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1. 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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2. AB0465 Early remission induction and outcome in primary medium and small vessel vasculitis - retrospective review of ten years cohort in east yorkshire

Author

M. Nallasivan, Y. Patel, K. Manchegowda, O. Ogunbambi, M. Abuzakouk, S. Kallankara, E. Middleton, and E. Baguley

Subjects
medicine.medical_specialty, Pediatrics, Cyclophosphamide, business.industry, medicine.medical_treatment, Immunology, Immunosuppression, Azathioprine, medicine.disease, General Biochemistry, Genetics and Molecular Biology, Rheumatology, Internal medicine, medicine, Immunology and Allergy, Rituximab, business, Vasculitis, Rheumatism, medicine.drug, Systemic vasculitis
Abstract

Background The systemic vasculitides continue to present the practising clinician with many challenges. The advent of effective immunosuppressive therapy (cyclophosphamide with high-dose corticosteroids) has markedly improved patients’ survival (78% at 5 years)1. New diagnostic tools have helped earlier diagnosis.2 Objectives Our aim was to study the patients under rheumatology care, with primary medium and small vessel vasculitis over the last 10 years and to analyse their presentations, diagnosis, treatment outcomes and to assess the impact of early remission induction therapy. Methods Cases were retrieved using hospital records and a serology database using ANCA request. All new cases of GPA, EGPA, MPA, and PAN and other small to medium vasculitis between 2002 and 2012 were included, provided they met pre-defined criteria of Chapel Hill classification. Demographic profile, clinical features, laboratory data, treatment details, and clinical outcome of patients were analyzed retrospectively. Results 52 patients were identified. Two patients were excluded due to lack of clarity of diagnosis. Mean age was 56.3 years, Female: Male= 29:21. Most frequent symptoms at diagnosis include arthralgia, vasculitic rash, cough, dyspnea and fever. Most had raised inflammatory markers (PV and CRP in 82%). 13 patients had elevated creatinine (112-187). ANCA was positive in 32/50.Diagnosis included the following: (50) 50% had IV glucocorticoids and cyclophosphamide (dose from 500mg-1gm as per weight) for induction therapy. We continued for 6 cycles and then switched to oral therapy. 6 patients had relapse, of which 5 had further cyclophosphamide and two achieved remission. 6/50 (one failed, another refused cyclo) patients needed Rituximab for adequate disease control. Other drugs used included Azathioprine (29) Mycophenolate (9) and Methotrexate (7) System involvement The median time to achieve remission was 5 months since diagnosis. Median duration of follow up was 76.4 months (3-230). 30% of patients (15/50) were able to stop immunosuppression while maintaining remission. Conclusions Cyclophosphamide and glucocorticoids have achieved high remission rates 80% (24/30), compared to Lane et al1 (78% at 5 years). Rituximab has achieved remission in refractory vasculitis. Aggressive early induction therapy and sustained remission have achieved a favourable impact on the long term outcome of our patient groups. References S E Lane et al. Primary systemic vasculitis: Clinical features and mortality. QJM (2005) 98 (2): 97-111. C Mukhtyar et al. Outcomes from studies of antineutrophil cytoplasm antibody associated vasculitis: a systematic review by the European League against Rheumatism systemic vasculitis task force. Ann Rheum Dis 2008;67:1004–1010 Disclosure of Interest None Declared

Published
2013
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3. AB0356 Treat to target in early rheumatoid arthritis clinic (eac): remission rates on combination of leflunomide, hydroxychloroquine and methotrexate

Author

S. Kallankara, H. Thompson, E. Baguley, O. Ogunbambi, O. Semenova, and Y. Patel

Subjects
Cytopenia, medicine.medical_specialty, business.industry, Immunology, Hydroxychloroquine, Treat to target, Early rheumatoid arthritis, medicine.disease, Gastroenterology, Rash, General Biochemistry, Genetics and Molecular Biology, Surgery, Rheumatology, Internal medicine, Early ra, medicine, Immunology and Allergy, Methotrexate, medicine.symptom, business, medicine.drug, Leflunomide
Abstract

