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Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory condition with an increased risk of cardiovascular events. Diabetes is a well-established risk factor for cardiovascular disease and stroke. Multiple lines of evidence have suggested a connection between axSpA and diabetes due to inflammatory processes and shared risk factors1.Objectives:This study aimed to conduct a systematic review and meta-analyses to: (i) identify the prevalence of diabetes in axSpA and (ii) compare the risk of diabetes between axSpA and control populations.Methods:A comprehensive literature search was conducted for articles published between 1 January 2000 and 15 November 2023 using Medline, Embase and Scopus. All observational studies reporting prevalence, incidence, or risk of diabetes in axSpA were included. Studies not published in English were excluded. Search results were independently screened by at least two reviewers, and data extracted into a proforma. A meta-analysis was performed using a random-effects model. The methodological quality of each included study was assessed using the JBI critical appraisal tool. The study protocol was registered in PROSPERO (CRD42023482573).Results:In total, 2257 articles were identified, from which 23 studies were included for analysis amounting to a combined sample size of 65 025 patients. The pooled prevalence of diabetes in patients with axSpA was 7.0% (95% CI 5.0-8.0%) which was statistically significant (p=0.00). There was also a significantly higher odds of diabetes in patients with axSpA compared to controls (pooled OR 1.29, 95% CI 1.08-1.55). The funnel plot was symmetric, thereby indicating a low risk of publication bias.Conclusion:Our findings indicate that the prevalence of diabetes in patients with axSpA is high. Routine screening for diabetes and lifestyle modifications should be encouraged in this population.REFERENCES:[1] Hintenberger R, Affenzeller B, Vladychuk V, et al. Cardiovascular risk in axial spondyloarthritis-a systematic review. Clin Rheumatol 2023; 42: 2621–2633.Figure 1.Pooled prevalence of diabetes in axial spondyloarthritis.Acknowledgements:NIL.Disclosure of Interests:Leher Gumber: None declared, Harini Samarasinghe: None declared, Praveen Gladston: None declared, Arumugam Moorthy Previously received speaker fee from Ellily, Galapagos and Novartis but not related to this project.

BackgroundJAK inhibitor uptake has increased in recent years, and recent NICE (National Institute for Health and Care Excellence) approval of certain JAK inhibitors for moderate rheumatoid arthritis disease activity will likely increase this further. The EULAR guidance on the management of rheumatoid arthritis recommends JAK inhibitors as part of the treat-to-target strategy, provided certain risk factors are considered [1]. However, there remains limited data on discontinuation rates for this drug class.ObjectivesThis retrospective study aimed to measure the discontinuation rates of the four UK approved JAK inhibitors in a multi-ethnic population at a UK tertiary centre, thereby providing real-world data on the durability of the different JAK inhibitors.MethodsAll patients ever prescribed a JAK inhibitor at University Hospitals of Leicester were identified on a drug monitoring database. Discontinuation rates were calculated for each JAK inhibitor, as well as the median duration of time on each drug prior to discontinuation. The baseline characteristics of the patients who discontinued a JAK inhibitor were documented, as well as reason for discontinuation. These were categorized as either primary inefficacy, secondary inefficacy, toxic adverse events, non-toxic reasons, and disease remission.ResultsIn total, 375 patients had been prescribed a JAK inhibitor since 2018. Discontinuation rates and duration of time prior to discontinuation for each drug are shown in Table 1.Table 1.JAK inhibitor discontinuation rates and duration of use.Duration prior to discontinuation (weeks)DrugNumber of patientsProportion discontinuedMedianMinimumQ1Q3MaximumMeanStandard deviationStandard error of meanBaricitinib23351/233 (21.89%)35.000.8618.4368.14230.1049.5548.686.82Tofacitinib6133/61 (54.09%)70.295.2937.8696.93161.1072.3543.297.54Filgotinib514/51 (7.84%)13.504.716.5415.8616.1411.965.142.57Upadacitinib300/30 (0%)n/an/an/an/an/an/an/an/aFigure 1.JAK inhibitor survival proportions.Of the 88 patients who discontinued a JAK inhibitor, 86% were female and 14% male. Median age was 60 years (IQR 53-70 years), and median duration of drug intake was 45.60 weeks (IQR 19.29-74.07). Of these 88 patients, 77% were Caucasian, 20% from the Indian subcontinent, and the remaining patients mixed race, Asian other, and not stated. Furthermore, 65.9% of patients were on concomitant DMARDs, 71.6% had received a previous biologic drug (median number of previous biologics was 1 [0-2]). Diagnosis was seropositive RA (rheumatoid arthritis) in 59.1%, seronegative RA in 27.3%, PsA (psoriatic arthritis) in 11.4%, and 2.2% in RA/PsA overlap.Of the 88 patients where the JAK inhibitor was discontinued, reasons included primary inefficacy 37.5%, toxic adverse events 35.23%, non-toxic reasons 17.05%, secondary inefficacy 5.68%, disease remission 1.14%, and not stated 3.41%. Adverse events of interest included viral infections 