore, N. O'Leary, A. Tracey, H. Ennis, G. Dinsdale, C. Roberts, A. Herrick, C. P. Denton, L. Guillevin, E. Hunsche, D. Rosenberg, B. Schwierin, M. Scott, T. Krieg, M. Anderson, M. Matucci-Cerinic, R. Alade, S. Xu, S. Nihtyanova, K. E. Clark, F. W. K. Tam, R. Unwin, R. J. Stratton, B. Schreiber, C. Seng Edwin Lim, E. Corsiero, N. Sutcliffe, H. Wardemann, C. Pitzalis, M. Bombardieri, H. Tahir, S. Donnelly, M. Greenwood, T. O. Smith, V. Easton, H. Bacon, E. Jerman, K. Armon, F. Poland, A. Macgregor, D. van der Heijde, J. Sieper, D. Elewaut, A. L. Pangan, D. Nguyen, C. Badenhorst, S. Kirby, D. White, A. Harrison, J. A. Garcia, S. Stebbings, J. W. MacKay, S. Aboelmagd, K. Gaffney, A. Deodhar, J. Braun, M. Mack, B. Hsu, T. Gathany, C. Han, R. D. Inman, N. Cooper-Moss, J. Packham, V. Strauss, J. E. Freeston, L. Coates, J. Nam, A. R. Moverley, P. Helliwell, R. Wakefield, P. Mease, R. Fleischmann, J. Wollenhaupt, D. Kielar, F. Woltering, C. Stach, B. Hoepken, T. Arledge, D. Gladman, G. Coteur, A. Kavanaugh, O. Purcaru, I. McInnes, A. B. Gottlieb, L. Puig, P. Rahman, C. Ritchlin, S. Li, Y. Wang, A. Mendelsohn, M. Doyle, W. Tillett, D. Jadon, G. Shaddick, C. Cavill, G. Robinson, R. Sengupta, E. Korendowych, C. de Vries, R. C. Thomas, T. Shuto, N. Busquets-Perez, H. Marzo-Ortega, D. McGonagle, G. Richards, S. Bingham, P. John Hamlin, R. Adshead, S. Cambridge, P. Suppiah, M. Cullinan, A. Nolan, W. M. Thompson, H. R. Mathieson, S. L. Mackie, D. Bryer, M. Krutikov, L. Gray, E. Bruce, A. Keat, W. Innes, R. Pandit, L. Kay, S. Lapshina, L. Myasoutova, S. Erdes, D. Wallis, N. Waldron, I. Thorne, C. Harris, K. Vohra, D. Khinchi, L. Kaur, A. Jones, N. Harrison, D. Harris, T. Jones, J. Rees, A. Bennett, S. Fazal, N. Tugnet, N. Barkham, N. Basu, A. McClean, L. Harper, E. N. Amft, N. Dhaun, R. A. Luqmani, M. A. Little, D. R. Jayne, O. Flossmann, J. McLaren, V. Kumar, D. M. Reid, G. J. Macfarlane, G. Jones, M. Yates, R. A. Watts, L. Igali, C. Mukhtyar, H. Doll, S. Yew, R. Suppiah, P. Hoglund, D. Jayne, K. Westman, W. Win Maw, P. Patil, M. Williams, T. Adizie, D. Christidis, F. Borg, A. Robertson, A. P. Croft, S. Smith, S. Carr, S. Youssouf, A. Salama, C. Pusey, and M. Morgan

Subjects
medicine.medical_specialty, business.industry, Stem cell factor, Systemic scleroderma, medicine.disease, In vitro, Rheumatology, medicine.anatomical_structure, Internal medicine, Immunology, medicine, Pharmacology (medical), Fibroblast, business
Published
2013
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3. Muscle disorders * 111. The impact of fatigue in patients with idiopathic inflammatory myopathy: a mixed method study

