Presence Of Rheumatoid Arthritis Research Articles

Association between dry eye disease subtypes and rheumatoid arthritis

Aim of the workTo evaluate the association of dry eye disease (DED) subtypes (aqueous deficient dry eye, ADDE and evaporative dry eye, EDE) and the presence of rheumatoid arthritis (RA) in patients. Patients and methods260 volunteer DED participants were recruited for an observational cross-sectional study based on the Tear Film Ocular Society Dry Eye Workshop II criteria, which included tear film osmolarity, fluorescence break-up time, and ocular surface damage assessment. Participants were recruited using QR linked to designated mobile forms to obtain symptomatology status, demographics, and RA diagnosis by their medical doctor. Tear meniscus and lipid layer were also evaluated to differentiate between ADDE, EDE, or mixed dry eye in addition to the DED diagnostic criteria. Participants with mixed dry eye were excluded from the analysis to avoid bias. ResultsAfter initial recruitment, 149 eligible participants with an ADDE or EDE diagnosis were included in the final analysis, where 12,1% have an RA diagnosis. The ADDE group had a higher likelihood of having RA (OR = 4.69, 95 %CI = 1.46–15.01) than the EDE group. Additionally, the number of participants with RA in the ADDE group was statistically higher than those in the EDE group (all p = 0.006). Furthermore, a correlation was obtained between RA and a diagnosis of ADDE (p = 0.005). ConclusionThere was a significant association between ADDE and the presence of RA in patients and the association was more likely compared to those with EDE. This finding underscores the need for specific diagnostic and management strategies for RA patients presenting with DED.

Diminished antibody response to SARS-CoV-2 in rheumatoid arthritis compared to metabolic disorders following the primary series of vaccinations and its recovery with a booster: A single-center prospective observational study.

To compare antibody responses after vaccinations between patients with rheumatoid arthritis (RA) and patients with metabolic disorders (MD). The study places special emphasis on understanding how common diseases affect antibody responses in individuals with RA within real-world settings. The participants were 117 patients with RA (66 with RA only and 51 with RA and MD) and 37 patients with MD who received both the primary series of vaccinations and a booster. Antibody titers were compared after the primary series of vaccinations and a booster, and factors influencing the antibody response were assessed. Following the primary series of vaccinations, a significant reduction in antibody titers was observed in patients with longer days between vaccination and antibody measurement, the use of IL-6 inhibitors, selective T cell co-stimulation modulators, and methotrexate. Comorbid MD did not exhibit significant influences on antibody response in RA. Notably, the presence of RA itself was not significant in multivariate linear regression analysis. After the administration of the booster, however, day between vaccination and antibody measurement, the use of IL-6 inhibitor, and methotrexate no longer remained significant. Only the use of selective T cell co-stimulation modulators retained its significance. MD did not exhibit a significant impact on antibody responses in RA patients. The reduced antibody response following the primary series in RA patients appeared to be attributed more to specific RA medications rather than to the disease itself. Booster vaccines are vital in restoring the antibody response in RA.

Associations of per- and polyfluoroalkyl substances (PFAS) and their mixture with risk of rheumatoid arthritis in the U.S. adult population

BackgroundPer- and polyfluoroalkyl substances (PFAS) are known environmental contaminants with immunosuppressive properties. Their connection to rheumatoid arthritis (RA), a condition influenced by the immune system, is not well studied. This research explores the association between PFAS exposure and RA prevalence.MethodsThis research utilized data from the NHANES, encompassing a sample of 10,496 adults from the 2003–2018 cycles, focusing on serum levels of several PFAS. The presence of RA was determined based on self-reports. This study used multivariable logistic regression to assess the relationship between individual PFAS and RA risk, adjusting for covariates to calculate odds ratios (ORs). The combined effects of PFAS mixtures were evaluated using BKMR, WQS regression, and quantile g-computation. Additionally, sex-specific associations were explored through stratified analysis.ResultsHigher serum PFOA (OR = 0.88, 95% CI: 0.79, 0.98), PFHxS (OR = 0.91, 95% CI: 0.83, 1.00), PFNA (OR = 0.87, 95% CI: 0.77, 0.98), and PFDA (OR = 0.89, 95% CI: 0.81, 0.99) concentration was related to lower odds of RA. Sex-specific analysis in single chemical models indicated the significant inverse associations were only evident in females. BKMR did not show an obvious pattern of RA estimates across PFAS mixture. The outcomes of sex-stratified quantile g-computation demonstrated that an increase in PFAS mixture was associated with a decreased odds of RA in females (OR: 0.76, 95% CI: 0.62, 0.92). We identified a significant interaction term of the WQS*sex in the 100 repeated hold out WQS analysis. Notably, a higher concentration of the PFAS mixture was significantly associated with reduced odds of RA in females (mean OR = 0.93, 95% CI: 0.88, 0.98).ConclusionsThis study indicates potential sex-specific associations of exposure to various individual PFAS and their mixtures with RA. Notably, the observed inverse relationships were statistically significant in females but not in males. These findings contribute to the growing body of evidence indicating that PFAS may have immunosuppressive effects.

