Brittny Major

The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease

Objective To examine the role of rheumatoid arthritis (RA) flare, remission and RA severity burden in cardiovascular disease (CVD). Methods In a population-based cohort of patients with RA without CVD (age ≥30 years; 1987 American College of Rheumatology criteria met in 1988–2007), we performed medical record review at each clinical visit to estimate flare/remission status. The previously validated RA medical Records-Based Index of Severity (RARBIS) and Claims-Based Index of RA Severity (CIRAS) were applied. Age- and sex-matched non-RA subjects without CVD comprised the comparison cohort. Cox models were used to assess the association of RA activity/severity with CVD, adjusting for age, sex, calendar year of RA, CVD risk factors and antirheumatic medications. Results Study included 525 patients with RA and 524 non-RA subjects. There was a significant increase in CVD risk in RA per time spent in each acute flare versus remission (HR 1.07 per 6-week flare, 95% CI 1.01 to 1.15). The CVD risk for patients with RA in remission was similar to the non-RA subjects (HR 0.90, 95% CI 0.51 to 1.59). Increased cumulative moving average of daily RARBIS (HR 1.16, 95% CI 1.03 to 1.30) and CIRAS (HR 1.38, 95% CI 1.12 to 1.70) was associated with CVD. CVD risk was higher in patients with RA who spent more time in medium (HR 1.08, 95% CI 0.98 to 1.20) and high CIRAS tertiles (HR 1.18, 95% CI 1.06 to 1.31) versus lower tertile. Conclusions Our findings show substantial detrimental role of exposure to RA flare and cumulative burden of RA disease severity in CVD risk in RA, suggesting important cardiovascular benefits associated with tight inflammation control and improved flare management in patients with RA.

Polymyalgia Rheumatica and its Association with Cancer.

OBJECTIVE Polymyalgia rheumatica (PMR) is a common rheumatologic disease in the elderly population. Studies on the relationship between PMR and cancer have yielded mixed results and have been limited by multiple factors. This study examined the association between PMR and development of cancer in a community cohort. METHODS A population-based cohort of 359 patients with PMR diagnosed between 1/1/1970 and 12/31/1999 and followed to 12/31/2013 was assembled along with a comparison cohort of 357 subjects. Records of the PMR and comparator subjects were reviewed for details concerning diagnosis of cancer. The cumulative incidence of malignancy in patients with and without PMR, adjusted for the competing risk of death, was estimated and compared using methods of Gray. Cox proportional hazards models were used to assess the trends in malignancy over time. RESULTS There was no significant difference in the prevalence of malignancy prior to PMR incidence date/index date between the two groups with prior malignancies in 41 (11%) of patients with PMR, and 50 (14%) of non-PMR subjects (p-value=0.31). As well, there was no difference in the cumulative incidence of malignancy at 10 years following PMR incidence between patients with PMR and non-PMR subjects (cumulative incidence at 10 years ± SE: PMR 13.8 ± 2.0, control 13.1 ± 2.0; p-value=0.89). CONCLUSION There is no increased risk of malignancy in patients who are diagnosed with PMR when compared to subjects without PMR in this population-based cohort.

Cranial Tumor Surgical Outcomes at a High-Volume Academic Referral Center

Objective: To determine adverse event rates for adult cranial neuro‐oncologic surgeries performed at a high‐volume quaternary academic center and assess the impact of resident participation on perioperative complication rates. Patients and Methods: All adult patients undergoing neurosurgical intervention for an intracranial neoplastic lesion between January 1, 2009, and December 31, 2013, were included. Cases were categorized as biopsy, extra‐axial/skull base, intra‐axial, or transsphenoidal. Complications were categorized as neurologic, medical, wound, mortality, or none and compared for patients managed by a chief resident vs a consultant neurosurgeon. Results: A total of 6277 neurosurgical procedures for intracranial neoplasms were performed. After excluding radiosurgical procedures and pediatric patients, 4151 adult patients who underwent 4423 procedures were available for analysis. Complications were infrequent, with overall rates of 9.8% (435 of 4423 procedures), 1.7% (73 of 4423), and 1.4% (63 of 4423) for neurologic, medical, and wound complications, respectively. The rate of perioperative mortality was 0.3% (14 of 4423 procedures). Case performance and management by a chief resident did not negatively impact outcome. Conclusion: In our large‐volume brain tumor practice, rates of complications were low, and management of cases by chief residents in a semiautonomous manner did not negatively impact surgical outcomes.