6.81%, non-viral infections 4.54%, malignancy 2.27%, and MHRA alerts 9.09%. In this multi-ethnic population, there were no discontinuations for venous thromboembolism, or major adverse cardiovascular events, although patients are screened for risk factors prior to commencement, and MHRA alerts led to discontinuation if risk factors developed during treatment.ConclusionIn this real-world population, tofacitinib followed by baricitinib had the highest discontinuation rates. While discontinuation rates for the 2nd generation JAK inhibitors appear more promising, patient numbers were lower. The most common reasons for discontinuation were primary inefficacy and toxic adverse events. Further real-world observational data is needed, particularly from multi-ethnic patient populations, to increase confidence levels in JAK inhibitor prescribing.Reference[1]Smolen JS, Landewé RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023 Jan;82(1):3-18.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Background:Exercise is a first line nonpharmacological recommendation for inflammatory arthritis by all professional societies. However, despite the recommendations, it is often not advised, nor followed uniformly.Objectives:The aim of these study was to collect feedback from patients regarding their perception of exercise advice and physiotherapy provided, details of exercise undertaken and associated factors and comorbidities that may influence exercise patterns.Methods:A paper-based survey comprising of 22 multiple choice questions were given by clinician and nurses to patients with inflammatory arthritis who were attending routine rheumatology outpatient clinic. The questions covered basic demographic details, associated factors like smoking history, comorbidities like diabetes and heart disease, diagnosis, advice regarding exercise, physiotherapy referral and details regarding their exercise habits. They answered the survey independently in the clinic. Data was analyzed using Microsoft Excel and Prism GraphPad.Results:There were 79 paper surveys (19 males, 59 females, 1 no response) that were handed back to the coordinator. Majority (38.46%) of the respondents were 61 years or above, followed by 23.08% who were between 41-50 years. 53.16% were employed and rest were not working. 44.3% were ever smokers. (Current, ex, social and vaping). The various diagnosis reported by the patients were Rheumatoid arthritis (19), Psoriatic Arthritis (5), Ankylosing spondylitis (3), Inflammatory arthritis (8), SLE (1) and no response (43). 57% of the group said exercise has not been discussed with them. Of those who said it has been discussed, 44% each said it has been discussed at the time of diagnosis or subsequent visits. 61% of the group said “Yes” when asked if they exercised. 22 respondents exercise 3-5 times a week and 13 said they only exercise when they feel like it. Aerobic exercise was most popular (21) followed by stretching (18). 62% said they have never had a formal physiotherapy consult and only 34% perceived any benefit in symptoms on exercising. When the group who said “Yes” to exercise was compared to the group who said “no”, the “no” group had significantly higher number of respondents who were not working (p:0.0032) and reported heart problems (0.0018) and diabetes (0.0035). There was no difference in age distribution, gender, education level and smoking history.Conclusion:Patients do not perceive that they have received exercise advice in clinics and majority have not seen a physiotherapist formally. Liaising with primary care to deal with comorbidities like diabetes and heart problems can help promote exercise habits within patients.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Soil samples were collected from different crop research center(s) from G B Pant University of Agriculture and Technology, Pantnagar, Uttarakhand, India to isolate & identify the occurrence of entomopathogenic nematodes (EPNs). The isolated EPN from soil samples was identified as Steinernema abbasi (PN-1) based on morpho-taxometric and molecular studies. Phylogenetic analysis of the present isolate S. abbasi PN-1 based on D2/D3 regions showed no variation among populations of S. abbasi . This is the first report of the existence of an indigenous isolate of EPN ( Steinernema abbasi ) in Pantnagar, Uttarakhand, India. To understand the host range of S. abbasi , PN-1, insects of different orders: Lepidoptera, Coleoptera, and Hemiptera were selected and exposed to PN-1 at the concentration of 200 IJ (Infective Juvenile)/1000 µl. PN-1 was found to be effective against insects of all the order used in present study. However, the insects from order Lepidoptera were highly susceptible to PN-1 as 100 per cent mortality was recorded at 48 h after treatment. To study time concentration mortality response of PN-1, five different doses were used and tested against 2nd, 3rd, 4th instar larvae of Galleria mellonella , Helicoverpa armigera , Spodoptera frugiperda , and Spodotera litura in laboratory condition. From this study it was concluded that late instars were more susceptible to younger instars. There was a positive correlation between nematode concentration and insect mortality, while the median lethal time (LT50) was negatively correlated with increased nematode concentration and larval instar stages.

