Midland Rheumatology Society



Midland Rheumatology Society

Spring Meeting

Friday 14th March 2014

Pedigree Suite, iPro Stadium, Pride Park, Derby, DE24 8XL

09:00 Coffee and Registration

10:00 Welcome and Introduction

10:05 “Hepatology for Rheumatologists”

Dr Andrew Austin, Consultant Hepatologist

Royal Derby Hospital

10:45 Clinical cases (Derby team)

11:45 Coffee break & Poster viewing

12:00 Clinical papers

1. Can we replace temporal artery biopsy with cranial ultrasound for the diagnosis of giant cell arteritis? A retrospective cohort study of the diagnostic utility of ultrasound in routine clinical practice

Adam P. Croft, Nicola Thompson, Martin Duddy, Fazal Khattak, Susan Mollan and Paresh Jobanputra

2. Health Related Quality Of Life in gout: cross-sectional analysis from a prospective cohort study.

P Chandratre, C Mallen, S Muller, J Richardson, S Hider, K Rome and E Roddy

3. Progressive Strength Training in Rheumatoid Arthritis: Interim Results from a Service Review of the Derby Body-Sculpt Programme  

Sue Kennedy, Anne Hardy, Ruth Machej and Tony Moore

4. Out-patient management of gout by rheumatologists in the East and West Midlands: the BSR national gout audit

Edward Roddy, Jon Packham, Karen Obrenovic, Jo Ledingham

13:00 Lunch & Poster viewing

14:00 BSR Update

14:30 Clinical papers

Long-term efficacy and safety of Rituximab in ANCA associated vasculitis

Fiona Pearce, Anshul Sama, Alastair Ferraro, Simon Johnson, Peter Lanyon

5. Safety of Topical NSAIDs – a meta-analysis of randomised controlled trials (RCTs) and observational studies Rakesh Kumari, Michael Doherty, Weiya Zhang

6. Birmingham’s National Behçet’s Centre: the first year!

Carolyn Bell, Tracey Toms, David Carruthers, Philip Murray, Yiota Stavrou, A Denniston, D Mitton, J Hamburger, A Richards, Deva Situnayake

7. Implementation of treat to target for Early Rheumatoid arthritis patients in Cannock

Subhra Raghuvanshi, Shilpa Jagadeesh, Cauline Molloy, Jacky McPeake, Barbara Doughlas, Deborah Lloyd, Abdul Baker, T Sheeran, S Venkatachalam

15:30 Coffee break & Poster viewing

15:45 “Dermatology for Rheumatologists”

Dr Tanya Bleiker, Consultant Dermatologist,

Royal Derby Hospital

16:30 “BSR President 2012-2014 – A retrospective, non randomised, semi-blind, cross-dressing, alcohol-fuelled, observational study”

Dr Chris Deighton ,Consultant Rheumatologist, Royal Derby Hospital,

President of British Society for Rheumatology

17:15 Close

17:30 Tour of the iPro Stadium

18:30 Drinks reception and dinner at the iPro Stadium

RCP approved - CPD code number 88146

The meeting is kindly sponsored by

UCB, Chughai, Pfizer, Abbvie, Actelion and MSD

Chugai Pharma UK/Roche has provided payment for an exhibition stand space at this educational meeting and have had no control over the agenda and arrangements

Clinical Papers

CAN WE REPLACE TEMPORAL ARTERY BIOPSY WITH CRANIAL ULTRASOUND FOR THE DIAGNOSIS OF GIANT CELL ARTERITIS? A RETROSPECTIVE COHORT STUDY OF THE DIAGNOSTIC UTILITY OF ULTRASOUND IN ROUTINE CLINICAL PRACTICE

Adam P. Croft1, Nicola Thompson2, Martin Duddy2, Fazal Khattak3, Susan Mollan2 and Paresh Jobanputra2

1Centre for Translational Inflammation Research, University of Birmingham, 2Department of Rheumatology, Queen Elizabeth Hospital, Birmingham, UK. 3Department of Radiology, Queen Elizabeth hospital, Birmingham, UK. 4Department of Rheumatology, Sandwell and West Birmingham NHS Trust

Background: Temporal artery biopsy (TAB) has historically been considered the ‘gold standard’ diagnostic test for Giant Cell Arteritis (GCA). However, the potential for false negative results due to segmental vascular inflammation (up to 44% of patients with GCA have a normal biopsy) means that a negative biopsy result rarely informs clinical decision-making but a positive result does provide almost definitive confirmation of the diagnosis. The aim of this study was to evaluate the diagnostic utility of cranial duplex ultrasound (CDUS) in patients with a suspected diagnosis of GCA in routine clinical practice.