Rheumatoid Arthritis and Its Implications on Inflammatory Bowel Disease.

The association between inflammatory bowel disease (IBD) and arthritis has long been known, but it was not until the 1950s that IBD-associated arthritis was recognized as a distinct pathology independent from rheumatoid arthritis (RA). There is evidence that RA and other autoimmune conditions exist at higher rates in patients with IBD compared to the general population. We aimed to determine if the presence of RA in IBD patients is a factor for mortality and IBD-related surgery in this population. Using Epic's Slicer Dicer function, we queried the International Classification of Diseases, 10th Revision (ICD-10) codes K50 and K51 to identify patients with IBD. Duplicates and those with incomplete information were excluded, leaving a total of 3,613 patients. Data collected included basic demographic information, surgical history, and the presence of RA. We used Student's t-test to analyze between group differences for the continuous variables. When it was determined that variances for the comparisons of continuous data were unequal, Welch-Satterthwaite t-test statistics were used. We used the Chi-square test to analyze between group differences for the categorical variables. The Fisher's exact test was employed when any of the expected frequencies was 5 or less. All tests were two-sided with criterion for statistical significance at a P value less than 0.05. All the analyses were done by SAS 9.4 (SAS Institute, Cary, NC). Of the approximately 2.7 million adults in Slicer Dicer, there were 3,613 patients (0.13%) identified with IBD. Patients with ulcerative colitis (UC) accounted for 37% of the total group (n = 1,343) and 2,270 patients (62.8%) had Crohn's disease (CD). From the total, 2,084 were women (57.68%) and 1,529 (42.32%) were men. More than 90% of the patients were white (n = 3,321). The mean age was 53.3 ± 18.5. Eight hundred forty-eight patients (23.47%) had documented RA. Mortality was higher in patients with IBD and RA than those with IBD alone (7.31% vs. 3.98%, P value ≤ 0.0001). IBD patients with RA have higher mortality rates and need for IBD-related surgery than patients with IBD alone.

INFLAMMATORY BOWEL DISEASE AND RHEUMATOID ARTHRITIS

Abstract Inflammatory bowel disease has been associated with arthritis since the late 20th century, but it was not until a few decades ago that IBD-associated arthritis was recognized as a distinct pathology independent from rheumatoid arthritis (RA). There is evidence that RA and other autoimmune conditions exist in higher rates in patients with IBD compared to the general population. This is an important distinction because of the different pathophysiology, clinical manifestations, management, complications, and prognosis of both diseases. METHODS: This study was reviewed and approved by the University of Pittsburgh Medical Center of Central Pennsylvania Review Board. Using Epic’s SlicerDicer function, patients with Inflammatory Bowel disease were identified using ICD-10 codes (K50 and K51). Those with incomplete information or duplicated were excluded obtaining a total of 3613 patients. Data collected included basic demographic information, surgical history, and the presence of Rheumatoid arthritis. We reported continuous variables as mean (range) and categorical variables as number (percent). We used Student’s t-test to analyze between group differences for the continuous variables. When it was determined that variances for the comparisons of continuous data were unequal, Welch-Satterthwaite t test statistics were used. We used chi-square test to analyze between group differences for the categorical variables. The Fisher exact test was employed when any of the expected frequencies was five or less. All tests were 2-sided with criterion for statistical significance at a p-value less than 0.05. All the analyses were done by SAS 9.4 (SAS Institute, Cary NC). RESULTS: Of the approximately 2.7 million adults in SlicerDicer, there were 3613 patients (0.13%) identified with Inflammatory Bowel disease. Patients with Ulcerative Colitis accounted for 37% of the total group (n= 1343) and 2270 patients (62.8%) had Crohn’s Disease. From the total, 2084 were women (57.68%) and 1529 (42.32%) were men. The mean age was 53.3 +- 18.5. 848 (23.47%) had documented Rheumatoid arthritis. Mortality was higher in patients with IBD and RA than those with IBD alone (7.31% vs 3.98%, p value= <0.0001). More than 90% of the patients were white (n=3321). CONCLUSION: IBD patients with RA have higher mortality than patients with IBD alone.