Author

R. Campbell, D. Hofmann, S. Hatch, P. Gordon, H. Lempp, L. Das, P. Blumbergs, V. Limaye, E. Vermaak, N. McHugh, M. H. Edwards, K. Jameson, A. A. Sayer, E. Dennison, C. Cooper, F. B. Salvador, C. Huertas, D. Isenberg, E. J. Jackson, A. Middleton, D. Churchill, K. Walker-Bone, P. R. Worsley, S. Mottram, M. Warner, D. Morrissey, S. Gadola, A. Carr, M. Stokes, R. N. Srivastava, D. Sanghi, A. Elbaz, A. Mor, G. Segal, M. Drexler, D. Norman, E. Peled, N. Rozen, Y. Goryachev, E. M. Debbi, A. Haim, A. Wolf, R. Debi, M. S. Cohen, I. Igolnikov, Y. Bar Ziv, V. Benkovich, B. Bernfeld, J. Collins, R. J. Moots, P. D. Clegg, P. I. Milner, H. D. Ejtehadi, P. N. Nelson, C. Wenham, S. Balamoody, R. Hodgson, P. Conaghan, R. Wilkie, M. Blagojevic, K. P. Jordan, J. Mcbeth, M. J. Peffers, R. J. Beynon, D. J. Thornton, R. Chapman, V. Chapman, D. Walsh, S. Kelly, M. Hui, W. Zhang, S. Doherty, F. Rees, K. Muir, R. Maciewicz, M. Doherty, S. Snelling, R. K. Davidson, T. Swingler, A. Price, I. Clark, E. Stockley, G. Hathway, H. Faas, D. Auer, G. Hirsch, E. Hale, G. Kitas, R. Klocke, A. Abraham, M. S. Pearce, K. D. Mann, R. M. Francis, F. Birrell, M. Tucker, S. J. Mellon, L. Jones, A. J. Price, P. A. Dieppe, H. S. Gill, S. Ashraf, D. A. Walsh, D. McCollum, C. McCabe, S. Grieve, J. Shipley, R. Gorodkin, A. G. Oldroyd, B. Evans, C. Greenbank, M. Bukhari, R. Rajak, C. Bennett, A. Williams, J. C. Martin, R. Abdulkader, C. MacNicol, K. Brixey, S. Stephenson, G. Clunie, R. N. Andrews, E. M. Clark, V. C. Gould, L. Carter, L. Morrison, J. H. Tobias, S. R. Pye, D. Vanderschueren, T. W. O'Neill, D. M. Lee, I. Jans, J. Billen, E. Gielen, M. Laurent, F. Claessens, J. E. Adams, K. A. Ward, G. Bartfai, F. Casanueva, J. D. Finn, G. Forti, A. Giwercman, T. S. Han, I. Huhtaniemi, K. Kula, M. E. Lean, N. Pendleton, M. Punab, F. C. Wu, S. Boonen, C. Mercieca, J. Webb, A. Bhalla, S. Fairbanks, K. E. Moss, C. Collins, P. Sedgwick, J. Parker, N. C. Harvey, Z. A. Cole, S. R. Crozier, G. Ntani, P. A. Mahon, S. M. Robinson, H. M. Inskip, K. M. Godfrey, E. M. Dennison, M. Bridges, S. Ruddick, C. R. Holroyd, P. Mahon, K. Godfrey, T. McNeilly, C. McNally, T. Beringer, M. Finch, A. Coda, J. Davidson, J. Walsh, P. Fowlie, T. Carline, D. Santos, P. Patil, C. Rawcliffe, A. Olaleye, S. Moore, A. Fox, D. Sen, Y. Ioannou, S. Nisar, K. Rankin, M. Birch, S. Finnegan, M. Rooney, D. S. Gibson, A. Malviya, C. M. Ferris, S. P. Rushton, H. E. Foster, H. Hanson, K. Muthumayandi, D. J. Deehan, L. Birt, F. Poland, A. MacGregor, K. Armon, M. Pfeil, F. McErlane, M. W. Beresford, E. M. Baildam, W. Thomson, K. Hyrich, A. Chieng, J. Gardner-Medwin, M. Lunt, L. Wedderburn, K. Newell, A. Evans, G. Manning, C. Scaife, C. McAllister, S. R. Pennington, M. Duncan, T. Moore, C. Pericleous, S. C. Croca, I. Giles, K. Alber, H. Yong, A. Midgely, A. Rahman, M. Rzewuska, C. Mallen, V. Y. Strauss, J. Belcher, G. Peat, R. Byng-Maddick, M. Wijendra, H. Penn, E. Roddy, S. Muller, R. Hayward, F. Kamlow, A. Pakozdi, A. Jawad, D. J. Green, S. L. Hider, S. Singh Bawa, S. Bawa, A. Turton, M. Palmer, J. Lewis, T. Moss, C. E. Goodchild, N. Tang, D. Scott, P. Salkovskis, S. Selvan, L. Williamson, N. Thalayasingam, M. Higgins, V. Saravanan, M. Rynne, J. D. Hamilton, C. Heycock, C. Kelly, S. Norton, A. Sacker, J. Done, A. Young, J. S. Smolen, R. M. Fleischmann, P. Emery, R. F. van Vollenhoven, B. Guerette, S. Santra, H. Kupper, L. Redden, A. Kavanaugh, E. C. Keystone, D. van der