Faster improvement in outcome scores in posterior stabilised total knee arthroplasty compared to medial congruent system with posterior cruciate ligament retained

Most studies comparing medial pivot to the posterior stabilised (PS) systems sacrifice the PCL. It is unknown whether retaining the PCL in the Medial Congruent (MC) system may provide further benefit compared to the more commonly used PS system. A retrospective review of a single-surgeon's registry data comparing 44 PS and 26 MC with PCL retained (MC-PCLR) TKAs was performed. Both groups had similar baseline demographics. The PS and MC-PCLR groups had similar pre-operative range of motion (ROM) (PS:104º ± 20º vs. MC-PCLR: 101º ± 19º, p = 0.70), Oxford Knee Score (OKS) (PS: 27 ± 6 vs. MC-PCLR: 26 ± 7, p = 0.62), and Knee Society Scoring System (KS) Function Score (KS-FS) (PS: 52 ± 24 vs. MC-PCLR: 56 ± 23, p = 0.49). The pre-operative KS Knee Score (KS-KS) was significantly lower in the PS group (PS: 44 ± 14 vs. MC-PLR: 53 ± 18, p < 0.05). At 12-months post-operation, there was significant improvement in all parameters (p < 0.01). Both groups had similar ROM (PS: 115º ± 13º vs. MC-PCLR: 114º ± 10º, p = 0.98), OKS (PS: 41 ± 5 vs. MC-PCLR: 40 ± 4, p = 0.50), KS-FS (PS: 74 ± 22 vs. MC-PCLR: 77 ± 16, p = 0.78), and KS-KS (PS: 89 ± 10 vs. MC-PCLR: 89 ± 10, p = 0.89). The PS group had significant improvement in all parameters from preoperation to 3-month postoperation (p < 0.05), but not from 3-month to 1-year postoperation (p ≥ 0.05). The MC-PCLR group continued to have significant improvement from 3-month to 1-year postoperation (p < 0.05). Preserving the PCL when using MC may paradoxically cause an undesired additional restrain that slows the recovery process of the patients after TKA. Compared to MC-PCLR, a PS TKA may expect significantly faster improvement at 3 months post operation, although they will achieve similar outcomes at 1-year post operation.

The ASAS-OMERACT core domain set for axial spondyloarthritis

BACKGROUND

The current core outcome set for ankylosing spondylitis (AS) has had only minor adaptations since its development 20 years ago. Considering the significant advances in this field during the preceding decades, an update of this core set is necessary.

OBJECTIVE

To update the ASAS-OMERACT core outcome set for AS into the ASAS-OMERACT core outcome set for axial spondyloarthritis (axSpA).

METHODS

Following OMERACT and COMET guidelines, an international working group representing key stakeholders (patients, rheumatologists, health professionals, pharmaceutical industry and drug regulatory agency representatives) defined the core domain set for axSpA. The development process consisted of: i) Identifying candidate domains using a systematic literature review and qualitative studies; ii) Selection of the most relevant domains for different stakeholders through a 3-round Delphi survey involving axSpA patients and axSpA experts; iii) Consensus and voting by ASAS; iv) Endorsement by OMERACT. Two scenarios are considered based on the type of therapy investigated in the trial: symptom modifying therapies and disease modifying therapies.

RESULTS

The updated core outcome set for axSpA includes 7 mandatory domains for all trials (disease activity, pain, morning stiffness, fatigue, physical function, overall functioning and health, and adverse events including death). There are 3 additional domains (extra-musculoskeletal manifestations, peripheral manifestations and structural damage) that are mandatory for disease modifying therapies and important but optional for symptom modifying therapies. Finally, 3 other domains (spinal mobility, sleep, and work and employment) are defined as important but optional domains for all trials.

CONCLUSION

The ASAS-OMERACT core domain set for AS has been updated into the ASAS-OMERACT core domain set for axSpA. The next step is the selection of instruments for each domain.

AB0699 RESIDUAL DISEASE BURDEN PRESENT IN AXIAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS PATIENTS ACHIEVING LOW DISEASE ACTIVITY STATES

Background:

Despite achieving Low Disease Activity (LDA) states, patients with SpondyloArthritis (SpA) may have considerable residual disease. Sparse data is currently available from Asia.

