Alexander Fraser

Study to Determine the Criterion Validity of the SenseWear Armband as a Measure of Physical Activity in People With Rheumatoid Arthritis

Measuring physical activity in people with rheumatoid arthritis (RA) is of great importance in light of the increased mortality in this population due to cardiovascular disease. Validation of activity monitors in specific populations is recommended to ensure the accuracy of physical activity measurement. Thus, the purpose of this study was to determine the validity of the SenseWear Pro3 Armband (SWA) as a measure of physical activity during activities of daily living (ADL) in people with RA.

Refractory PMR with aortitis: life-saving treatment with anti-IL6 monoclonal antibody (tocilizumab) and surgical reconstruction of the ascending aorta

Aortitis is uncommon but well described in patients with polymyalgia rheumatica (PMR). While glucocorticoid remains the mainstay therapy for large-vessel vasculitis, there have been cases where tocilizumab therapy led to clinical and serological improvement in patients with relapsing or refractory disease. We report a case of life-threatening PMR with aortitis in the absence of manifestations related to giant cell arteritis, which, having failed to respond to corticosteroid therapy, was successfully treated with tocilizumab and emergency reconstruction of the ascending aorta. This case adds to the literature supporting the potential value of interleukin-6 inhibition in rare rheumatological conditions such as inflammatory aortitis.

Criterion Validity of the activPAL Activity Monitor for Sedentary and Physical Activity Patterns in People Who Have Rheumatoid Arthritis

Background Accurate measurement of physical activity and sedentary behavior is an important consideration for health care professionals. The activPAL activity monitor has not been validated against a criterion measure for people with rheumatoid arthritis (RA). Objective The objective of this study was to determine the criterion validity of the activPAL activity monitor for measuring step counts, transition counts, and time spent in sedentary, standing, and walking behaviors in people with RA. Design A laboratory-based criterion validation study was conducted. Methods Participants with a confirmed medical diagnosis of RA were recruited from 2 outpatient rheumatology clinics. The testing procedure consisted of standardized testing components and tasks related to activities of daily living. Participants wore an activPAL activity monitor and were video recorded throughout the testing procedure. Direct observation was used as the criterion measure. Data analysis consisted of validation analysis of the activPAL activity monitor data and the criterion measure data. Results Twenty-four people participated in the study. Data from 20 participants were included in the final analysis. The activPAL significantly underestimated step counts by 26% and transition counts by 36%. There was no significant difference between the activPAL activity monitor and the criterion measure for time spent in sedentary, standing or light activity, and walking behaviors. Limitations Validation of activities of daily living in a laboratory environment is a limitation of this study. Conclusions The activPAL activity monitor underestimated step and transition counts and, therefore, is not valid for measuring these outcomes in people with RA. Relative to direct observation, the activPAL activity monitor is valid for measuring time spent in sedentary, standing, and walking behaviors in people with RA.

Parkinsonism can be cured

This case describes a woman with a history of rheumatoid arthritis with secondary vasculitic skin ulcers, Sicca syndrome and idiopathic Parkinsons disease that was diagnosed by a neurologist in 2005. The patients parkinsonian symptoms were difficult to control, despite the use of antiparkinsonian medications. During a regular clinical review in 2011, the patients rheumatologist had prescribed cyclophosphamide infusions to help with the vasculitic skin ulcers. Over the following 2u2005months, the patients parkinsonian symptoms completely resolved.

A Young Male with Severe Myocarditis and Skeletal Muscle Myositis

A 34-year-old male presented with retrosternal chest pain, fatigue, shortness of breath, and a history of a previous episode of myocarditis four years prior. He had elevated troponin T, normal skeletal muscle enzymes, and negative inflammatory markers. Cardiac magnetic resonance imaging (MRI) confirmed active myocarditis with extensive myocardial fibrosis and normal left ventricular ejection fraction (LVEF). His myocarditis symptoms resolved with steroids and anti-inflammatory treatment, but on closer questioning, he reported a vague history of long-standing calf discomfort associated with episodes of stiffness, fatigue, and flu-like symptoms. MRI of the lower legs consequently demonstrated active myositis in the calf muscles. Immunomodulatory therapy was commenced with good effect. The patient is undergoing regular follow-up in both cardiology and rheumatology outpatient departments. Repeated MRI of the legs showed significant interval improvement in his skeletal muscle myositis, and repeat cardiac MRI demonstrated the resolution of myocarditis along with persistent stable extensive myocardial fibrosis and preserved LVEF. The patient has returned to full-time work.