Heijde, M. E. Weinblatt, N. Mozaffarian, S. Liu, N. Zhang, S. Wilkinson, M. Riaz, A. J. Ostor, M. K. Nisar, G. Burmester, X. Mariette, F. Navarro-Blasco, U. Oezer, S. Kary, K. Unnebrink, P. Jobanputra, F. Maggs, A. Deeming, D. Carruthers, E. Rankin, A. Jordan, A. Faizal, C. Goddard, M. Pugh, S. Bowman, S. Brailsford, P. Nightingale, N. Tugnet, S. C. Cooper, K. M. Douglas, C. S. Edwin Lim, S. Bee Lian Low, C. Joy, L. Hill, P. Davies, S. Mukherjee, P. Cornell, S. L. Westlake, S. Richards, F. Rahmeh, P. W. Thompson, F. Breedveld, E. Keystone, R. Landewe, M. McIlraith, C. Dharmapalaiah, L. Shand, G. Rose, R. Watts, A. Eldashan, B. Dasgupta, F. A. Borg, G. M. Bell, A. E. Anderson, R. A. Harry, J. N. Stoop, C. M. Hilkens, J. Isaacs, A. Dickinson, E. McColl, S. Banik, L. Smith, J. France, A. Rutherford, A. Scott Russell, J. Smith, I. Jassim, R. Withrington, P. Bacon, D. De Lord, L. McGregor, I. Morrison, A. Stirling, D. R. Porter, S. A. Saunders, S. Else, O. Semenova, H. Thompson, O. Ogunbambi, S. Kallankara, E. Baguley, Y. Patel, S. Alzabin, S. Abraham, T. E. Taher, A. Palfeeman, D. Hull, K. McNamee, E. Pathan, A. Kinderlerer, P. Taylor, R. O. Williams, R. A. Mageed, O. Iaremenko, G. Mikitenko, M. Ferrari, T. Kamalati, C. Pitzalis, F. Pearce, S. Tosounidou, K. Obrenovic, N. Erb, J. Packham, R. Sandhu, C. White, C. M. Cardy, E. Justice, M. Frank, L. Li, M. Lloyd, A. Ahmed, S. Readhead, A. Ala, M. Fittall, J. Manson, J. Sibilia, R. Marc Flipo, B. Combe, C. Gaillez, M. Le Bars, C. Poncet, A. Elegbe, R. Westhovens, R. Hassanzadeh, C. Mangan, R. Fleischmann, R. van Vollenhoven, T. W. J. Huizinga, R. Goldermann, B. Duncan, J. Timoshanko, K. Luijtens, O. Davies, M. Dougados, J. Hewitt, M. Owlia, M. Schiff, R. Alten, J. L. Kaine, P. T. Nash, I. Delaet, K. Qi, M. C. Genovese, J. Clark, S. Kardash, E. Wong, R. Hull, F. McCrae, R. Shaban, L. Thomas, S. Young-Min, J. Ledingham, A. Covarrubias Cobos, G. Leon, E. F. Mysler, M. W. Keiserman, R. M. Valente, J. Abraham Simon Campos, W. Porawska, J. H. Box, C. W. Legerton, E. L. Nasonov, P. Durez, R. Pappu, J. Teng, C. J. Edwards, N. Arden, J. Campbell, T. van Staa, C. Housden, I. Sargeant, E. Choy, S. McAuliffe, K. Roberts, P. Sarzi-Puttini, A. Andrianakos, T. P. Sheeran, D. Choquette, A. Finckh, M.-L. Desjuzeur, E. K. Gemmen, C. Mpofu, J.-E. Gottenberg, P. Shah, M. Cox, A. Nye, A. O'Brien, P. Jones, G. T. Jones, P. Paudyal, H. MacPherson, J. Sim, E. Ernst, M. Fisken, G. Lewith, J. Tadman, G. J. Macfarlane, P. Bertin, C. Arendt, I. Terpstra, B. VanLunen, M. de Longueville, H. Zhou, A. Cai, E. Lacy, J. Kay, E. Matteson, C. Hu, E. Hsia, M. Doyle, M. Rahman, D. Shealy, D. L. Scott, F. Ibrahim, H. Abozaid, A. Hassell, M. Plant, D. Walker, G. Simpson, A. Kowalczyk, P. Prouse, A. Brown, M. George, N. Kumar, K. Mackay, S. Marshall, C. L. Ludivico, B. Murthy, M. Corbo, W. Samborski, F. Berenbaum, J. Ambrugeat, B. Bennett, H. Burkhardt, V. Bykerk, J. Roman Ivorra, J. Wollenhaupt, A. Stancati, C. Bernasconi, D. G. I. Scott, P. Claydon, C. Ellis, S. Buchan, J. Pope, C. O. Bingham, E. M. Massarotti, G. Coteur, M. Weinblatt, C. Ball, T. Ainsworth, J. Kermik, J. Woodham, I. Haq, E. Quesada-Masachs, A. Carolina Diaz, G. Avila, I. Acosta, X. Sans, C. Alegre, S. Marsal, D. McWilliams, P. D. Kiely, R. Bolce, J. Wang, M. Ingham, R. Dehoratius, D. Decktor, V. Rao, A. Pavlov, M. Klearman, D. Musselman, J. Giles, J. Bathon, N. Sattar, J. Lee, D. Baxter, J. S. McLaren, M.-M. Gordon, K. Z. Thant, E. L. Williams, S. Earl, P. White, J. Williams, A. K. Jan, A. I. Bhatti, C. Stafford, M. Carolan, and S. A. Ramakrishnan