Objectives:

We aimed to evaluate the burden of residual disease in patients with axial SpondyloArthritis (axSpA) or Psoriatic Arthritis (PsA) who achieved LDA.

Methods:

We used data from a registry of SpA from an outpatient setting in a tertiary hospital in Singapore. For axSpA, LDA was defined as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <4/10. For PsA, LDA was defined by achieving 5/7 cutoffs in the Minimal Disease Activity (MDA) or clinical Disease Activity index for Psoriatic Arthritis (cDAPSA) ≤13.

Results:

From 262 cases of axSpA (21% women; mean ± standard deviation (SD) age 42 ± 14 years), 58% of patients achieved LDA states. While from 142 cases of PsA (49% women; mean ± SD age 51 ± 14 years), 38% and 63% achieved MDA and cDAPSA LDA, respectively. Both axSpA and PsA patients with LDA had pain scores range from 17.2 to 25.7/100 and fatigue scores from 3.3 to 3.5/10. (Table 1). Substantial burden in physical disability and mental well-being were seen as a low physical and mental component summary of SF-36. cDAPSA classified nearly twice as many PsA patients into LDA than MDA. Compared to PsA patients in MDA, PsA patients in cDAPSA LDA had higher pain scores, Patient Global Assessment (PtGA), dactylitis, and enthesitis. axSpA patients in LDA classified by BASDAI had the highest pain and fatigue scores, and PtGA.

Table 1.

Residual disease burden in patients with axSpA and PsA who have achieved LDA

axSpAPsALDA (n=153)LDA by MDA (n=54)LDA by cDAPSA (n=90)Age, years¥42.2 (14.0)52.5 (13.2)52.5 (13.2)Female, n (%)26 (17.0)30 (55.6)45 (50.0)TJC¥0.1 (0.3)0.8 (1.0)1.0 (1.4)SJC¥0.1 (0.3)0.7 (1.3)0.9 (1.3)VAS-pain (0-100)¥25.7 (19.0)17.2 (17.8)20.8 (16.7)BASDAI (0-10)¥2.3 (1.0)2.4 (1.6)2.7 (1.7)BASDAI fatigue (0-10)¥3.5 (2.2)3.3 (2.3)3.4 (2.3)PtGA (0-100)¥27.8 (19.5)20.9 (17.9)23.5 (17.6)Dactylitis (0-20)¥–0.3 (0.5)0.5 (0.9)LEI (0-6)¥–0.1 (0.4)0.2 (0.5)HAQ (0-3)¥0.1 (0.1)0.1 (0.2)0.2 (0.4)HAQ < 0.5, n (%)149 (97.4)52 (96.3)77 (85.6)SF-36 PCS¥46.8 (9.9)45.8 (11.5)45.1 (11.7)SF-36 MCS¥46.4 (11.2)46.1 (11.3)45.6 (10.6)

axSpA, axial Spondyloarthritis; PsA, Psoriatic Arthritis; LDA, Low Disease Activity; MDA, Minimal Disease Activity; cDAPSA, clinical Disease Activity index for Psoriatic Arthritis; TJC, tender joint count; SJC, swollen joint count; VAS, Visual Analog Scale; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; PtGA, patient’s global assessment; LEI, Leeds Enthesitis Index; HAQ, Health Assessment Questionnaire; SF-36, Short-Form 36; SF-36 PCS, norm-based Physical Component Summary (mean=50, SD=10); SF-36 MCS, norm-based Mental Component Summary (mean=50, SD=10)

¥mean (SD)

Conclusion:

Despite being in LDA, axSpA and PsA patients experienced substantial pain, fatigue and poorer functional health and mental well-being.

Disclosure of Interests:

Venice Liu: None declared, Warren Fong Consultant of: Abbvie, Janssen, Novartis, Speakers bureau: Abbvie, Janssen, Novartis, Yu Heng Kwan: None declared, Ying Ying Leung Speakers bureau: Novartis, Janssen, Eli Lilly

SAT0371 ARE ENGLISH-LANGUAGE VIDEOS ON YOUTUBE A USEFUL SOURCE OF INFORMATION FOR SPONDYLOARTHRITIS?