Impact of fibromyalgia and related factors on foot function and quality of life: Cross-sectional study

BackgroundThe aim of study is to examine the factors that may influence pain, disability and the limitation of activity due to the presence of fibromyalgia in the foot. Methods323 patients diagnosed with fibromyalgia were recruited. Each participant completed the Foot Function Index questionnaire (FFI) and the Revised Fibromyalgia Impact Questionnaire (FIQR). A multivariate analysis was performed to determine the factors associated with high scores in each of these questionnaires. ResultsIn both questionnaires, the subscales presenting the highest scores were foot pain (FFI score: 71.18 ± 20.40) and symptom intensity (FIQR score: 36.23 ± 8.04). According to the multivariate analysis, foot function is influenced by age (p = <0.001), BMI (p = 0.001), lack of physical activity (p = <0.001), the presence of rheumatoid arthritis (p = 0.012), retirement due to disability (p = <0.001) and being unemployed (p < 0.001). ConclusionFibromyalgia affects foot function, provoking significant pain. Related factors include age, BMI, lack of physical activity, the presence of rheumatoid arthritis, and employment status.

Aortic Stenosis Risk in Rheumatoid Arthritis

Although an increased risk of ischemic cardiovascular disease has been associated with rheumatoid arthritis (RA), the risk of aortic stenosis (AS) is unknown. To examine the risk of incident AS, aortic valve intervention, AS-related death, and risk factors for AS development in patients with RA. This cohort study linked data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services from 2000 to 2019. Patients with RA were matched by age, sex, and VHA enrollment year with up to 10 patients without RA. The cohort was followed until incident AS, aortic valve intervention, or death. Data were analyzed from August 23, 2022, to March 3, 2023. the primary exposure was the presence of RA, defined using validated RA algorithms. Aortic stenosis was defined as a composite of inpatient or outpatient diagnoses, surgical or transcatheter aortic valve replacement, or AS-related death using diagnostic and procedural codes. Risk of AS development was assessed with multivariable Cox proportional hazards models adjusted for race, ethnicity, smoking status, body mass index, rurality, comorbidities, and health care use. The cohort included 73 070 patients with RA (64 008 [87.6%] males; mean [SD] age, 63.0 [11.9] years) matched with 639 268 patients without RA (554 182 [86.7%] males; mean [SD] age, 61.9 [11.7] years) and 16 109 composite AS outcomes that occurred over 6 223 150 person-years. The AS incidence rate was 3.97 (95% CI, 3.81-4.13) per 1000 person-years in patients with RA and 2.45 (95% CI, 2.41-2.49) per 1000 person-years in the control patients (absolute difference, 1.52 per 1000 person-years). Rheumatoid arthritis was associated with an increased risk of composite AS (adjusted hazard ratio [AHR], 1.48; 95% CI, 1.41-1.55), aortic valve intervention (AHR, 1.34; 95% CI, 1.22-1.48), and AS-related death (AHR, 1.26; 95% CI, 1.04-1.54). In this cohort study, RA was associated with a higher risk of developing AS and the subsequent risks of undergoing aortic valve intervention and suffering from AS-related death. Future studies are needed to confirm whether valvular heart disease, specifically AS, may be an overlooked cardiovascular disease complication in RA.

Evaluation of CTLA-4 (+ 49A/G) polymorphism association with rheumatoid arthritis in Egyptian patients

Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) is an inhibitory molecule that has an essential role in T-cell homeostasis and self-tolerance because of its inhibitory signals. Genetic polymorphisms in the CTLA-4 gene have been associated with several autoimmune diseases. We aimed to assess the association between the CTLA-4 +49 A/G polymorphism (rs231775) and rheumatoid arthritis (RA) in Egyptian RA patients. The study included 104 RA patients and 81 apparently healthy control individuals. The polymorphism was assessed using restriction fragment-length polymorphism analysis. Genotype distribution was compared between patients and controls under different models of inheritance. Under the codominant model, RA patients showed a higher frequency of AG and GG genotypes compared to the control subjects (p=0.0092). Under the dominant model, RA patients showed a higher frequency of AG and GG genotypes grouped together compared to control subjects (p=0.0026). Under the over-dominant model, the AG genotype was more frequent in RA patients compared to control subjects (p= 0.0395). No association was observed between CTLA-4 polymorphism rs231775 and RA using the recessive model (p=0.1356). A significant association was observed between carrying the G allele and the presence of RA (p=0.0032). In conclusion, our findings showed a positive association between the CTLA-4 gene +49 A&gt;G polymorphism and RA. However, discrepancies in literature reflect both ethnic variability in CTLA-4 gene polymorphisms as well as the complex pathogenesis of RA.

Association of rheumatoid arthritis with bronchial asthma and asthma-related comorbidities: A population-based national surveillance study.