The comparative effectiveness of decision aids in diverse populations with early stage prostate cancer: a study protocol for a cluster-randomized controlled trial in the NCI Community Oncology Research Program (NCORP), Alliance A191402CD

BackgroundTreatments for localized prostate cancer present challenging tradeoffs in the face of uncertain treatment benefits. These options are best weighed in a process of shared decision-making with the patient’s healthcare team. Minority men experience disparities in prostate cancer outcomes, possibly due in part to a lack of optimal communication during treatment selection. Decision aids facilitate shared decision-making, improve knowledge of treatment options, may increase satisfaction with treatment choice, and likely facilitate long-term quality of life.Methods/designThis study will compare the effect of two evidence-based decision aids on patient knowledge and on quality of life measured one year after treatment, oversampling minority men. One decision aid will be administered prior to specialist consultation, preparing patients for a treatment discussion. The other decision aid will be administered within the consultation to facilitate transparent, preference-sensitive, and evidence-informed deliberations. The study will utilize a four-arm, block-randomized design to test whether each decision aid alone (Arms 1 and 2) or in combination (Arm 3) can improve patient knowledge and quality of life compared to usual care (Arm 4). The study, funded by the National Cancer Institute’s Community Oncology Research Program (NCORP), will be deployed within select institutions that have demonstrated capacity to recruit minority populations into urologic oncology trials.DiscussionUpon completion of the trial, we will have 1) tested the effectiveness of two evidence-based decision aids in enhancing patients’ knowledge of options for prostate cancer therapy and 2) estimated whether decision aids may improve patient quality of life one year after initial treatment choice.Trial registrationClinicaltrials.gov: NCT03103321. The trial registration date (on ClinicalTrials.gov) was April 6, 2017.

SAT0341 Polymyalgia Rheumatica and its Association with Cancer

Background Polymyalgia rheumatica (PMR) is a common rheumatologic disease in the elderly population. Several other rheumatologic conditions, including rheumatoid arthritis and systemic lupus erythematosus have been associated with certain forms of cancer. Studies on the relationship between PMR and cancer have yielded mixed results, with one finding up to a 69% increase in the risk of cancer in the first 6 months after diagnosis with PMR while other studies have found no association. These studies have been limited by small sample sizes, limited follow up time and cohort source. Objectives The purpose of this study is to further investigate if, based on data obtained through the Rochester Epidemiology Project, there is an association between PMR and development of cancer. Methods A population-based cohort of PMR patients diagnosed between 1/1/1970 and 12/31/1999 was assembled. A comparison cohort of subjects with similar age and sex was also established. Records of the PMR and comparator subjects were reviewed for details concerning diagnosis of cancer. For each malignancy the date of diagnosis, site and type of malignancy were collected. Descriptive statistics were used to summarize the data comparing the PMR and non-PMR cohorts. The cumulative incidence of malignancy in patients with and without PMR, adjusted for the competing risk of death, was estimated and compared using methods by Gray. Cox proportional hazards models were used to assess the trends in malignancy over time. Results This study included 359 patients diagnosed with PMR and 357 non-PMR subjects. The individuals in these two comparison groups were similar in age (mean age in years ± SD: PMR 73.5±8.5, non-PMR 73.3±8.5), sex (PMR 66.6% female, non-PMR 66.9% female) and follow up time (mean follow up time in years ± SD: PMR 11.8±6.7, non-PMR 10.7±7.4). There was no significant difference in the prevalence of malignancy prior to PMR incidence date/index date between the two groups, with prior malignancies in 41 (11%) of PMR patients and 50 (14%) of non-PMR subjects (p-value 0.31). Analysis of individual solid and hematologic malignancies also revealed no difference between the two groups. Following PMR incidence, evaluation of the cumulative incidence of malignancy at 10 years for PMR patients and non-PMR subjects also showed no difference between the two groups (cumulative incidence at 10 years ± SE: PMR 13.8±2.0, control 13.1±2.0; p-value 0.89). Conclusions There is no increased risk of malignancy in patients who are diagnosed with PMR when compared to subjects without PMR in this population-based cohort study. Disclosure of Interest None declared