Methods: All patients undergoing CDUS between Jan 2005 and July 2013 were identified and clinical data obtained from electronic records, and, if necessary primary care providers. American College of Rheumatology (ACR) criteria for GCA (3 or more of: age >50 years, a new headache, abnormal temporal artery palpation, ESR >50mm and an abnormal temporal artery biopsy) were used to classify patients. US reports were independently classified according to whether there was evidence of an arteritis or not. Explicit US features of GCA such as a halo sign were not required to make this determination. The relationship between the ACR criteria alone or in combination with US and a final clinical diagnosis of GCA (made after a minimum of 3-month follow-up) was analysed. A clinical diagnosis of GCA after 3 months of follow up served as our gold standard. The sensitivity and specificity of CDUS and of TAB were examined against our gold standard.

Results: A total of 87 patients underwent CDUS for suspected GCA. 36 patients (41%) had a confirmed clinical diagnosis at 3-month follow-up. When compared to clinical diagnosis at 3 months, the sensitivity of CDUS was 81%, specificity 98%, positive likelihood ratio 41, negative likelihood ratio 0.2, positive predictive value of 97% and negative predictive value of 88%. In contrast, when compared to clinical diagnosis at 3 months TAB had a sensitivity of 53%, specificity 100%, positive likelihood ratio 2.3, negative likelihood ratio 0.2, positive predictive value of 100% and negative predictive value of 47%. Detailed data for comparison of ACR criteria and ultrasound for prediction of 3-month clinical diagnosis is shown in Table 1.

Conclusions: CDUS had a greater sensitivity than TAB and a comparable specificity to diagnose GCA. The CDUS result was the strongest predictor for a diagnosis of GCA at 3 months, whereas ACR criteria when used alone were insufficiently specific to accurately predict or exclude the diagnosis of GCA at 3 months. In contrast, the high positive and negative predictive value of CDUS over TAB indicates that TAB may be unnecessary particularly where clinical suspicion of GCA is high or quite low.

Table 1: Summary of descriptive data & likelihood ratios

| |Total (%) |Diagnosed GCA |Positive likelihood ratio (95% |Negative likelihood ration (95% |

| | | |Confidence interval) |confidence interval) |

|All patients |87 (100%) |36/87 (41%) |- |- |

|ACR Criteria +ve (>3) |36 (41%) |21/36 (58%) |2.2 (1.3-3.6) |0.5 (0.3-0.8) |

|CDUS +ve |30 (34%) |29/30 (96%) |41 (5.9-288) |0.2 (0.1-0.4) |

|ACR +ve and CDUS +ve |19 922%) |18/19 (86%) |25 (3.6-182) |0.51 (0.4-0.5) |

|Biopsied |24 (28%) |17/24 (71%) |- |- |

Health Related Quality Of Life in gout: cross-sectional analysis from a prospective cohort study.

Chandratre P, Mallen C, Muller S, Richardson J, Hider S, Rome K and Roddy E.

Background: Gout has a significant impact on Health Related Quality Of Life (HRQOL). Existing studies are limited by use of only generic HRQOL questionnaires or being undertaken in selective populations such as hospital clinics. We undertook the first large primary care study of gout to use both disease-specific and generic HRQOL questionnaires.

Objectives: To investigate the cross-sectional associations between socio-demographic, comorbid and gout characteristics and HRQOL using the Health Assessment Questionnaire Disability Index (HAQ-DI), Short-Form 36 Physical Function subscale (PF10) and Gout Impact Scale (GIS).

Method: Patientswith gout registered with 20 UK general practices were identified by gout consultationsor prescriptions for colchicine or allopurinol in the preceding 2 years. 1805 eligiblepatientswere mailed a questionnaire to ascertain self-reported gout characteristics, comorbiditiesand HRQOL. Serum uric acid and tophi were ascertained from consentingparticipants’ medical records. Differences between mean scores of HRQOL were assessed using t test and analysis of variance (ANOVA). Associations between HRQOL and independent variables were assessed in univariable and multivariable linear regression models (adjusted for age, gender, socio-economic status and comorbidities).

Results: 1184 completed questionnaires were received (adjusted response 65.5%). Mean age (SD) of the responders was 65.63 (12.48), 83.6% were males and 95.1% Caucasian. The mean frequency (SD) of attacks over the last year was 1.66 (1.72) and 36.8% had polyarticular gout. The median (Interquartile range) dose of allopurinol was 300 mg (100 mg-300 mg). The commonest co-existing comorbidity was hypertension (61.8%).

Worse generic and gout-specific HRQOL was seenin females, current or polyarticular gout, increasing attack frequency, comorbidities (stroke and renal failure),anxiety, depression, body pain, obesity, no further education, and highest neighbourhood deprivation (p ................
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