The aim of this study was to investigate the impact of rheumatoid arthritis (RA) on the prevalence of bronchial asthma and asthma-related comorbidities. We also aimed to identify the influence of RA on interrelationship between asthma and asthma-related comorbidities. From the Korean National Health and Nutrition Examination Survey, participants >40 years of age who completed questionnaires and spirometry tests were enrolled. Patient data on RA, asthma, allergic rhinitis, atopic dermatitis, chronic obstructive pulmonary disease (COPD), sinusitis, otitis media, and body mass index (BMI) were collected. Logistic regression and network analyses were performed. A total of 14,272 subjects were enrolled, among which, 334 (2.4%) had RA. RA was significantly associated with asthma (OR 2.32; 95% CI 1.51-3.57), allergic rhinitis (OR 1.51; 95% CI 1.08-2.10), and sinusitis (OR 1.64; 95% CI 1.08-2.50). The network analysis of total patients revealed a positive interrelationship between asthma and allergic rhinitis, sinusitis, otitis media, atopic dermatitis, BMI, and RA. The interrelationship between asthma and sinusitis was stronger in the RA group. Of note, the relationship between asthma and BMI was distinctively found only in the RA group (r = 0.214, P < 0.05). In patients with asthma, the prevalence of obesity was 64% in the presence of RA, and 40% in the absence of RA (P = 0.034). This study supports the positive association of RA with asthma, allergic rhinitis, and sinusitis. Our analysis suggests a notable interrelationship between the presence of asthma and higher BMI values in patients with RA, indicating that asthma is more obesity-related in patients with RA.

Vascular health in subjects with rheumatoid arthritis: assessment of endothelial function indices and serum biomarkers of vascular damage.

The cardiovascular risk (CVD) in patients with rheumatoid arthritis (RA) is 1.5-2 times higher than that in individuals of the same age and sex. To analyse the degree of endothelial dysfunction, the atherogenic immunoinflammatory serum background and the relationships among some vascular indices, cardiovascular comorbidities, and cognitive performance in subjects with RA. All consecutive patients with a rheumatoid arthritis diagnosis admitted to the Rheumatology Ward of "Policlinico Paolo Giaccone" Hospital of Palermo were enrolled from July 2019 to September 2020. We evaluated our patients' cognitive functions by administering the Mini-Mental State Examination (MMSE). Reactive Hyperaemia Index (RHI) was evaluated for assessment of endothelial function. Serum levels of angiopoietin 2, osteopontin and pentraxin 3 were assessed by blood collection. Fifty-eight consecutive patients with RA and 40 control subjects were analysed. RA patients showed significantly lower mean RHI values, significantly higher mean Augmentation Index (AIX) values and significantly lower mean Mini-Mental State Examination (MMSE) score values than the control group. Patients with rheumatoid arthritis also showed higher mean serum values of pentraxin 3 and angiopoietin 2 than healthy controls. Multivariate logistic regression analysis showed a significant association between pentraxin 3 and angiopoietin 2 and the presence of RA. Angiopoietin 2 and pentraxin 3 could be considered surrogate biomarkers of endothelial activation and vascular disease, as they could play an essential role in the regulation of endothelial integrity and inflammation.

Evaluation of serum levels of c-reactive protein after total knee arthroplasty in patients with rheumatoid arthritis

Objective: The objective of this study is to evaluate the serum levels of C-reactive protein in the first three weeks after total knee arthroplasty, in patients with knee osteoarthritis secondary to rheumatoid arthritis and a control group. Methods: This is a prospective study evaluating 30 patients with knee osteoarthritis secondary to rheumatoid arthritis who underwent total knee arthroplasty between January 2015 and March 2017. A control group of patients submitted to total knee arthroplasty by primary osteoarthritis was created with data from the institution’s database. The proportion was of three controls for each case and the criteria used for pairing were age, gender, ethnicity and body mass index. Serum C-reactive protein was measured on the day before, and on the third and twenty-first days after the procedure in all patients. Results: No statistically significant changes were found between the case and control groups for the C-reactive protein levels evaluated nor their variations. The results suggest that the presence of rheumatoid arthritis does not interfere in the postoperative response of C-reactive protein. Conclusion: The serum values of C-reactive protein after TKA do not differ between patients with primary or secondary osteoarthritis to RA. Thus, the reference values can be considered equal in both cases.

Impact of disease burden or inflammation on nutritional assessment by the GLIM criteria in female patients with rheumatoid arthritis.