Subjects
medicine.medical_specialty, Comorbid anxiety, business.industry, Osteoarthritis, Primary care, medicine.disease, Rheumatology, Internal medicine, General practice, medicine, Anxiety, Pharmacology (medical), In patient, medicine.symptom, business, Depression (differential diagnoses)
Published
2012
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4. Poster Presentations (PP01-PP67)

Author

P. Santos-Moreno, J. Bello, A. Palomino, L. Villarreal, D. Zambrano, L. Amador, O. Andrade, A. Urbina, C. Guzman, M. Cubides, A. Arbelaez, R. Valle-Onate, C. Galarza-Maldonado, K. Brickmann, F. Furst, S. Kielhauser, J. Hermann, H.-P. Brezinsek, W. Graninger, V. Ziaee, P. Sadghi, M.-H. Moradinejad, D. H. Yoo, J.-H. Woo, Y. J. Kim, J. J. Kim, C.-B. Choi, Y.-K. Sung, T.-H. Kim, J.-B. Jun, S.-C. Bae, W. Park, K. Joo, M.-J. Lim, S.-R. Kwon, K.-H. Jung., S.-Y. Bang, S.-R. Park, K. W. Lee, S. Donmez, O. N. Pamuk, G. E. Pamuk, A. Aksoy, H. Almoallim, A. Almasari, H. Khadawardi, A. Haroyan, M. Petrova, D. Shah, A. Bhatnagar, A. Wanchu, M. Okada, F. E. Ardakani, M. Owlia, S. Hesami, M. B. Owlia, H. Soleimani, H. S. Saleh-Abadi, M. Lotfi, A. Dehghan, B. Saberir, M. H. Moradinejad, G. Zamani, A. Aghamohammadi, H. Soheili, S. shahinpour, H. Abolhassani, A. Hirbod, N. Arandi, M. Tavassoli, N. Parvaneh, N. Rezaei, Z. Rezaieyazdi, M.-R. Hatef, S. Sedighi, H. Ah Kim, C. K. Chung, R. Martinez Perez, M. Leon, J. Uceda, S. Rodriguez Montero, A. Munoz, M. Velloso, J. Marenco, N. Tsiliakou, O. Giotakos, L. Koutsogeorgopoulou, D. Kassimos, N. Fernandes, V. Silva, R. Hernandez Sanchez, P. Gonzalez Moreno, J. Uceda Montanes, J. Marenco de la Fuente, E. Aytekin, S. E. Demir, S. C. Okur, N. S. Caglar, S. Tutun, S. Eroglu Demir, A. Rezvani, N. Ozaras, E. Poyraz, M. Guneser, H. K. Asik Celik, I. Batmaz, M. Sariyildiz, B. Dilek, I. Yildiz, O. Ayyildiz, K. Nas, R. Cevik, T. Gunay, Y. Garip, H. Bodur, T. Baykal, B. Seferoglu, K. Senel, M. Kara, T. Tiftik, A. Kaya, M. Engin Tezcan, M. Akif Ozturk, S. Ozel, A. Akinci, L. Ozcakar, D. Saliha Eroglu, A. Ebru, K. Ilhan, A. Teoman, D. Gulis, F. Ileana, G. Linda, P. Cristina, D. Laura, S. Simona, R. Simona, S. Ataman, S. Venkatesan, L. Ng, C. Carbone, E. Jaeggi, E. Silverman, S. Kamphuis, N. Mak, L. Lim, D. Levy, E. Ciobanu, M. Mazur, L. Mazur-Nicorici, S. Jin Park, E.-J. Cheon, C.-K. Chung, N. Tugnet, J. Dixey, C. Cheng, S. Schmidt, K. Stoy, A. Seisenbayev, G. Togizbaev, F. Gonzalez, L. Villareal, C. Galarza, E. Nikiphorou, A. MacGregor, S. Morris, D. James, A. Young, M. A. Alomari, R. Shammaa, D. M. Shqair, K. Alawneh, O. F. Khabour, T. C. Namey, S. Kolahi, A. G. Haghjoo, M.-J. Lee, C.-H. Suh, Y.-W. Park, H.-S. Lee, Y.-M. Kang, S.-C. Shim, W.-K. Lee, H. Park, J. Lee, R.-H. Wong, C.-H. Huang, J. Cheng-Chung Wei, S.-P. Chiou, Y.-C. Tu, S. Ok, J.-O. Kim, J.-S. Lee, I.-H. Sung, J.-H. Kim, S.-H. Lee, J. Choi, S. Kim, R. Song, Y.-A. Lee, S.-J. Hong, H.-I. Yang, K. Matsui, K. Yoshida, H. Oshikawa, T. Kobayashi, H. Nakano, M. Utsunomiya, M. Kimura, O. Seniz, J. Yoon, N. Yoon, S. Lee, and Y. Kim