AB1273 Uptake of pneumococcal and influenza vaccination in patients receiving biological dmards (BDMARDS) in ireland

Background Biological disease-modifying antirheumatic drugs (bDMARDs) have made significant positive outcomes in the lives of patients with rheumatic disease. This treatment has proven efficacy in delaying joint destruction and inducing disease remission.1 Studies have shown that pneumococcal vaccination is cost effective while the influenza vaccination significantly prevents morbidity and mortality in the elderly and in patients with chronic disease.1 Objectives To evaluate the pneumococcal and influenza vaccination status in patients receiving biological disease-modifying antirheumatic drugs (bDMARDs). Methods Patients on bDMARDs attending the rheumatology infusion unit were asked about their vaccination status on pneumococcal and influenza using a questionnaire. The patients’ diagnosis, current bDMARD and reasons for not having had vaccination were recorded. Results 92 patients were recruited. Mean age of 53.2 years with 63 (68.5%) female and 29 (31.5%) male. A total of 30 (32.6%) patients received both pneumococcal and influenza vaccination, 1 (1.1%) received pneumococcal vaccination alone, 22 (23.9%) received influenza vaccination alone and 39 (42.4%) had neither. Of the 18 (19.6%) patients age >65 years, 5 (27.8%) received influenza vaccination alone and 8 (44.4%) received both. Patients who did not receive vaccinations were given an educational booklet. The most common diagnosis from our cohort was rheumatoid arthritis(37%), followed by spondyloarthritis(13%), Behçet’s disease(9.8%), myositis(7.6%), vasculitis(5.4%), systemic lupus erythematosus(5.4%), psoriatic arthritis(4.4%) and others(17.4%). 48 (52.2%) were on rituximab, 37 (40.2%) on infliximab, 6 (6.5%) were on tocilizumab and 1 (1.1%) was on abatacept. Of the 61 (66.3%) patients who did not receive the pneumococcal vaccine, 44 (72.1%) were unaware of its availability, 6 (9.8%) were not interested in receiving it, 4 (6.6%) were afraid of the side effects, 4 (6.6%) declined vaccination and 3 (4.9%) were unaware it was recommended. 40 (43.5%) who did not receive the influenza vaccine stated that they were either unaware(45%), not interested(25%), declined vaccination(10%), forgotten(5%), unaware it was recommended(5%) and afraid of the side effects(2.5%). 3 (7.5%) had previous bad experiences from influenza vaccination. Conclusions This is the first study in Ireland looking at vaccination uptake in patients on bDMARDS. The vaccination rate in our cohort was less than satisfactory. Patients on immunosuppressants are recommended to have these vaccinations and preferably to receive them before commencing on the immunosuppressants.2 The lack of awareness is the main reason for failure to be vaccinated. Hence, primary care physicians and the rheumatology team should take active roles in increasing awareness amongst patients about the recommendation for pneumococcal and influenza vaccination. References [1] Doe S, Pathare S, Kelly CA, et al. Uptake of influenza vaccination in patients on immunosuppressant agents for rheumatological diseases: a follow-up audit of the influence of secondary care. Rheumatology. 2007;46:715–6 [] 2Assen S V, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2011;70:414–22 Disclosure of Interest None declared