In 2018, the Global Leadership Initiative on Malnutrition (GLIM) released a global standard for evaluating malnutrition. The etiologies of malnutrition in the GLIM criteria includes disease burden/inflammation, but how this view affects nutritional assessment remains unclear. This study aimed to investigate the impact of disease burden/inflammation on the proportion of malnourished patients defined by GLIM criteria, and how differences in methods for determining disease burden/inflammation in GLIM criteria affect existing nutritional indices among patients with rheumatoid arthritis (RA). We also investigated factors associated with malnutrition in RA patients. Data from 135 female RA patients (66.8±12.6 years) were cross-sectionally analyzed. Among the etiologies of malnutrition, disease burden/inflammation was defined as: (1) moderate or higher disease activity score (disease activity score composite of the 28-joint score and erythrocyte sedimentation rate [DAS28-ESR] ≥ 3.2) [DAS-malnutrition (MN)]; (2) elevated C-reactive protein (CRP) ≥0.5mg/dL (CRP-MN); and (3) presence of RA (RA-MN). In each of the three conditions, nutritional indicators between well-nourished and malnourished groups were compared by analysis of covariance. Factors associated with malnutrition were analyzed with logistic regression analysis. The frequencies of malnutrition as defined by DAS-MN, CRP-MN, and RA-MN were 39%, 30%, and 71%, respectively. When malnutrition was defined by the DAS-MN and/or the CRP-MN, grip strength and serum ceruloplasmin, iron, and zinc levels showed significant differences between the well-nourished and malnourished groups (p<0.05). The use of targeted synthetic or biological disease-modifying antirheumatic drugs (ts-/b-DMARD) (OR=0.29; 95% CI 0.11-0.82), grip strength (OR=0.83; 95% CI 0.75-0.91), subjective reduction in walking speed (OR=5.24; 1.85-14.86) were significantly associated with malnutrition as determined by DAS-MN. Differences in disease burden/inflammation affect nutritional assessments. The number of malnourished patients with RA was negatively associated with the use of ts-/b-DMARDs and high physical function in women.

Association of Methicillin-Resistant Coagulase-Negative Staphylococci on Preoperative Skin and Surgical Site Infection in Patients Undergoing Spinal Surgery: A Retrospective Cohort Study.

The aim of this study was to investigate the association of methicillin-resistant coagulase-negative staphylococci (MRCNS) on preoperative skin and surgical site infections (SSIs) in patients undergoing spinal surgery. A total of 507 cases (239 males and 268 females; mean age: 56.1 years) were included in this retrospective study, using prospectively collected data. All patients underwent skin culturing of the surgical site preoperatively. To identify independent risk factors for SSIs as the dependent variable, sequential multivariate logistic regression analyses were conducted. Age, sex, body mass index, presence of rheumatoid arthritis (RA), steroid uses, the American Society of Anesthesiologists Physical Status (ASA-PS) ≥3, MRCNS-positivity on skin bacterial culture, instrumentation, and Japanese Orthopedic Association (JOA) score were used as independent variables. Preoperatively, MRCNS was detected from skin culture in 50 (9.9%) cases. The frequency of RA, steroid uses, and ASA-PS ≥3 was significantly higher in MRCNS-positive cases than in MRCNS-negative cases. There were 21 (4.1%) post-spinal surgery SSI cases. Multivariate logistic regression analyses revealed that JOA scores (odds ratio (OR), 0.864; 95% confidence interval (CI), 0.764-0.977) and MRCNS-positivity (OR, 5.060; 95% CI, 1.787-14.323) were significantly associated with SSIs. Preoperatively, the incidence of MRCNS was 9.9%; it was the most common cause of postoperative SSIs. MRCNS-positivity was the most associated factor for SSIs.

Factors Affecting Patient Reported Outcomes after Surgical Fixation of Lisfranc Injury

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: The Lisfranc joint accounts for a small percentage of all fractures and is typically caused by trauma, high falls, or from athletic injuries. The treatment can be divided into operative and non-operative management based on the extent of the injury. Currently, as to the best of our knowledge, there is no literature that assesses patient reported outcomes after surgical intervention for Lisfranc injuries. This study provides an overview of the relationship between PROMIS scores and overall outcomes of patients who underwent surgical management for Lisfranc injury. Methods: A retrospective analysis was conducted for patients that underwent Lisfranc surgical repair at our facility from 2010- 2020. Using the electronic medical record (EMR), basic patient demographics, mechanism of injury, presence of rheumatoid arthritis, osteopenia/osteoporosis, time from injury to surgery, type of intervention utilized (ORIF, pinning, arthrodesis), use of bone grafting, and surgical complications were recorded. To evaluate outcomes, we used the Patient Reported Outcomes Measurement Information System (PROMIS) survey and Foot Function Index (FFI) scores. Results: A total of 248 patients met the criteria for our study with 80 participants completing both the PROMIS and FFI surveys. The average PROMIS physical function, pain interference, and depression scores were reported as 43.2, 55.4, and 45.4, respectively. The average FFI scores in this population are as follows: FFI pain- 37.1, FFI disability- 34.2, FFI activity limitation- 12.35, and the average FFI total score was 30.95. There was a significant decrease in postoperative pain scores when compared to preoperative pain from 5.23 to 1.85 (p=0.046). Complications were fairly low in this population with 4 patients experiencing surgical site infection, 36 patients described problematic hardware, and 45 patients underwent revisional surgery. Conclusion: Preliminary results suggest surgical intervention for Lisfranc injuries may be viewed as satisfactory amongst patients. Further analysis to compare patient reported outcomes based on the type of surgical intervention, hardware used for fixation, and whether any patient demographic factors have any influence on these outcomes are being conducted. Our fairly large patient population has a time from surgery date ranging from 1.5 years to 11.2 years. We believe further analysis will also provide quality information on the long-term outcomes regarding Lisfranc injuries

