Rosalie Magro

Characterisation of Patients with Systemic Lupus Erythematosus in Malta: A Population Based Cohort Cross-Sectional Study

Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disorder. The aim of this study was to characterise the SLE patients living in Malta in order to estimate the prevalence and incidence of SLE and characterise the clinical presentation as well as identify any unmet needs. 107 SLE patients who fulfilled SLICC classification criteria were identified. These were invited to participate in the study by means of an interview, blood and urine tests, and filling of the following questionnaires: Fatigue Severity Scale (FSS), visual analogue scale (VAS) for fatigue, Hospital Anxiety and Depression Scale (HADS), VAS for pain, Pittsburgh Sleep Quality Index (PSQI), and modified Health Assessment Questionnaire (mHAQ). The estimated prevalence of SLE in Malta is 29.3 patients per 100,000 and the estimated incidence is 1.48 per 100,000 per year. 93.5% of SLE patients were female, and the mean age at diagnosis was 33.1 years. 60.8% were overweight or obese and body mass index (BMI) had a significant positive correlation with daily dose of prednisolone (R=0.177, p=0.046). 20.7% and 3.3% had a moderate and high disease activity, respectively, as measured by SLEDAI-2K. Disease activity had a significant positive correlation with functional disability measured by mHAQ (R=0.417, p<0.001). 56.5% had an abnormal level of fatigue (FSS >3.7) and 57.6% had a high level of anxiety (HADS ≥8). This study has identified a number of unmet needs of SLE patients, including obesity, uncontrolled disease activity, fatigue, and anxiety.

AB0622 Characteristics of systemic lupus erythematosus patients in malta; a population based cross-sectional cohort study

Background Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that involves multiple systems including the skin, musculoskeletal, renal, neurological, haematologic, cardiovascular and respiratory systems. Objectives The aim of this study was to characterise the patients with systemic lupus erythematosus living in Malta, in terms of age of disease onset, BMI, co-morbidities, drug history, disease activity, damage and other factors including fatigue, sleep quality, depression, anxiety and vitamin D level. Methods The study consisted of a cross-sectional cohort study of all known SLE patients, over the age of 18, living in Malta. 92 patients who fulfilled the SLICC classification criteria for SLE, gave informed consent and an interview was carried out. Fatigue, anxiety, depression, sleep quality and disability were assessed respectively by filling in the following questionnaires: Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI) and modified Health Assessment Questionnaire (mHAQ). Results 92.4% of SLE patients studied were female. Table 1 summarises the characteristics of the SLE patients. 23.9% of SLE patients were in remission (SLEDAI-2K 0), while 52.2% had a low disease activity (SLEDAI-2K 1–5) at the time of the interview. 20.7% and 3.3% had a moderate (SLEDAI-2K 6–10) and high (SLEDAI-2K 11–19) disease activity respectively. A significant positive correlation was noted between function measured by mHAQ and SLEDAI (R=0.417, p=0.000). 56.5% were noted to have an abnormally high level of fatigue (FSS >3.7). 6.5% were noted to have depression (HADS D>10) and 35.9% had anxiety (HADS A>10). 55.4% were noted to have poor sleep quality (PSQI >5) and 26.1% had an abnormal level of function (mHAQ >0.3). 15.2% were found to have vitamin D deficiency and 27.2% were vitamin D insufficient.Abstract AB0622 – Table 1 Clinical characteristics of the cohort Characteristics Values Age, mean (S.D.) years 46.9 (13.9) Caucasian race, n/N (%) 90/92 (97.8) Disease duration, median (range) years 13 (0–35) Age of SLE onset, mean (S.D.) years 33.8 (12.8) BMI, median (range) kg/m2 26.5 (17.7–53.5) Current smoker, n/N (%) 14/92 (15.2) Family history of SLE in first degree relative, n/N (%) 3/92 (3.3) Osteopaenia/osteoporosis, n/N (%) 30/92 (32.6) Hypertension, n/N (%) 22/92 (23.9) Diabetes mellitus, n/N (%) 7/92 (7.6) Fibromyalgia, n/N (%) 9/92 (9.8) Anti-phospholipid syndrome, n/N (%) 7/92 (7.6) Sjogren’s syndrome, n/N (%) 4/92 (4.3) Rheumatoid arthritis, n/N (%) 3/92 (3.3) Current prednisolone, n/N (%) 41/92 (44.6) Current hydroxychloroquine, n/N (%) 55/92 (59.8) Current azathioprine, n/N (%) 20/92 (21.7) Current methotrexate, n/N (%) 10/92 (10.9) Current mycophenolate, n/N (%) 6/92 (6.5) Conclusions This is the first population based study on SLE to be carried out in Malta. The prevalence of SLE in Malta is estimated to be 25.5 patients per 1 00 000 and the estimated incidence is 1.05 patients per 1 00 000 per year. A high frequency of obesity and vitamin D deficiency and insufficiency were noted in SLE patients. Other unmet needs include an uncontrolled disease activity, fatigue, poor sleep quality and anxiety. Disclosure of Interest None declared

Health status of COPD patients undergoing pulmonary rehabilitation : a comparative responsiveness of the CAT and SGRQ