Subjects
medicine.medical_specialty, Rheumatology, business.industry, medicine, Pharmacology (medical), Medical physics, business
Published
2012
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5. Characterisation and outcomes of different subsets of low disease activity states in patients with systemic lupus erythematosus.

Author

Hao Y, Hansen D, Louthrenoo W, Chen YH, Cho J, Lateef A, Hamijoyo L, Luo SF, Wu YJ, Navarra S, Zamora L, Li Z, Sockalingam S, Katsumata Y, Harigai M, Zhang Z, Chan M, Kikuchi J, Takeuchi T, Bae SC, Goldblatt F, O'Neill S, Ng K, Basnayake BMDB, Tugnet N, Tanaka Y, Lau CS, Li N, Golder V, Hoi A, Kandane-Rathnayake R, Morand E, Oon S, and Nikpour M

Subjects
Humans, Female, Male, Adult, Prospective Studies, Middle Aged, Remission Induction, Follow-Up Studies, Lupus Erythematosus, Systemic complications, Severity of Illness Index
Abstract

Objectives: The lupus low disease activity state (LLDAS) allows for certain clinical and/or serological activity of SLE, provided overall disease activity does not exceed predefined cut-offs. This study aimed to evaluate the outcomes of patients who achieved LLDAS with clinical activity, serological activity only or neither clinical nor serological activity., Methods: Patients with SLE enrolled in a prospective multinational cohort from March 2013 to December 2020 who were in LLDAS at least once were included. Visits that fulfilled both LLDAS and Definition of Remission in SLE (DORIS) criteria were excluded., Results: 2099 patients were included, with median follow-up of 3.5 (IQR 1.3-5.8) years. At 6150 visits, patients were in LLDAS but not DORIS criteria; of these 1280 (20.8%) had some clinical activity, 3102 (50.4%) visits had serological activity only and 1768 (28.8%) visits had neither clinical nor serological activity. Multivariable regression analysis showed that compared with non-LLDAS, all three subsets of LLDAS had a protective association with flares in the ensuing 6 months and damage accrual in the ensuing 36 months. LLDAS with no clinical or serological activity had a significantly stronger protective association with severe flares in the ensuing 6 months compared with LLDAS with clinical activity (HR 0.47, 95% CI (0.27 to 0.82), p=0.007)., Conclusions: LLDAS without any clinical activity accounted for almost 80% of LLDAS visits. This study confirms that all subsets of LLDAS are associated with reduced flare and damage accrual. However, LLDAS without any clinical or serological activity has the strongest protective association with severe flares., Competing Interests: Competing interests: SO'N received consulting fees from AstraZeneca, Biogen, Boehringer Ingelheim; lecture/speaker fees from AstraZeneca, Biogen, Boehringer Ingelheim, Pfizer and GSK and research grants from Aurania, Biogen, Idorsia, Novartis. ZL received consulting fees from Pfizer, Roche, Janssen, Abbott, AbbVie, Bristol-Myers Squibb, MSD, Celgene, Eli Lilly, GSK, Novartis, UCB and have royalties with Pfizer, Roche, Janssen, Abbott, AbbVie, Bristol-Myers Squibb, MSD, Celgene, Eli Lilly, GSK, Novartis, UCB. SS received consulting fees from Pfizer, AstraZeneca, ZP Therapeutics. YK received payment/Honoria from Asahi Kasei, Astellas, AstraZeneca, Chugai, GlaxoSmithKline, Janssen, Mitsubishi Tanabe, Pfizer Japan and Sanofi. MH received speaker’s fee from AbbVie Japan, Ayumi, Boehringer Ingelheim Japan, Bristol-Myers Squibb, Chugai, Eisai, Eli Lilly Japan, GlaxoSmithKline, Kissei Pharmaceutical, Pfizer Japan, Takeda and Teijin; consultant fees from AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Kissei Pharmaceutical and Teijin and research grants from AbbVie Japan GK, Asahi Kasei, Astellas, Ayumi, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo. Eisai, KisseiPharmaceutical, Mitsubishi Tanabe, Nippon Kayaku, Sekisui Medical, Shionogi, Taisho, Takeda and Teijin. TT received grants from Astellas, Asahi Kasei, Chugai, Mitsubishi Tanabe, and consulting fees from Astellas, Chugai. KN received Advisory Board participation fees from AbbVie. YT has received research grants from Eli Lilly, AstraZeneca, AbbVie, Gilead, Chugai, Behringer-Ingelheim, GlaxoSmithKline, Eisai, Taisho, Bristol-Myers, Pfizer and Taiho. AH received research grants from AstraZeneca, and consulting fees from EUSA Pharma (UK), and Speaker/Honoraria from Limbic, Novartis, Moose Republic, AbbVie, Eli Lilly. RK-R received research grants from Novartis and GlaxoSmithKline. EM received research grants and/or consulting fees from AbbVie, AstraZeneca, Biogen, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead, Genentech, GlaxoSmithKline, Genentech, Janssen, Novartis, Servier, EMD Serono, Takeda and UCB. MN received research grants and honoraria from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Janssen., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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6. Association of Modified Systemic Lupus Erythematosus Responder Index Attainment With Long-Term Clinical Outcomes: A Five-Year Prospective Study.