Background The Early Rheumatoid Arthritis Clinic (EAC) was established in 2010 to meet NICE recommendations for treatment of early RA [1]. Locally developed protocol of rapid escalation of treatment with combination of conventional DMARDs was used. High remission and low disease activity (LDA) rates after 1 year of this treatment were reported earlier [2]. In order to control disease activity many patients had to go on combination of Methotrexate (MTX), Hydroxychloroquine (HCQ) and Leflunomide (LEF). Objectives To analyse tolerance and efficacy of combination of MTX, HCQ and LEF in EAC patients. Methods Patients were adults with diagnosis of RA ≤ 2 years and active disease (DAS > 3.2). Target of treatment was DAS28 remission (DAS28 Results Of 148 who have continued to attend the EAC, 47 patients (32%) needed treatment with the combination of LEF + HCQ + MTX. The female to male ratio was 1.7:1. At the first visit, all patients had DAS28 > 3.2, and 79% of them were seropositive. 22 of 47 patients (46%) had to stop LEF because of side effects (such as abnormal liver tests, diarrhoea, cytopenia or rash), compliance issues or an onset of a-TNF treatment. All side effects were reversible and not severe. The remaining 25 pts (54%) continued treatment and were still on the MTX+ HCQ + LEF combination at the last visit to the EAC. Almost all patients were on combination of 25mg of MTX (20mg in 3 cases), HCQ 200mg (except 3 cases of intolerance) and LEF 10 mg or 20 mg (12 and 13 patients, respectively). Results of treatment are shown in Table 1. Conclusions 54% of the patients tolerated the treatment and among these it was highly effective and resulted in LDA or remission in 24 of 25 patients (96%). Our results agree well with limited available data on LEF+MTX efficacy [3, 4]. In the 46% of patients who could not tolerate the combination all of the side effects were reversible. Due to close monitoring of patients in the EAC, LEF could be stopped at the very first signs of intolerance, with serious side effects avoided. References NICE, Feb 2009. Semenova O et al., Annals Rheum. Dis. 2012: 71, S3, 205. Sakellariou GT et al., Clin. Rheumatol. 2011, Sept 9 (Epub ahead of print). Sakellariou GT et al., Rheumatol. Int. 2012, Nov 5 (Epub ahead of print). Disclosure of Interest None Declared

Published
2013
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4. THU0250 Treat to Target in Early Rheumatoid Arthritis Clinic (EAC): Low Radiological Progression and Good Functional Outcomes on Conventional Disease Modifying Drugs (DMARDS)

Author

Y. Patel, S. Kallankara, E. Baguley, O. Ogunbambi, O. Semenova, and H. Thompson

Subjects
Female to male, medicine.medical_specialty, business.industry, Everyday activities, Immunology, Treat to target, Disease, Early rheumatoid arthritis, General Biochemistry, Genetics and Molecular Biology, Surgery, Rheumatology, Internal medicine, Radiological weapon, Early ra, medicine, Immunology and Allergy, business, Employment outcomes
Abstract

Background EAC was established in 2010, where we used protocol-driven rapidly escalating treatment with combination of conventional DMARDs. High remission rates (DAS28), achieved after 1 year of this treatment have been previously reported [1], but progression of the disease has not been analysed. Objectives To analyse the results of radiological, functional and employment outcomes after 1 year of treatment in EAC. Methods All patients had active early RA and went on rapid escalation of treatment protocol [1]. Target of treatment was DAS28 Results 79 patients have completed 1 year of treatment in the EAC. The female to male ratio was 1.7:1, and 78% of patients were seropositive. Disease activity and progression are shown in Table 1. Conclusions After 1 year of targeted protocol-driven treatment of early RA with conventional DMARDs, the majority of patients reported only minimal impact of the disease on everyday activities, retained their jobs and had significant improvement of HAQ score. Only 18% of patients developed new erosions, and only 11% of them needed biologic drugs. References Semenova O et al., Annals Rheum. Dis. 2012: 71, S3, 205. Disclosure of Interest None Declared

Published
2013
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