Five-Year Minimum Patient-Reported Outcomes Following Isolated Gastrocnemius Recession for Plantar Fasciitis and Achilles Tendinopathy

Category: Hindfoot; Other Introduction/Purpose: Plantar fasciitis and Achilles tendinopathy are common foot and ankle overuse conditions encountered in clinical practice. Treatment modalities for these diagnoses vary however, isolated gastrocnemius recession may be a viable treatment option for these conditions when conservative management has failed. There is little published on the long-term outcomes of this procedure with very few studies able to report on the five-year reported outcomes in these patients. Here, we assess patient-reported outcome in those with a minimum of five-year follow up that underwent isolated gastrocnemius resection for the above indications. Methods: A retrospective analysis of patients that underwent gastrocnemius recession at our facility from 2011 to 2018 was conducted. Patients were selected if they underwent an isolated gastrocnemius recession specifically due to Achilles tendinopathy or plantar fasciitis. Patients were excluded if they had a history of musculoskeletal disorders of a history of previous recession. Basic patient demographics, chronic use of fluoroquinolones and NSAIDs, duration of symptoms, presence of rheumatoid arthritis, history of previous foot and ankle operations, and surgical complications were all recorded. To evaluate outcomes, we utilized Foot Function Index (FFI) scores as well as the Patient Reported Outcomes Measurement Information System (PROMIS) survey. Results: A total of 141 patients met inclusion criteria with all individuals completing both the PROMIS survey and 115 completing the FFI survey. The average time point at which outcomes were collected was 6.6 years postoperatively. Postoperative PROMIS scores for physical function, pain interference, and depression were all within one standard deviation of the reference population. The average PROMIS physical function, pain interference, and depression scores for this population was 45.67, 50.87, and 41.20, respectively. The mean FFI scores were 28.58 for pain, 36.11 for disability, 21.11 for activity limitation with an average total FFI of 31.40. Six patients developed surgical site infection, 36 patients reported postoperative symptoms of sural neuropathy with 12 reporting complete resolution of the neuropathy, and four patients required revisional surgery. Conclusion: With the limited data regarding the long-term outcomes of gastrocnemius recession, we sought to explore patient- reported outcomes in terms of pain, disability, physical function, depression, and pain interference. Our results prove that gastrocnemius recessions for Achilles tendinopathy and plantar fasciitis can lead to long term satisfaction for patients and can expect relatively low complication rates during the process. Additionally, the high retention rate of patients answering all required patient surveys further strengthens the findings reported here.

Correlation between the Control of Blood Glucose Level and HbA1C and the Incidence of Surgical Site Infection after Emergent Surgery for the Lower Limb Fracture among Type II DM Patients Aged More Than 50 Years Old.

This is the first study focusing on perioperative blood glycemic monitoring for the incidence of surgical site infection (SSI) among patients with type II DM (T2DM) during the 1-year follow-up after emergent orthopedic surgery. We retrospectively collected the data of 604 patients who had received surgery for unilateral lower limb traumatic fracture from January 2011 to January 2021, including 215 men and 389 women with a mean age of 71.21 and a mean BMI of 25.26. In total, 84 (13.9%) of them developed SSI during the 1-year follow-up. Higher preoperative and postoperative -3-month hemoglobin A1c (HbA1c) and AC blood glucose and the presence of rheumatoid arthritis were all associated with increased rates of SSI. The thresholds for predicting SSI were the following: (1) preoperative HbA1c > 7.850% (area under curve [AUC] = 0.793); (2) postoperative HbA1c > 6.650% (AUC = 0.648); (3) preoperative AC blood glucose > 130.50 mg/dL (AUC = 0.773); and (4) postoperative AC blood glucose > 148.5 mg/dL (AUC = 0.709) by receiver-operating characteristic curve method. These findings may provide a useful control guideline for patients with T2DM older than 50 years old and who received surgery for a lower limb fracture in the prevention of postoperative SSI.