Background:

Spondyloarthritis (SpA) is a family of chronic inflammatory disorders. Social media, such as YouTube, is a popular online platform where patients often visit for information. However, the validity of the content uploaded onto YouTube is not known.

Objectives:

This study aimed to evaluate the content, reliability and quality of the most viewed English-language YouTube videos on SpA.

Methods:

Keywords “spondyloarthritis”, “spondyloarthropathy” and “ankylosing spondylitis” were searched on YouTube on October 7th, 2019. The top 270 videos were screened. Videos were excluded if they were irrelevant, in non-English language or if they had no audio. Total number of views, duration on YouTube (days), video length, upload date, number of likes, dislikes, subscribers and comments were recorded for videos. A modified 5-point DISCERN tool1and the 5-point Global Quality Scale (GQS) score2were used to assess the reliability and quality of the videos, with higher scores indicating greater reliability and quality respectively.

Results:

Two hundred of 270 videos were included in the final analysis [61.5% from healthcare professionals, 37.0% from patients, 1.5% from news channels]. Of the 200 videos, 15 were uploaded within the last year and 112 in the last five years. 120 (60%) were categorized as useful information (Group 1), 6 (3%) as misleading information (Group 2), 52 (26%) as useful patient opinion (Group 3) and 22 (11%) as misleading patient opinion (Group 4). Useful videos were mainly from healthcare professionals or patients (86%). Useful videos (Group 1 and 3) had higher median (IQR) number of subscribers [2700 (14700) vs 211 (457), p < 0.01], reliability scores [3 (1) vs 2 (1), p < 0.01] and GQS scores [3 (1) vs. 2 (1), p < 0.001] compared to misleading videos (Group 2 and 4), respectively.

Videos uploaded by healthcare professionals tended to have more useful information [94% (116 of 123) vs. 66% (49 of 74), p < 0.001] and had higher median (IQR) reliability scores [3 (1) vs 2 (1), p < 0.001] and GQS scores [3 (2) vs 2 (1), p < 0.001] compared to patient uploaded videos respectively. Of the 5 (out of 123) videos from healthcare professionals that had misleading information, it was because of outdated information on diagnosis (3 videos) and treatment (5 videos) of SpA. Of the 22 videos that had misleading patient opinion, 9 (41%) wrongly described the clinical features for SpA and 14 (64%) portrayed the current evidence based treatment options as ineffective and described alternative treatment plans (i.e. diet restrictions, complementary and alternative medicine).

Conclusion:

The majority of English language YouTube videos have useful information on the topic of SpA, however, 31% of patient opinions have inaccurate information on the clinical features and treatment options, and viewers need to be cognisant of these “fake news”.

References:

[1]Charnock D, Shepperd S, Needham G, Gann R (1999) DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 53(2): 105-111

[2]Bernard A, Langille M, Hughes S, Rose C, Leddin D, Veldhuyzen van Zanten S (2007) A systematic review of patient inflammatory bowel disease information resources on the World Wide Web. Am J Gastroenterol 102(9):2070-2077

Disclosure of Interests:

Sakktivel Elangovan: None declared, Yu Heng Kwan: None declared, Warren Fong Consultant of: Abbvie, Janssen, Novartis, Speakers bureau: Abbvie, Janssen, Novartis

AB0836 PREVALENCE AND DETERMINANTS OF FATIGUE IN PSORIATIC ARTHRITIS IN AN ASIAN POPULATION

Background:

Fatigue is one of the core domains to be measured in all clinical trials for psoriatic arthritis (PsA). Studies of fatigue in PsA in Asia are scarce.

Objectives:

To describe the prevalence and evaluate the factors associated with fatigue in PsA patients within a multi-ethnic Asian population.

Methods:

We used data from the PRESPOND registry for PsA patients attending an outpatient clinic of a tertiary institution in Singapore. Demographics data and disease characteristics were evaluated. Fatigue was assessed by question 1 of BASDAI (BASDAI-F) and the vitality domain of SF-36 (SF-36 VT).