The St. George’s Respiratory Questionnaire (SGRQ) and chronic obstructive pulmonary disease (COPD) assessment test (CAT) are the measures used to assess health status. This study aims to examine the responsiveness of these tools by severity of dyspnoea category in patients with COPD. Forty-nine COPD patients who underwent a 12-week pulmonary rehabilitation (PR) programme were assessed at baseline, 12 weeks and at 28-week follow-up. Patients were categorized into two groups by severity of dyspnoea category (i.e. mild to moderate (modified Medical Research Council (mMRC) 1–2) and severe to very severe (mMRC 3–4)) using the mMRC dyspnoea scale. Effect size (ES) was computed as estimates of responsiveness. The SGRQ demonstrated greater responsiveness by total sample (SGRQ, ES = 0.87; CAT, ES = 0.75) and for the mMRC 3–4 category (SGRQ, ES = 0.91; CAT, ES = 0.76) on completion of PR. At 28-week follow-up, overall comparable responsiveness of the CAT and SGRQ was identified by total sample (SGRQ, ES = 0.75; CAT, ES = 0.74) and by severity of dyspnoea category. The symptom, impact and activity domains of the SGRQ showed good responsiveness, with greater ESs obtained overall for the mMRC 3–4 category. On completion of PR, the SGRQ demonstrates a greater responsiveness with COPD patients, especially in relation to the mMRC 3–4 category, while both the CAT and SGRQ show comparable responsiveness on follow-up.

THU0108 Closing The Audit Cycle: Have Cardiovascular Risk Assessment and Management in Rheumatoid Arthritis Patients Improved?

Background Patients who suffer from rheumatoid arthritis have an increased risk of morbidity and mortality from cardiovascular disease. This is due to the high prevalence of traditional risk factors and the effect of systemic inflammation. Objectives The aim of the audit was to determine whether the cardiovascular risk assessment and management in rheumatoid arthritis patients at Mater Dei Hospital is in concordance with the recommendations by the European League Against Rheumatism (EULAR). Methods An audit was carried out retrospectively on 91 patients who suffer from rheumatoid arthritis by using the medical notes to collect data on demographics, co-morbidities, drug history and cardiovascular risk assessment and management over a two year period (August 2010 to July 2012). The results of the first audit were then disseminated through the rheumatology department and a form for cardiovascular risk assessment and management in rheumatoid arthritis patients was implemented. The audit was repeated on 107 patients and data was collected retrospectively over the two year period starting from January 2013 to December 2014. Results Documentation of cardiovascular risk factors over the two year period audited improved as follows from the first to the second audit: weight in 27.5% to 52.3%, height in 0% to 27.1%, BMI in 0% to 10.3%, smoking status in 72.5% to 93.5%, blood pressure in 72.5% to 92.5%, blood glucose in 72.5% to 97.1% and lipid profile in 54.9% to 96.3%. Documentation of smoking cessation advice improved from 15.8% to 41.1% and advice on other lifestyle changes improved from 14.3% to 18.7%. Moreover calculation of DAS28 over a one year period improved from 20.9% to 51.4%. In the first audit, 13.8% of patients who had complete data and in whom the ten year cardiovascular risk could be calculated (29 patients), would benefit from the use of a statin according to the guidelines (and were not currently receiving one). In the re-audit, this decreased to 8.6% of such patients (93 patients). In the second audit it was noted that the form that had been introduced for cardiovascular risk assessment was used in 15% (16 patients). The documentation of lifestyle advice was significantly higher (p<0.001) in the group of patients in whom the form was used. The same applies for documentation of weight (p<0.001), height (p<0.001), BMI (p<0.001) and calculation of DAS28 over a one year period (p<0.001). The prevalence of diagnosed hypertension in our cohort of rheumatoid arthritis patients was 49.0%; diabetes was 19.7%; hyperlipidaemia was 21.8%; and ischaemic heart disease was 8.8%. Conclusions Cardiovascular risk factors are highly prevalent in rheumatoid arthritis patients. This audit showed that cardiovascular risk assessment and management improved through raising awareness of its importance in the rheumatology department as well as the implementation of the cardiovascular risk assessment form. References Peters M JL, Symmons D PM, McCarey D, Dijkmans B AC, Nicola P, Kvien T K et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis, Feb 2010; 69: 325–33. Disclosure of Interest None declared

A man with generalised lymphadenopathy.

A 75 year old man with Paget’s disease, hypercholesterolaemia, and hypertension presented with a three year history of multiple neck lumps, which had never been investigated and had increased in size over the past two months. He felt generally well and had no history of fever or weight loss. His appetite was normal and there was no change in bowel habit. Clinical examination showed no abnormalities and he had no shortness of breath, chest pain, lower limb oedema, joint pains, or neurological symptoms. On examination, he had hepatomegaly (width of three fingers) and his cervical, axillary, and inguinal lymph nodes were enlarged, hard, and non-tender bilaterally. His blood count, renal function, and C reactive protein (<57 nmol/L; reference range 0-95) were normal. He had a raised erythrocyte sedimentation rate (102 mm in the first hour (28-32) and altered liver function tests (alkaline phosphatase 6.5 µkat/L (0.67-2.15), alanine aminotransferase 0.35 µkat/L (0.08-0.68), γ-glutamyl transferase 9.67 µkat/L (0.13-1.02), and total bilirubin 29.5 µmol/L (1.72-17.1). Proteinuria (0.25 g/L) was noted on urinalysis. Chest radiography showed mediastinal lymphadenopathy. Computed tomography of the thorax, abdomen, and pelvis showed enlarged mediastinal, axillary, and inguinal lymph nodes, which varied in size from 1 cm to 3 cm, with eggshell calcifications and an enlarged liver with hypodense texture. A lymph node biopsy was done and histological analysis performed (figure⇓). Fig 1 Section from a lymph node biopsy stained with Congo red and viewed under polarised light. Image courtesy of Ed Uthman, Houston, Texas, with permission1 ### 1. What are the causes of generalised lymphadenopathy? #### Short answer Generalised lymphadenopathy can be caused by infections (viruses, bacteria, fungi, or protozoans), cancer (including lymphoproliferative disorders), autoimmune disorders (including …