SAT0138 Cumulative Burden of Rheumatoid Arthritis Disease Severity Impacts Cardiovascular Disease Risk

Background Rheumatoid arthritis (RA) disease severity is linked to unfavorable cardiovascular disease (CVD) outcomes. Cumulative measures of RA disease burden on CVD have not been well-studied and could be used to determine the potential impact of treat-to-target strategies on CVD risk in RA. Objectives To examine the impact of long-term cumulative burden of RA disease severity on CVD in RA. Methods The previously validated RA medical Records-Based Index of Severity (RARBIS1) and Claims-based Index of RA Severity (CIRAS2) were used to estimate RA severity in an incident cohort of Olmsted County, MN, USA residents with RA who were ≥30 years old, fulfilled 1987 ACR criteria in 1988-2007, and had no history of CVD. Medical record review was used to collect data at each medical visit to calculate the RARBIS: joint surgeries, erosions, extra-articular manifestations, arthritis flares, morning stiffness, rheumatoid factor (RF) positivity, acute phase reactants and antirheumatic medications. Claims data were used to calculate the CIRAS daily during follow-up using 1 year prior data on number of inflammatory marker tests, platelet counts, chemistry panels, rheumatology visits, rehabilitation visits, assessment of RF, and Feltys syndrome. Data on CVD risk factors (i.e. hypertension, diabetes, smoking and dyslipidemia) and incident CVD (i.e. myocardial infarction, CVD death, angina, stroke, intermittent claudication, and heart failure) were also collected. Cox models with time-dependent covariates were used to assess the association of RARBIS and CIRAS with CVD, adjusting for age, sex, calendar year of RA, CVD risk factors and antirheumatic medication use. Results The study included 525 patients with RA (mean age at RA incidence 54.6 years, 71% female). During the mean follow-up of 10.1 years, 129 patients developed CVD. The mean RARBIS and CIRAS scores at RA incidence were 2.5 (SD 1.1; min 0; max 7) and 4.5 (SD 1.9; min 0.6; max 9.5). There was no apparent association of RARBIS or CIRAS at RA incidence with CVD risk (hazard ratio [HR] 1.07 per 1 unit increase, 95% confidence interval [CI] 0.89-1.30, p=0.46 and HR 1.06, 95%CI 0.95-1.17, p=0.32). The highest RARBIS and CIRAS values in the first year were marginally associated with higher CVD risk (HR 1.12, 95%CI 0.99-1.27, p=0.08 and HR 1.16, 95%CI 1.01-1.32, p=0.03). Increase in cumulative moving average of daily CIRAS was associated with increased CVD risk (HR 1.39, 95%CI 1.13, 1.71, p=0.002). Furthermore, patients who spent more time in medium and high CIRAS tertiles were more likely to have an increased risk of CVD vs those who spent more time in the lower tertile (HR 1.09, 95%CI 0.98, 1.20 and HR 1.19, 95%CI 1.07, 1.32, respectively, per 1 year increase; p=0.004). However, the associations between cumulative measures of RARBIS and risk of CVD were not significant. Conclusions Higher long-term burden of RA severity as expressed by cumulative moving average of daily CIRAS and cumulative amount of time in medium and high CIRAS tertiles was associated with significantly increased risk of CVD in RA suggesting accrued detrimental impact of RA severity over time. This implies that treat-to-target strategies designed to minimize cumulative disease burden could have a positive impact on the risk of CVD in RA. References Cabral et al. Arth Rheum 2005;53:61-6. Ting et al. Arth Res Ther. 2008;10:R95 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3880