Results:

131 patients (50.4% men, 63.4% Chinese, median PsA duration 1.78 years) with completed data for fatigue were included. The median (IQR) tender and swollen joint count was 2 (5) and 1 (3) respectively. 45 patients (34%) experienced high fatigue (defined by BASDAI-F ≥ 6/101,2). 5 clusters of factors were identified using principal component analysis that explained 66.2% of the variance of all factors, which mapped to disease activity, disease chronicity, demographics (ethnicity and gender), and BMI (Figure 1). Of these, disease activity and chronicity were significantly associated with BASDAI-F and SF-36 VT. In a multivariate analysis, back pain, peripheral joint pain and patient global assessment were associated with BASDAI-F, whereas peripheral joint pain, HAQ-DI, age and BMI were associated with SF-36 VT (Table 1).

Table 1.

Multivariable analysis for variables associated with fatigue

BASDAI-FSF-36 VTb95% CIβpb95% CIβpBack pain (0-10)0.335(0.180, 0.490)0.356<0.001----Peripheral joint pain (0-10)0.027(0.012, 0.042)0.2680.001-2.296(-3.410, -1.182)-0.320<0.001PGA (0-100)0.211(0.061, 0.361)0.2360.006----HAQ-DI (0-3)-----12.74(-17.97, -7.51)-0.386<0.001Age, y----0.260(0.065, 0.456)0.1790.009BMI, kg/m2-----0.644(-1.183, -0.105)-0.1650.020Figure 1.

Principal component analysis with 5 components and residuals (in dotted lines). Only factor loadings with magnitudes greater than 0.40 are shown.

Conclusion:

PsA-associated fatigue is prevalent in this Asian PsA cohort and is associated with disease activity and chronicity.

References:

[1]Gudu T, Etcheto A, de Wit M, Heiberg T, Maccarone M, Balanescu A, et al. Fatigue in psoriatic arthritis - a cross-sectional study of 246 patients from 13 countries. Joint Bone Spine. 2016;83(4):439-43.

[2]Walsh JA, McFadden ML, Morgan MD, Sawitzke AD, Duffin KC, Krueger GG, et al. Work productivity loss and fatigue in psoriatic arthritis. J Rheumatol. 2014;41(8):1670-4.

Disclosure of Interests:

Joel Shi Quan Tan: None declared, Warren Fong Consultant of: Abbvie, Janssen, Novartis, Speakers bureau: Abbvie, Janssen, Novartis, Yu Heng Kwan: None declared, Ying Ying Leung Speakers bureau: Novartis, Janssen, Eli Lilly

A systematic review of factors affecting medication adherence among patients with osteoporosis

The aim of this review was to identify factors that influence patients' adherence to anti-osteoporotic therapy. Factors identified that were associated with poorer medication adherence included polypharmacy, older age, and misconceptions about osteoporosis. Physicians need to be aware of these factors so as to optimize therapeutic outcomes for patients.

INTRODUCTION

To identify factors that influence patients' adherence to anti-osteoporotic therapy.

METHODS

A systematic review of literature was performed for articles published up till January 2018 using PubMed®, PsychINFO®, Embase®, and CINAHL®. Peer-reviewed articles which examined factors associated with anti-osteoporotic medication adherence were included. Classes of anti-osteoporotic therapy included bisphosphonates, parathyroid hormone-related analogue, denosumab, selective estrogen receptor modulators, estrogen/progestin therapy, calcitonin, and strontium ranelate. Meta-analyses, case reports/series, and other systematic reviews were excluded. Identified factors were classified using the World Health Organization's five dimensions of medication adherence (condition, patient, therapy, health-system, and socio-economic domains).

RESULTS

Of 2404 articles reviewed, 124 relevant articles were identified. The prevalence of medication adherence ranged from 12.9 to 95.4%. Twenty-four factors with 139 sub-factors were identified. Bisphosphonates were the most well-studied class of medication (n = 59, 48%). Condition-related factors that were associated with poorer medication adherence included polypharmacy, and history of falls was associated with higher medication adherence. Patient-related factors which were associated with poorer medication adherence included older age and misconceptions about osteoporosis while therapy-related factors included higher dosing frequency and medication side effects. Health system-based factors associated with poorer medication adherence included care under different medical specialties and lack of patient education. Socio-economic-related factors associated with poorer medication adherence included current smoker and lack of medical insurance coverage.