Different shaped floating wick (FW) material in the basin improved the efficacy of a single slope solar still (SS). Thermocol is used to support a basin in which cotton wicks are suspended. The three forms of modified solar stills (MSS) are analyzed, each with a unique absorber geometry. Absorber surfaces in the MSS-RCT (Rectangular teeth), MSS-ITT (Isosceles Triangular teeth), and MSS-HCT (Half-circular teeth) configurations are made up of FW layers. These improved designs are far more efficient and effective than the Conventional solar still (CSS). All MSS absorber surfaces produce more potable water than the CSS experiment does for the bulk of the workday. The MSS-HCT process achieved a maximum daily yield that was on par with that of the other modified stills and a 68 % increase in daily yield compared to the CSS process.

BackgroundRheumatology as a specialty moving rapidly due to the advent of novel therapeutic agents. Rheumatic Disease management concepts are also changing with a treat to target approach and early escalation of therapies. Role of Rheumatology specialist nurses should not be underestimated in the tight control and achieve treat to target goals. The expectation of Specialist Nurse role has been changed over the years. NHS pressure in service delivery compromised teaching and training opportunities for Specialists Nurses which may result in the knowledge gap. Education and training for Rheumatology nurses are key in delivering high-quality service to rheumatology patients. We attempted to explore the current knowledge and skills among Rheumatology specialist nurses regionally.Objectives1To explore the knowledge perception of different disease management2. To identify the difference in two disease management RA and Spondyloarthropathy(SpA).3. To evaluate the confidence level in assessing different Rheumatic diseasesMethodsThis is a Questionnaire based prospective study among east midlands Rheumatology Specialist Nurses. The initial questionnaire was piloted and improved 17 questionnaires were distributed among the specialist nurses working in our region via email and in person. The questions were designed to gauge the nurses level of confidence in assessing different rheumatology conditions and also their confidence in making treatment decisions for different conditions.Results26 out of 40 nurses in East Midlands responded with response rate of 65%. 77% Reponses are from nurses working in University hospitals and 23% working from DGH. The level of experience in current role is variable from 2 to 20 Year and clinical session performed by nurses varies from 2–8 per week. The nurses are mostly supervised by consultant and some do independent clinic. The awareness of delay in diagnosis of Spa is about 80% with average reported delay as 6 years. Confidence in assessing RA is very good however not confident in assessing SLE. Confidence level in counselling biologic therapy varies with different diseases with SLE been very low. SpA assessment with extra articular management is low and less confidence in advising therapy in Pregnancy. Interesting note the awareness concept of Non-Radiographic Spa and MRI protocols in Spa Confidence is exists. Variable level of confidence in the in assessment of various diseases. Confidence in assessing Fibromyalgia in a patient with Rheumatic disease is at a low level.Conclusionswe noted the very good level of confidence in RA and PSA assessment and management however low