Author

Connelly K, Kandane-Rathnayake R, Hoi A, Louthrenoo W, Hamijoyo L, Luo SF, Wu YJ, Cho J, Lateef A, Lau CS, Chen YH, Navarra S, Zamora L, Li Z, An Y, Sockalingam S, Hao Y, Zhang Z, Chan M, Katsumata Y, Harigai M, Oon S, Bae SC, O'Neill S, Gibson KA, Basnayake B, Kikuchi J, Takeuchi T, Ng KPL, Tugnet N, Kumar S, Goldblatt F, Law A, Tee M, Tee C, Tanaka Y, Ohkubo N, Tan JY, Karyekar CS, Nikpour M, Golder V, and Morand EF

Subjects
Humans, Prospective Studies, Prednisolone therapeutic use, Glucocorticoids therapeutic use, Odds Ratio, Lupus Erythematosus, Systemic drug therapy
Abstract

Objective: In trials of systemic lupus erythematosus (SLE), the SLE Responder Index (SRI) is the most commonly used primary efficacy end point but has limited validation against long-term outcomes. We aimed to investigate associations of attainment of a modified version of the SRI (mSRI) with key clinical outcomes in SLE patients with up to 5 years of follow-up., Methods: We used data from a large multicenter, longitudinal SLE cohort in which patients received standard of care. The first visit with active disease (defined as SLE Disease Activity Index 2000 [SLEDAI-2K] score ≥6) was designated as baseline, and mSRI attainment (defined as a reduction in SLEDAI-2K ≥4 points with no worsening in physician global assessment ≥0.3 points) was determined at annual intervals from baseline up to 5 years. Associations between mSRI attainment and outcomes including disease activity, glucocorticoid dose, flare, damage accrual, Lupus Low Disease Activity State (LLDAS), and remission were studied., Results: We included 2,060 patients, with a median baseline SLEDAI-2K score of 8. An mSRI response was attained by 56% of patients at 1 year, with similar responder rates seen at subsequent annual time points. Compared to nonresponders, mSRI responders had significantly lower disease activity and prednisolone dose and higher proportions of LLDAS and remission attainment at each year, and less damage accrual at years 2 and 3. Furthermore, mSRI responder status at 1 year predicted clinical benefit at subsequent years across most outcomes, including damage accrual (odds ratio [OR] range 0.58-0.69, P < 0.05 for damage accrual ORs at all time points)., Conclusion: In SLE patients with active disease receiving standard of care, mSRI attainment predicts favorable outcomes over long-term follow-up, supporting the clinical meaningfulness of SRI attainment as an SLE trial end point., (© 2022 The Authors. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Published
2023
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7. 'Not at target': prevalence and consequences of inadequate disease control in systemic lupus erythematosus-a multinational observational cohort study.

Author

Kandane-Rathnayake R, Louthrenoo W, Hoi A, Luo SF, Wu YJ, Chen YH, Cho J, Lateef A, Hamijoyo L, Navarra SV, Zamora L, Sockalingam S, An Y, Li Z, Katsumata Y, Harigai M, Hao Y, Zhang Z, Kikuchi J, Takeuchi T, Basnayake BMDB, Chan M, Ng KPL, Tugnet N, Kumar S, Oon S, Goldblatt F, O'Neill S, Gibson KA, Ohkubo N, Tanaka Y, Bae SC, Lau CS, Nikpour M, Golder V, and Morand EF

Subjects
Cohort Studies, Glucocorticoids, Humans, Prevalence, Severity of Illness Index, Lupus Erythematosus, Systemic epidemiology, Quality of Life
Abstract

