Fifteen-minute consultation: a structured approach to the diagnosis of idiopathic orbital inflammation

Abstract

48 BSPAR157 FIFTEEN-MINUTE CONSULTATION: A STRUCTURED APPROACH TO THE DIAGNOSIS OF IDIOPATHIC ORBITAL INFLAMMATION E. Oliver, E. Mosley and S. Rangaraj Nottingham Children’s Hospital, University Hospitals Nottingham, UK Correspondence to: E. Oliver. E-mail: emma_oliver05@hotmail.com Introduction: Idiopathic orbital inflammation (IOI) also known as orbital pseudotumour was first noted in 1905 by Birch Hirchfield. IOI is the third most common condition to affect the orbit. Aims: Sclerosing IOI is a rare subdivision of IOI, causing 5% of all orbital inflammation. Oral corticosteroids, immunosuppression, radiotherapy and surgery have been successful in a number of cases; however, there remains to be a consensus on treatment. Results: We present two cases which failed to respond to oral corticosteroids and were subsequently successfully treated with i.v. pulsed methylprednisolone. Case 1, a 13-year old boy presented with a painless diplopia, ptosis, proptosis and right eyelid swelling. Initial treatment with i.v. antibiotics failed. Investigations for autoimmune and infective causes were negative. Imaging revealed a 3 x 1 cm extraocular mass overlying the right globe. Biopsy was consistent with an inflammatory lesion. Oral corticosteroid failed to improve the clinical picture. Pulsed i.v. methylprednisolone weaned over a 9 month period resulted in resolution of the lesion. Case 2, a 10-year-old girl presented with peri-orbital oedema, ptosis, proptosis and diplopia of the left eye. Treatment for orbital cellulitis resulted in resolution of erythema only. Imaging revealed a left ocular mass in the left lacrimal gland. Histopathology was consistent with sclerosing idiopathic orbital inflammation. Oral steroids resulted in limited improvement. Subsequent pulsed i.v. methylprednisolone for 5 months resulted in resolution of the lesion. Conclusion: We report two cases successfully treated with pulsed methylprednisolone. We propose pulsed methylprednisolone as first line treatment for IOI. Disclosure statement: The authors have declared no conflicts of interest. ABSTRACT 49 BSPAR158 PHYSICAL ACTIVITY, SELF-EFFICACY AND PERCEPTIONS OF ILLNESS IN ADOLESCENTS WITH CHRONIC MUSCULOSKELETAL DISEASE W. Williamson, A. Doherty, C. Foster, E. Kendall, E. Parsons, J. Sheehan, J. Dwyer and N. Wilkinson BHF Health Promotion Research Group, University of Oxford, OxPARC Oxford University Hospitals Trusts, Oxford, UK and University of Guelph, Canada Correspondence to: W. Williamson. E-mail: wilby.williamson@dph.ox.ac.uk Introduction: Moderate-to-vigorous physical activity (MVPA) is essential for growth, well-being and reducing cardio-metabolic risk. Promoting activity in adolescent disease groups requires understanding of baseline behaviour. Aims: Survey MVPA of adolescents attending a regional rheumatology clinic and identify associations been health beliefs and self-efficacy measures that may explain MVPA behaviour. Method: Three validated questionnaires covering physical activity, sedentary behaviour, self-efficacy to overcome barriers to activity and illness perceptions, were distributed over six consecutive clinics. Results: Questionnaires were completed by 42 patients [mean age 15 (range 11–21) years; 25 with JIA and 26 females]. Activity profiles: 17% inactive (zero days 60 min MVPA), 36% low-active (1–2 days 60 min MVPA), 33% moderately active (3–4 days 60 min MVPA) 14% active (>5 days 60 min MVPA). Sedentary profile: 55% report 4 or more h daily TV viewing and digital recreation. Illness-perception responses: 1 in 3 report severe symptoms, restricted lives and limited activity, 1 in 2 report negative emotional well-being. Positive illness perceptions for illness duration, concern, understanding and emotional response tended towards significant for being active (P1⁄4 0.054–0.073). MVPA self-efficacy responses did not correlate significantly with activity. The majority were confident overcoming harassment and physical environment barriers and somewhat confident overcoming internal, social and symptom barriers. TV viewing (OR 0.18 P1⁄4 0.05) and being on a sports teams (OR 9.7 P1⁄40.01) are strong correlates of inactivity/ activity. Reporting lots of opportunity for activity positively correlated with MVPA (r1⁄4 0.5, P1⁄40.03). Conclusion: Adolescents with musculoskeletal disease are less active than the general population. Reducing screen-time and promoting social sports are potential targets for MVPA promotion. A larger sample with repeated measures is required to explore correlation of self-efficacy and illness-perceptions with MVPA. Disclosure statement: The authors have declared no conflicts of interest. ABSTRACT 50 BSPAR15950 BSPAR159 PAEDIATRIC SARCOIDOSIS: A SINGLE CENTRE PAEDIATRIC RHEUMATOLOGY EXPERIENCE E. Mosley, M. Yiallorides and S. Rangaraj Nottingham Children’s Hospital, University Hospitals Nottingham, UK Correspondence to: E. Mosley. E-mail: EllenMosley@doctors.org.uk Introduction: Sarcoidosis is a rare chronic multisystem granulomatous disease. We present two cases highlighting the varied clinical presentation in children. Aims: Case 1, a 6-year-old girl, with a 4-month history of parotid swelling, unresponsive to antibiotic treatment. Paediatric referral and subsequent multisystem investigations revealed raised ACE level, elevated calcium, Schirmer’s test showed 2 mm of wetting after 5 min, punctate epithelial erosions on the cornea, pan uveitis. Renal investigations revealed hypertension, raised calcium, renal impairment POSTER PRESENTATIONS iii17