levels of confidence in the assessment of SLE and SpA. More education and training is needed particularly focused on assessment. This is the first study among Rheumatology Specialist Nurses with limitations. Education and training through continuous Medical education for Rheumatology nurses are key to achieve tight control of Rheumatic diseases, reduce the morbidity and Mortality.Reference[1] Solomon DH, Bitton A, Fraenkel L, Brown E, Tsao P, Katz JN. Roles of nurse practitioners and physician assistants in rheumatology practices in the US. Arthritis Care Res2014Jul;66(7):1108–13.Acknowledgements1. All East Midlands Nurses who completed this regional survey.Disclosure of InterestNone declared

BackgroundLittle is known about the association between ethnicity and response to TNF inhibitors (TNFi) in people with rheumatoid arthritis (RA).ObjectivesThis study examines the association between self-reported ethnicity and DAS28 response after 6 months of treatment in patients starting their first TNFi using data from the British Society for Rheumatology Biologics Register for RA.Methods14133 RA patients with self-reported ethnicity starting their first TNFi were included. Due to a very low proportion of non-white patients, ethnicity was divided into white or non-white for analysis. Outcomes included the change in disease activity using DAS28, the proportion of patients who achieved DAS28 remission and EULAR response at month 6. Adjusted regression models appropriate to outcome were used to compare between the two groups. Multiple imputation was used to account for missing data.ResultsOf 14133 patients starting TNFi with recorded ethnicity, only 607 (4.3%) recorded themselves as non-white (389 Asian, 134 Black, 57 Mixed ethnicity and 27 other) (Table 1). At start of TNFi, non-white patients were younger (non-white vs. white: mean 51 vs. 57 years; p<0.001), with shorter disease duration (median 8 vs. 10 years; p<0.001), higher proportion of females (86% vs. 76%; p<0.001) and fewer current cigarette smokers (9% vs. 20%; p<0.001). Non-white patients had lesser improvement in DAS28 at month 6 (adjusted regression coefficient (95% confidence interval (95%CI)): 0.3 (0.04-0.5)). However, using the white patients as a reference, non-white patients were not associated with the achievement of DAS28 remission (adjusted odds ratio (95%CI): 0.7 (0.5-1.1)) or EULAR response (aOR (95%CI): 0.8 (0.7-1.0)) at month 6.WhiteNon-whitepN13515607Age57.0±12.051.4±12.3<0.001Female (%)10262 (75.9%)520 (85.7%)<0.001Ethnicity (%)White13515 (100%)-Black-134 (22.1%)Asian-389 (64.1%)Mixed ethnicity-57 (9.4%)Other-27 (4.4%)Disease duration (years)10 (4-18)8 (4-15)<0.001RF positive (%)8341 (61.7%)390 (67.5%)0.08DAS286.4±1.16.4±1.10.4Tender joints15 (10-21)15 (9-21)0.6Swollen joints10 (6-14)9 (6-13)<0.001VAS75 (61-86)75 (61-88)0.9ESR35 (19-58)41 (25-65)<0.001CRP24 (10-53)19 (8-41)0.005HAQ1.9±0.61.9±0.70.4Biologic treatment (%)Adalimumab4107 (30.4%)165 (27.2%)0.1Certolizumab875 (6.5%)50 (8.2%)Etanercept5322 (39.4%)238 (39.2%)Infliximab3211 (23.8%)154 (25.4%)Concomitant csDMARDs (%)7595 (56.2%)340 (56%)0.9Methotrexate (%)5512 (40.8%)243 (40.0%)0.7Concomitant glucocorticoids (%)5017 (37.1%)199 (32.8%)0.03Current cigarette smoking (%)2698 (20.0%)57 (9.4%)<0.001Response to first-line TNFi at month 6DAS28 at month 64.7±1.85.0±1.80.02ΔDAS28*1 [reference]0.3 [0.04-0.5]0.02DAS28 remission (%)13%11%0.1Odds of DAS remission*1 [reference]0.7 [0.5-1.1]0.1Good EULAR response (%)18.2%16.5%Moderate EULAR response (%)33.7%33.2%Odds of achieving higher EULAR response*1 [reference]0.8 [0.7-1.0]Data is expressed as mean±SD, median (interquartile range), number (percentage), adjusted regression coefficient [95% confidence interval] or adjusted odds ratio [95% confidence interval].