Background: The unmet need in systemic lupus erythematosus (SLE) with the current standard of care is widely recognised, but few studies have quantified this. The recent definition of treat-to-target endpoints and other thresholds of uncontrolled disease activity provide an opportunity to formally define unmet need in SLE. In this study, we enumerated the prevalence of these states and examined their association with adverse outcomes., Methods: Data were collected prospectively in a 13-country longitudinal SLE cohort between 2013 and 2019. Unmet need was defined as never attaining lupus low disease activity state (LLDAS), a time-adjusted mean SLEDAI-2K (AMS) > 4, or ever experiencing high disease activity status (HDAS; SLEDAI-2K ≥10). Health-related quality of life (HRQoL) was assessed using SF36 (v2) and damage accrual using the SLICC-ACR SLE Damage Index (SDI)., Results: A total of 3384 SLE patients were followed over 30,313 visits (median [IQR] follow-up 2.4 [0.4, 4.3] years). Eight hundred thirteen patients (24%) never achieved LLDAS. Median AMS was 3.0 [1.4, 4.9]; 34% of patients had AMS > 4. Twenty-five per cent of patients had episodes of HDAS. Each of LLDAS-never, AMS>4, and HDAS-ever was strongly associated with damage accrual, higher glucocorticoid use, and worse HRQoL. Mortality was significantly increased in LLDAS-never (adjusted HR [95% CI] = 4.98 [2.07, 12.0], p<0.001) and HDAS-ever (adjusted hazard ratio (HR) [95% CI] = 5.45 [2.75, 10.8], p<0.001) patients., Conclusion: Failure to achieve LLDAS, high average disease activity, and episodes of HDAS were prevalent in SLE and were significantly associated with poor outcomes including organ damage, glucocorticoid exposure, poor quality of life, and mortality., (© 2022. The Author(s).)

Published
2022
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8. Management of MDA-5 antibody-positive dermatomyositis with interstitial lung disease-an Auckland case series.

Author

Dick M, Martin J, and Tugnet N

Abstract

Objective: The aim was to present our experience of managing six cases of anti-melanoma differentiation-associated gene 5 (anti-MDA-5) DM with associated interstitial lung disease (ILD), presenting between June 2017 and October 2020., Methods: The electronic notes were reviewed for six patients being followed up by the Rheumatology service at Auckland District Health Board. Three patients were initially diagnosed and treated in neighbouring Counties Manukau District Health Board and later transferred to Auckland District Health Board. All had different initial treating clinicians at a time before any predefined treatment algorithm. Emphasis was placed on initial diagnosis and treatment, subsequent disease activity and changes in management. Local management was compared retrospectively with existing evidence relating to the treatment of anti-MDA-5 DM with ILD. Ethical approval was not obtained, according to the New Zealand Health and Disability Ethics Committee exemption for audits and related activities., Results: Six patients with a variety of clinical presentations were identified appropriately as having anti-MDA-5 DM with ILD. They were commenced on different immunosuppressive regimens, with treatment adjusted according to response and on-going disease activity. Four have achieved clinical and biochemical remission, a fifth has improving active disease, and the sixth is in the early stages of their illness., Conclusion: Anti-MDA-5 DM is commonly associated with ILD. This can be rapidly progressive, with a poor prognosis in spite of treatment, particularly among Asian patients. Disease activity can seemingly be monitored with serum ferritin. The most effective management of this condition remains poorly researched; however, increasing retrospective evidence favours early aggressive multi-agent immunosuppression and a low threshold for escalation of therapy., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Published
2021
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9. A survey of the New Zealand rheumatology workforce.

Author

Harrison AA, Tugnet N, and Taylor WJ

Subjects
Adult, Age Distribution, Aged, Female, Hospitals, Public statistics & numerical data, Humans, Male, Middle Aged, New Zealand, Public Sector statistics & numerical data, Sex Distribution, Surveys and Questionnaires, Health Services Needs and Demand, Health Workforce trends, Rheumatologists supply & distribution, Rheumatology
Abstract

Aim: To characterise the demographics, size and distribution of the New Zealand rheumatology workforce., Method: An online survey was sent to New Zealand rheumatologists in February 2018., Results: The survey was completed by 63 of 64 practising New Zealand rheumatologists (response rate 98%). In public practice, the number of half-day clinics per FTE was five (R2 linear 0.87), so a half-day session in private practice was counted as 0.2 FTE. There were 28.71 FTE in the public sector, 14.97 in private and 43.68 total FTE. By district health board (DHB), public FTE per capita ranged from 0.20 FTE per 100,000 population in Nelson-Marlborough DHB to 0.96 in Whanganui DHB. None of the 20 DHBs met the Royal College of Physicians guideline of 1.16 FTE per 100,000 population in the public sector, and only four DHBs reached this level when private FTE were included. Rheumatologists under the age of 50 years were predominantly female (62% female), and older rheumatologists predominantly male (7.7% female, p<0.001). In the next five years 6.58 FTE public rheumatologists intended to retire, (94% male). 23/53 (43%) of public hospital rheumatologists offer appointments for non-inflammatory conditions, compared to 30/31 (97%) of private practice rheumatologists. Between 1999 and 2011, the FTE per 100,000 population increased by 35.4%, but the rate of improvement slowed in the interval between 2011 and 2018, increasing by 3.0%., Conclusion: The New Zealand rheumatologist workforce is becoming more gender-balanced but is below recommended FTE levels, is unevenly distributed, and previously documented improvements in overall FTE have now reached a plateau., Competing Interests: Nil.