CONCLUSION

This review identified factors associated with poor medication adherence among osteoporotic patients. To optimize therapeutic outcomes for patients, clinicians need to be aware of the complexity of factors affecting medication adherence.

The association between distance to public amenities and cardiovascular risk factors among lower income Singaporeans

Existing evidence on the association between built environment and cardiovascular disease (CVD) risk factors focused on the general population, which may not generalize to higher risk subgroups such as those with lower socio-economic status (SES). We examined the associations between distance to 5 public amenities from residential housing (public polyclinic, subsidized private clinic, healthier eatery, public park and train station) and 12 CVD risk factors (physical inactivity, medical histories and unhealthy dietary habits) among a study sample of low income Singaporeans aged ≥ 40 years (N = 1972). Using data from the Singapore Heart Foundation Health Mapping Exercise 2013–2015, we performed a series of logistic mixed effect regressions, accounting for clustering of respondents in residential blocks and multiple comparisons. Each regression analysis used the minimum distance (in km) between residential housing and each public amenity as an independent continuous variable and a single risk factor as the dependent variable, controlling for demographic characteristics. Increased distance (geographical inaccessibility) to a train station was significantly associated with lower odds of participation in sports whereas greater distance to a subsidized private clinic was associated with lower odds of having high cholesterol diagnosed. Increasing distance to park was positively associated with higher odds of less vegetable and fruits consumption, deep fried food and fast food consumption in the preceding week/month, high BMI at screening and history of diabetes, albeit not achieving statistical significance. Our findings highlighted potential effects of health-promoting amenities on CVD risk factors in urban low-income setting, suggesting gaps for further investigations.

•

We examined associations between access to 5 amenities and 12 CVD risk factors.

•

Only 2/60 associations were statistically significant.

•

Poorer access to train station was associated with lower odds of sports.

•

Poorer access to primary care was associated with lower high cholesterol diagnosis.

A systematic review of factors that influence treatment adherence in paediatric oncology patients

WHAT IS KNOWN AND OBJECTIVE

Treatment adherence is an essential component in ensuring best outcomes in the management of paediatric cancers. Compared to the adult population, treatment adherence in the paediatric population is a more complex subject which involves unique dimensions. In this study, we aimed to systematically review the literature to identify factors associated with treatment adherence in the paediatric oncology population.

METHODS

A literature search was carried out using related keywords on electronic databases.

RESULTS AND DISCUSSION

A total of 1036 articles were reviewed, and 39 articles were found to be relevant. A comprehensive review of these articles identified 17 factors that influence adherence. These factors were classified into five major categories: patient-/caregiver-related factors; therapy-related factors; condition-related factors; health system-related factors; and social/economic factors. A baby bear model was proposed to better visualize these five categories that affect treatment adherence, and a framework of questions was designed to help clinicians identify those at risk of non-adherence for early intervention.

WHAT IS NEW AND CONCLUSION

Seventeen factors reviewed were categorized into five main categories, namely patient-/caregiver-related factors, therapy-related factors, condition-related factors, health system factors and social/economic factors, as causes for poor medication adherence in the paediatric oncology population. Clinicians need to be aware that these factors can interact to influence treatment adherence and that some factors may be more relevant in specific contexts (e.g. third world countries, minority groups). The baby bear model is presented to help understand the issues affecting adherence in the paediatric oncology population, and a framework of questions is proposed to help clinicians identify patients at risk of non-adherence.

Effect of group-delay ripples on dispersion-managed soliton communication systems with chirped fiber gratings

The effect of group-delay ripples in dispersion-managed soliton communication systems that use chirped fiber gratings for dispersion compensation is studied. Using both a reduced model and direct numerical simulation, we find that dispersion-managed solitons exist even in the presence of large dispersion variation caused by group-delay ripples. The dispersion-managed solitons suppress the growth of intersymbol interference induced by the group-delay ripples.