Low-dose dietary supplementation with omega-3 fish oils in systemic lupus erythematosus not only has a therapeutic effect on disease activity but also improves endothelial function and reduces oxidative stress and may therefore confer cardiovascular benefits.

Objective To explore the role of chronic inflammation in rheumatoid arthritis (RA) on cognition. Methods and analysis Six hundred sixty-one men and women aged ≥55 years who fulfilled the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for RA were recruited from three healthcare trusts in the United Kingdom (UK) between May 2018 and March 2020. Study participants took part in interviews which captured sociodemographic information, followed by an assessment of cognition. RA specific clinical characteristics were obtained from hospital medical records. Participants were cognitively assessed using the Montreal Cognitive Assessment (MoCA) and were classified as cognitively impaired if they scored ≤27/30 points. Linear regression analyses were conducted to identify which demographic and clinical variables were potential predictors of cognitive impairment. Results The average age of participants was 67.6 years and 67% (444/661) were women. 72% (458/634; 95% CI 0.69 to 0.76) of participants were classified as cognitively impaired (MoCA≤27). Greater cognitive impairment was associated with older age (p = .006), being male (p = .041) and higher disease activity score (DAS28) (with moderate (DAS28 > 3.1) (p = 0.008) and high (DAS28 > 5.1) (p = 0.008)) compared to those in remission (DAS28 ≤ 2.6). There was no association between MoCA score and education, disease duration, RF status, anti-cyclic citrullinated peptide (anti-CCP) status, RA medication type or use of glucocorticoids or non-steroidal anti-inflammatory drugs (p > 0.05). Conclusion This study suggests that cognitive impairment is highly prevalent in older adults with RA. This impairment appears to be associated with higher RA disease activity and supports the concept that chronic systemic inflammation might accelerate cognitive decline. This underlines the importance of controlling the inflammatory response.

Structural and functional changes in wall and endothelial components of arterial blood vessels underlie the accelerated vascular disease progression in systemic lupus erythematosus (SLE). Using pulse contour analysis we sought to determine if subclinical vascular abnormalities could be identified in a well-characterised cohort of patients with SLE who had no increase in traditional cardiovascular risk factors. Radial artery pressure waveforms were obtained by applanation tonometry and pressure envelopes were analysed by descriptive and model-based approaches. Waveshape morphology was quantified by a novel eigenvector approach and model-based compliance indices of the large arteries (C1, capacitative arterial compliance) and small arteries (C2, reflective arterial compliance) were derived using a third-order four-element modified Windkessel model. Data were recorded from 30 patients with SLE (mean age 44 +/- 7 years and mean SLAM-R 10 +/- 4) and 19 age-matched control subjects. Significant differences in the lower frequency sinusoidal components of the pressure waveforms were evident between groups (P < 0.05). Both C1 and C2 were significantly reduced in patients with SLE: C1 mean +/- SD 13.5 +/- 4.0 ml/mmHg x 10 versus C1 17.5 +/- 4.8 ml/mmHg x 10 (P = 0.003 in patients vs. controls, respectively) and C2 5.2 +/- 3.4 ml/mmHg x 100 versus C2 9.4 +/- 2.8 ml/mmHg x 100 (P < 0.001 in patients vs. controls, respectively). In this group of SLE patients, without an excess of traditional cardiovascular risk factors and SLAM-R scores indicating mild disease, descriptive and model-based analysis of arterial waveforms identified vascular abnormalities at a preclinical stage.

BackgroundBritish Society of Rheumatology (BSR) guidelines, due to be updated in April 2018, recommend consideration of CT PET when there is suspicion of large-vessel GCA (LV-GCA) in patients with prominent systemic symptoms, limb claudication or persistently high-inflammatory markers despite adequate glucocorticosteroid therapy. Vascular Ultrasound is unhelpful in assessment of the aorta.ObjectivesWe investigated the use of CT PET in suspected cases of LV-GCA and its impact on management of patients in the BHSCT from August 2016 to August 2017.MethodsThe IT support team in Royal Victoria Hospital provided a list of CTPET scans requested under the specific code for vasculitis and/or Pyrexia/infection and another code for general. Of the 250 scans identified under these codes, 34 scans were requested by Rheumatology for possible vasculitis following a review of the electronic care records. A proforma was used to aid data collection.ResultsFemale:Male ratio was 3.25:1, with a mean age of 65. 88% of the scans were requested due to a suspected diagnosis of vasculitis and 12% were for follow up of known vasculitis. 24% of CT PET scans were positive for large vessel vasculitis (LVV). The ESR was greater than 50 mm/hr in 75% of positive scans. Of those patients with a positive CT PET scan, 88% were treated with steroids. Of those patients with a negative CT PET scan, 42% were treated with steroids. It is noteworthy that 29% of patients were on steroids at the time of CT PET which may impact results. 60% of patients who were on steroids at the time of CT PET were on 60 mg of prednisolone daily. 31% of patients with negative scans were on steroids at the time of CT PET. 46% of patients with negative CT PET scans remained on steroid treatment. Steroid treatment was continued in patients with negative scans on basis of active aortic valve histology ±clinical criteria for diagnosis of GCA ±cerebral vasculitis on neuroimaging ±polymyalgia rheumatica evident on CTPET. CT PET changed management in 65% of patients with positive results supporting steroid treatment and negative results guiding withdrawal of steroids.ConclusionsWe are fortunate to have access to CT PET in Northern Ireland. CT PET scans changed management in 65% of our patients, despite 29% of patients being on steroid treatment prior to CT PET. We wish to increase awareness of the role CTPET in the diagnosis and management of LVV. We are liaising with radiology colleagues to refine and maximise appropriate referrals for CT PET scans for patients with suspected vasculitis.References[1] BSR and BHPR guidelines for the management of giant cell arteritis. Bhaskar Dasgupta, et al. Rheumatology, Volume 49, Issue 8, 1 August 2010, Pages1594–1597, Published: 05 April 2010[2] EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Christian Dejaco, et al. Ann Rheum Dispublished online January 22, 2018Disclosure of InterestNone declared