Published
2019

10. Human Endogenous Retroviruses (HERVs) and Autoimmune Rheumatic Disease: Is There a Link?

Author

Tugnet N, Rylance P, Roden D, Trela M, and Nelson P

Abstract

Autoimmune rheumatic diseases, such as RA and SLE, are caused by genetic, hormonal and environmental factors. Human Endogenous Retroviruses (HERVs) may be triggers of autoimmune rheumatic disease. HERVs are fossil viruses that began to be integrated into the human genome some 30-40 million years ago and now make up 8% of the genome. Evidence suggests HERVs may cause RA and SLE, among other rheumatic diseases. The key mechanisms by which HERVS are postulated to cause disease include molecular mimicry and immune dysregulation. Identification of HERVs in RA and SLE could lead to novel treatments for these chronic conditions. This review summarises the evidence for HERVs as contributors to autoimmune rheumatic disease and the clinical implications and mechanisms of pathogenesis are discussed.

Published
2013
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11. To what extent is NICE guidance on the management of rheumatoid arthritis in adults being implemented in clinical practice? A regional survey.

Author

Tugnet N, Pearce F, Tosounidou S, Obrenovic K, Erb N, Packham J, and Sandhu R

Subjects
Adult, Female, Humans, Male, Prognosis, Retrospective Studies, United Kingdom, Antirheumatic Agents therapeutic use, Arthritis, Rheumatoid therapy, Disease Management, Practice Guidelines as Topic, Surveys and Questionnaires
Abstract

Rheumatoid arthritis (RA) is a chronic disease associated with significant morbidity. The 2009 NICE guidance advises on the management of patients with RA. In this study, we undertook a survey to assess the implementation of the guidance into practice across the Midlands. In total, 19 rheumatology units participated, of which nine have designated early inflammatory arthritis clinics (EIAC). Data for 311 patients with RA attending clinics were collected during a two week period. The median time from symptom onset to first visit was four months. Of the patients, 95.6% were seen within 12 weeks of referral. Of those seen in EIAC, 75.9% had erosions documented on X-rays versus 49.4% of non-EIAC patients. In addition, 57.9% of patients were offered combination disease-modifying antirheumatic drugs (DMARD) therapy in EIAC, versus 30.4% in non-EIAC units. Monthly disease-activity scores were calculated more in patients attending EIAC than non-EIAC units (51.1% versus 25.4%). Based on our results, there is significant regional variation in implementation of the NICE guidance. In addition, patients with RA attending EIACs are more likely to receive a treat-to-target approach.

Published
2013
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12. Wells' syndrome (eosinophilic cellulitis) secondary to infliximab.

Author

Tugnet N, Youssef A, and Whallett AJ

Subjects
Aged, Female, Humans, Infliximab, Tumor Necrosis Factor-alpha antagonists & inhibitors, Antibodies, Monoclonal adverse effects, Antirheumatic Agents adverse effects, Cellulitis chemically induced, Drug Eruptions etiology, Eosinophilia chemically induced
Published
2012
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13. Current management of male-to-female gender identity disorder in the UK.

Author

Tugnet N, Goddard JC, Vickery RM, Khoosal D, and Terry TR

Subjects
Female, Genitalia surgery, Humans, Male, Transsexualism diagnosis, Urogenital Surgical Procedures methods, Transsexualism therapy
Abstract

Gender identity disorder (GID), or transsexualism as it is more commonly known, is a highly complex clinical entity. Although the exact aetiology of GID is unknown, several environmental, genetic and anatomical theories have been described. The diagnosis of GID can be a difficult process but is established currently using standards of care as defined by the Harry Benjamin International Gender Dysphoria Association. Patients go through extensive psychiatric assessment, including the Real Life Experience, which entails living in the desired gender role 24 h a day for a minimum period of 12 months. The majority of GID patients will eventually go on to have gender realignment surgery, which includes feminising genitoplasty. The clinical features, diagnostic approach and management of male-to-female GID in the UK are reviewed, including the behavioural, psychological and surgical aspects.

Published
2007
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