Folic acid and methotrexate use and their association with COVID-19 diagnosis and mortality: a case–control analysis from the UK Biobank

ObjectiveTo determine if methotrexate or folic acid prescription was associated with differential risk for COVID-19 diagnosis or mortality.DesignCase–control analysis.SettingThe population-based UK Biobank (UKBB) cohort.ParticipantsData from 380 380 UKBB participants with...

Assessment of TNF-α expression in unstable atherosclerotic plaques, serum IL-6 and TNF-α levels in patients with acute coronary syndrome and rheumatoid arthritis.

The role of inflammatory cytokines is well researched in acute coronary syndrome (ACS) and rheumatoid arthritis (RA), but not in the presence of both conditions. This study aimed to compare TNF-α expression, serum TNF-α, IL-6, and hs-CRP in ACS patients with RA (n = 46) with ACS patients without RA (n = 49) and healthy controls (n = 50). TNF-α expression was assessed from coronary artery samples, taken during coronary artery bypass surgery. Serum levels TNF-α, IL-6, and hs-CRP were measured 24 and 48h after cardiac surgery. Stronger TNF-α expression was observed in the ACS patients with RA versus the ACS patients without RA, p = 0.001. Serum TNF-α, IL-6, and hs-CRP at the 24thh were significantly elevated in both patient groups and distinguished them from the healthy controls with accuracy ranging from 80 to 99%. At the 48th h, serum TNF-α and IL-6 in the ACS group without RA decreased to those of the healthy controls but remained high in the group with RA. ACS cases with RA could be correctly identified from the levels of IL-6 (AUC = 0.885, 95% CI 0.791 to 0.938) and TNF-α (AUC = 0.852, 95%CI 0.720 to 0.922). Our results suggest that the presence of RA in ACS cases is likely to provoke stronger TNF-α expression on atherosclerotic plaques, aggravate the pro-inflammatory response, and sustain it even after the cardiac stress is lowered. In ACS cases with RA, long-term monitoring and control of TNF-α and IL-6 levels can be a useful preventive strategy.