03.08 High vitamin d levels may downregulate inflammation in behçet’s disease patients

Background Vitamin D has been shown to be directly or indirectly involved in the regulation of proliferation, differentiation, and function of immune cells. Many studies have revealed higher levels of Vitamin D deficiency among patients with autoimmune diseases compared to controls. Aim Aim of the study was to evaluate the serum 25-hydroxyvitamin D (25(OH)D) levels in Behçet’s disease (BD) patients in the midwest region of Ireland, and to correlate with its disease activity. Methods All BD patients attending our rheumatology service and satisfying the ISGBD/ICBD criteria were included in the study and compared in a 1:5 ratio with samples taken from controls matched for age, gender- and the month of the year. Exclusion criteria included other rheumatological or bone/skeletal diseases, a history of chronic kidney disease or other chronic systemic diseases, malignancies, limited physical activity, and if on vitamin D supplementation or medications that could have affected vitamin D metabolism including calcium supplements, cytotoxic drugs, anticonvulsants, bisphosphonates and thyroxine but not glucocorticoids and disease-modifying anti-rheumatic drugs. The total serum 25(OH)D was measured by using competitive chemiluminescence immunoassays (DiaSorin, Dietzenbach, Germany). Levels<20u2009ng/ml were defined as deficient, between 20–40u2009ng/ml as insufficient. Results 19 Caucasian BD patients were included in the study (5 male, 14 female, median age of 37.5 years (interquartile range (IQR), 24.3–51.2 years). The median 25(OH)D of BD patients and controls were 45u2009ng/ml (IQR,33–65u2009ng/ml) and 22u2009ng/ml (IQR, 15–31u2009ng/ml) respectively. The median 25(OH)D was relatively lower in active BD patients in comparison to inactive patients: 35u2009ng/ml (IQR, 22.75–47.25u2009ng/ml) compared to 50u2009ng/ml (IQR, 35–67u2009ng/ml). Overall, none of the patients had Vit D deficiency, however 6 patients had Vit D insufficiency. Conclusion In contrast to many previous studies in other BD cohorts and other autoimmune diseases our study suggests the mean 25(OH)D levels was significantly higher in this BD group. In patients with active disease however serum levels were relatively low compared to the inactive group which is in concordance with the literature. Our findings suggest vitamin D may be a potential suppressor of inflammation in BD, however larger studies are needed to support this thesis and to conclusively understand its role in the inflammatory pathway.

Unmasking the elusive giant: an unusual case presenting as third nerve palsy in a patient with scleroderma

We report a case of an 80-year-old woman being treated with rituximab and maintenance corticosteroids for long-standing scleroderma who presented with right-sided third nerve palsy. Radiological investigations including CT, MRI and MR angiography of the brain were unremarkable. The patient was discharged with a diagnosis of probable microvascular third nerve palsy but was readmitted 1u2005week later with total visual loss in her left eye. Despite the absence of diagnostic clinical signs, giant cell arteritis (GCA) was suspected, and she was started on intravenous corticosteroids. Left temporal artery biopsy subsequently confirmed histological findings diagnostic of GCA. Unfortunately, she remained blind in the left eye.

Profile of energy expenditure in people with rheumatoid arthritis

BACKGROUNDnNo definitive conclusions have been made on the levels of physical activity in the rheumatoid arthritis (RA) population. Similarly no clear consensus has been reached on the correlates and predictors of physical activity in the population.nnnOBJECTIVEnTo profile total energy expenditure (TEE), resting energy expenditure (REE) and physical activity related energy expenditure (PAEE) levels using a validated objective measurement tool and to determine demographic and health related factors which influence and predict TEE and PAEE levels in individuals with RA.nnnMETHODSnFifty nine (41 female, 18 male) individuals with RA were recruited to this cross sectional study. Energy expenditure was measured over seven days using SenseWear Armband. Correlational analysis and logistic regression were used to examine the relationship between demographic and health related factors and TEE, REE and PAEE.nnnRESULTSnA profile of energy expenditure in RA individuals was developed in terms of levels, differences between genders and differences between weekdays and weekend days. Median TEE, PAEE and REE were 2204.0, 409.5 and 1506.2 kcal/day respectively. Energy expenditure was associated with factors such as gender, age, body mass index, employment status, disease severity and smoking.nnnCONCLUSIONnThe findings add to the growing research assessing energy expenditure in the RA population and strengthen the position due to the use of an objective validated tool. Some recommendations on what factors are associated with energy expenditure in the RA population are made, thus unveiling ways to tailor physical activity type interventions in this group.