*Adjusted for baseline age, gender, disease duration, concomitant csDMARDs, concomitant steroid, rheumatoid factor status, cigarette smoking status, DAS28 and HAQConclusionRecruitment to the BSRBR-RA of non-white patients was exceptionally low compared to expected population distribution – the reasons for this are not immediately evident. Among those recruited, there were no significant differences observed in initial treatment response although non-white patients were younger, more likely to be female, had shorter disease duration and less likely to be smokers. Further evaluation into both ways to increase representativeness in our national RA treatment register and influence of ethnic differences on longer term outcomes with biologic therapies is warranted.ReferenceNIL.Acknowledgements:NIL.Disclosure of InterestsMan Fung Tsoi: None declared, Rajinder Singh Andev Speakers bureau: Speaker fees from Novartis, Lianne Kearsley-Fleet: None declared, Kath Watson: None declared, Shirish Dubey Speakers bureau: Speaker fees from Janssen, Consultant of: Honoraria from Boehringer Ingelheim, Kanta Kumar: None declared, Arumugam Moorthy Speakers bureau: Novartis and Galapagos, Consultant of: Honoraria from Lilly and UCB, Monica Gupta: None declared, Adewale Adebajo: None declared, Kimme Hyrich Consultant of: Honoraria from Abbvie, Grant/research support from: Pfizer and BMS, and is supported by the NIHR Manchester Biomedical Research Centre.

Theileria annulata -infected host leukocytes exhibit cancer-like phenotypes, driven by mechanisms that remain incompletely understood. This study explores the genomic alterations underlying these transformations using whole-genome sequencing and bioinformatic analyses of six clinically relevant T. annulata -infected cell lines. Here we identify 7867 exon-linked somatic mutations shared across all cell lines, with significant enrichment in oncogenes (e.g., FLT4, NOTCH2, MAP3K1, DAXX, FCGR2B, ROS1 ) and tumor suppressor genes (e.g., BARD1, KMT2C, GRIN2A, BAP1 ). These mutations are associated with critical cancer-related pathways. Functional studies revealed that inhibition of the mutated oncogene ROS1 using crizotinib induces death in infected leukocytes, confirming its role in transformation. Additionally, we observe mutations in genes linked to genomic instability and the DNA damage response (DDR) pathways, highlighting potential parallels with cancer biology. Suppression of TP53, a key tumor suppressor, is implicated in the immortalization of infected cells, while upregulation of the DNA mutator enzyme APOBEC3H suggests a parasite-driven, mutation-inducing mechanism. Our findings provide new insights into how T. annulata reprograms host cells through genomic instability and mutations, identifying ROS1 and TP53 as critical targets for therapeutic intervention. This work advances understanding of parasite-induced oncogenic transformation and offers pathways for future research. Genomic characterization of host gene alterations in Theileria annulata -transformed leukocytes sheds light on parasite-induced genomic changes that might drive the acquisition of cancer-like phenotypes in host cells.