POS0609 STRESS-ASSOCIATED INCREASES IN RHEUMATOID ARTHRITIS DISEASE ACTIVITY AND FLARES DURING THE COVID-19 PANDEMIC

BackgroundThe novel coronavirus disease 2019 (COVID-19) pandemic has spurred global action. Beginning in March of 2020, the Southern California COVID-19 pandemic response to limit virus transmission was characterized by mandated lockdowns and quarantines, resulting in significant stressors for rheumatology patients and potentially threatening their disease.ObjectivesTo examine factors associated with changes in rheumatoid arthritis (RA) disease activity and flares in the COVID-19 pandemic.MethodsRA patients identified by ICD-9/10 codes and active email addresses within a University of California, Los Angeles (UCLA) Rheumatology database were sent surveys via email in July and November of 2020. The survey was UCLA Institutional Review Board approved and included electronic consent and questions related to: perceptions of disease activity/remission via Routine Assessment of Patient Index Data 3 (RAPID3), flare frequency, RA flare questionnaire (RA-FQ), Perceived Stress Scale (PSS-4), and pandemic impact on stress (i.e. emotional state, apprehension, panic, helplessness, work, home, financial, and social distancing stress). Demographics were extracted from electronic medical records. Results were examined via descriptive analyses, Pearson correlations, and chi-square test for comparisons plus linear stepwise regressions where appropriate to evaluate the relationship between stress measures, RA disease activity, and flare frequency and severity.ResultsAmong 5037 patients surveyed, 361 in July and 4676 in November,1128 (22.4%) responded. The study population demographics were: mean age of 57.5 ± 15.1 years, 79.4% female, racially diverse (69.6% Caucasian, 13.7 % LatinX, 9.5 % Asian, and 4.9% Black), and 62% seropositive (CCP and/or RF). Perceived disease activity and remission remained stable in most patients with 719 reporting no flares, and 409 in current flares at the time of the survey (Table 1). A minority reported perceived increases in disease activity which were associated with multiple aspects of perceived stress. At survey completion, 346 had not experienced flares, 290 had experienced one flare, and 492 had experienced multiple flares. Use of DMARDs was associated with lack of flare versus current flare (77.8% versus 71.6%, p = 0.02). The use of conventional synthetic, biologic, or targeted synthetic DMARDs were not associated with flare while current corticosteroid use was associated with flare (9.3% without flare and 20.8% with flare, p &lt; 0.0001). Current flare was associated with increased PSS-4 scores (odds ratio (OR): 1.17 (95% confidence interval: 1.12 – 1.22, p &lt; 0.0001). Figure 1 describes the odds ratio of experiencing aspects of stress with the presence of RA flare.Table 1.Current RA flare at time of survey completionCurrent FlareCurrent Flare YesP-ValueNoN=409N=719RA duration (mean ± SD) years15.6 ± 12.314.9 ± 11.60.3133Patient Global (mean ± SD), range 0-103.5 ± 2.56.1 ± 2.2&lt;0.0001RAPID3 (mean ± SD) range 0-306.1 ± 5.613.7 ± 5.7&lt;0.0001Patient-Reported Remission, no. (%)404 (57.1%)49 (12.1%)&lt;0.0001RA-FQ Score, (mean ± SD), range 0-5013.4 ± 11.429.7 ± 10.8&lt;0.0001PSS-4, (mean ± SD)5.2 ± 3.16.9 ± 3.1&lt;0.0001Overall stress level (%)0.0004 Increased62.3%72.9% Unchanged26.9%21.8% Decreased10.7%5.4%Current RA Therapy Any DMARD77.8%71.6%0.0218 csDMARD Only31.4%26.7%0.0911 bDMARD Only18.1%16.9%0.6082 tsDMARDs Only3.3%3.4%0.9394 bDMARD + csDMARD Only19.8%19.8%0.9823 tsDMARD + csDMARD Only4.6%4.9%0.8188Current Corticosteroid9.3%20.8%&lt;0.0001SD = standard deviation; No. = number; RA = rheumatoid arthritis; RAPID3 = routine assessment of patient index data 3; RA-FQ = rheumatoid arthritis flare questionnaire; PSS-4 = perceived stress scale; D/C = discontinued; DMARD = disease modifying antirheumatic drugs; csDMARD = conventional synthetic DMARD; bDMARD = biologic DMARD; tsDMARD = targeted synthetic DMARDConclusionIn a large survey population of RA patients during the COVID-19 pandemic, multiple aspects of stress were found to correlate with RA disease activity and flare.Disclosure of InterestsDaniel Furst Consultant of: Corbus; Galapagos; Novartis; Amgen, Grant/research support from: Actelion; Galapagos; National Institutes of Health; GlaxoSmithKline; Sanofi; Corbus; Pfizer; Novartis; Amgen; Bristol Myers Squibb; Roche/Genentech, Nicolette T Morris: None declared, Angela Q Pham: None declared, Thasia Woodworth: None declared, David Elashoff: None declared, Jenny Brook: None declared, Veena Ranganath Grant/research support from: Bristol Myers Squibb; Mallinckrodt Pharmaceuticals

P141 What are the predictors of fragility fracture in patients with low body mass index: an observational cohort study

Abstract Background/Aims Low body mass index (BMI) is known to be associated with increased risk of fracture and therefore measurements of height and weight contribute towards the Fracture Risk Assessment Tool (FRAX) score, an estimation tool used to calculate approximate risk of fracture to guide therapy decisions. However, data is lacking on which measurement of bone mineral density is best in those that are underweight. Using a large population of patients with low BMI, we aimed to determine which measurement of bone mineral density (BMD) is the most accurate predictor of fragility fracture in this group of patients. We also aimed to explore the relationship of other traditional risk factors for fracture in this subpopulation. Methods Data on risk factors for osteoporosis and fragility fractures was collected on patients presenting for BMD estimation at a district general hospital in North West England between June 2004 and October 2016. All analysis was performed on those with low BMI, defined as &amp;lt; 18.5kg/m2. Firstly, univariate logistic regression was performed to assess risk of fracture using BMD for lumbar spine, femoral neck and total hip; as well as smoking, alcohol use, presence of rheumatoid arthritis, history of steroid use and history of hip fracture in a parent. Risk factors were defined as per FRAX. This was followed by multivariate regression of available risk factors, using the best BMD predictor identified from univariate analysis. All models were controlled for sex and age at first scan. Results for continuous variables are reported as beta coefficients and for categorical variables as odds ratios. All results are reported with 95% confidence intervals. Area under ROC curve for each model was calculated. Results 921 of 35,759 patients had a BMI of under 18.5 and were included in analysis. Of these, 88.4% were female, mean age at time of scan was 58.6 years. Results are shown in the table. Conclusion In those with low BMI, BMD of left total hip was the best predictor of fragility fracture. Smoking, alcohol use and history of hip fracture were also associated, but previous steroid use and diagnosis of rheumatoid arthritis was not. Disclosure S.D. Sharma: None. M. Bukhari: None.