BackgroundBack pain is one of the commonest musculoskeletal presentation with an estimated prevalence of inflammatory back pain (IBP) of 15%. Previous study in UK has demonstrated the delay in diagnosis of IBP up to 8 years. This is partly due to lack of understanding of management of IBP among the primary and secondary care physicians. Focused training on IBP could help early diagnosis and target treatment more effectively. It is therefore imperative for medical registrars to acquire adequate knowledge in management of IBP. Our previous study among GP registrars, presented in EULAR congress, demonstrated the relative lack of understanding in diagnosis and management of IBP.1 We aim to explore the perception of training in management of IBP among speciality registrars in general internal medicine (GIM).Objectives1) To explore the knowledge of GIM trainees in management of chronic back pain. 2) To assess the knowledge of GIM trainees in diagnosis and management of inflammatory back pain.MethodsThis is an observational questionnaire based survey. The designed questionnaires were initially piloted locally, redesigned later and distributed across to all the GIM trainees including geriatrics, gastroenterology, dermatology, renal etc across the region both online and during the GIM educational study days. Data was collected and analysed using the online data manager, smart survey®.ResultsTotal responders were n=52 including GIM registrars from all specialities excluding rheumatology. In a typical working week about 14% of GIM registrars review 5-10 patients with chronic back pain.We noticed that trainees are more confident in assessing MBP (64% in MBP vs 14% in IBP) particularly in eliciting adequate history (74% for MBP vs 38% of IBP). More than 90% of registrars were satisfied with their undergraduate, foundation training in MBP whereas only 13% in IBP. 34% of the respondents were satisfied with registrar training in IBP.Seventy three % if respondents were confident in arranging appropriate investigations for MBP compared to only 14% for IBP. It is interesting to note that HLA B27 and MRI was the preferred mode of investigations as reported by the GIM trainees.More trainees were confident in national guideline based treatment of MBP compared to IBP (70% in MBP vs 14% in IBP).There was a dearth in adequate knowledge about management of IBP with NSAIDS (52%), physiotherapy (12%) among the trainees. Only 22% of respondents were aware of guideline based treatment with TNF blockers for IBP.Trainees wanted to review IBP patients 2 to 4 times (21%) and more than 5 times (6%) before specialist referral. Only 9% of trainees were aware of UK statistics about delay in specialist referral for AS patients. Interestingly 14% of respondents did not prefer specialist referral for IBP patients and 60% of respondents were unaware of AS speciality clinic in Leicestershire.ConclusionsThis study highlighted relative lack of confidence among GIM registrars in the assessment and management of IBP. Increased awareness amongst registrars could be achieved through web based training or formal rheumatology led training sessions. Optimum knowledge in managing chronic back pain would ensure early diagnosis, institution of appropriate care, prevent physical disability and financial losses.ReferencesP Das, A Moorthy, P Wells, S Makda. Diagnosing and managing Inflammatory Back pain - How good are our GP trainees? Ann Rheum Dis 2014;73(Suppl2): 802.Disclosure of InterestNone declared

BackgroundUveitis is associated with systemic autoimmune disease and often present to Eye Department as an emergency. Uveitis can be a first presenting symptom of systemic autoimmune disease and often not followed up in Rheumatology services. Approximately 40% of patients with acute anterior uveitis (AAU) have undiagnosed spondyloarthritis (1). Previous studies in UK by Hamilton et al showing delay in diagnosing spondyloarthropathy (SpA) up to 8 years (2). Delay in referral of HLA B27 positive Uveitis by primary care and secondary care physicians to Rheumatology may be a reason for the delayed diagnosis (3,4).This can be better avoided if inter-speciality referral and pathways are established. To enable the best effective care delivered for Uveitis patients,we attempted to review the current trends of our own cohort of patients with HLAB27 Associated UveitisObjectives- To review the cohort of HLA B27 positive uveitis in a busy tertiary care hospital serving multi ethnic patients.- To observe the pattern and association of systemic autoimmune disease particularly spondyloarthropathy.- To see how many cases been referred to Rheumatology services and how best they are managed with systemic immunosuppressive therapy.MethodsThe methodology includes retrospective analysis of data captured from the Uveitis Data Base maintained by ophthalmology department. The consecutive new cases of HLAB27 uveitis were identified for three-year period from 2011 to 2014. The clinical records, ophthalmology examination records, demographic details, ethnicity were reviewed. The type of uveitis, presenting symptoms and systemic associations were explored. Modes of treatment, complications and pattern of referral and input from other specialties were assessed as well treatment plans were collected. The data were captured by using standardized proforma. The captured data was analysed using excel spreadsheet.ResultsTotal of 624 Uveitis patients 73 cases (105 eyes) of HLAB27 positive uveitis (11.7%) were identified.The most common systemic association in our cohort was Ankylosing Spondylitis (31.8%). 34%of the affected eyes did not develop anycomplications.88% had anterior uveitis with 38% showing chronicity.79% of the patients had better than 0.3LogMar acuity in the affected eye on presentation.ConclusionsThe data collected emphasizes the higher incidence of Ankylosing Spondylitis in patients, who presents with uveitis associated with positive HLA B27. Our result reiterates the need for establishing combined clinics to avoid delay in referrals enhancing patient management and experience.Disclosure of InterestNone declared