A 56-year-old woman presented with an enlarging soft-tissue mass of the left ring finger, causing worsening range of motion in the metacarpophalangeal and interphalangeal joints. Excision of the mass was performed and a 3.5×3.5×3 cm lipoma was found displacing the digital neurovascular bundles laterally and posteriorly. Surgical pathology revealed a rare angiolipoma. This case was unusual because of the location of the mass, and the fact that it was non-tender, and larger than the typical angiolipoma presentation. Definitive identification of angiolipomas, especially those without gross vascularisation, as in this case, is often delayed until final pathology. Reporting cases of angiolipoma of the finger will increase awareness of this rare lesion and broaden the differential diagnosis to improve identification and management in future cases. We discuss a surgical approach which successfully increased range of motion of the hand and preserved neurovascular integrity.

BackgroundPatient-Reported Outcome Measures (PROMs) give us direct, immediate evidence of patient experience. Pain is a chronic, debilitating, multifactorial, presenting symptom that remains a difficult target to treat in populations with Inflammatory Arthritides.1 Increasingly, cannabis products are being utilized and investigated for their potential analgesic and immune-modulatory effects.2 The legislation and form of cannabis products deployed as therapy varies around the world and across populations. More data on usage and patient reported outcomes is needed to guide better clinical practice and inform sound legislative policy.ObjectivesTo describe PROMs of pain, stiffness with cannabis use in a population of patients with Rheumatoid Arthritis (RA) or Psoriatic Arthritis (PsA).MethodsThis investigation was a monocentric, cross-sectional study. Inclusion criteria were adults receiving care at a University Rheumatology practice in Central Florida, USA from December 2019 to March 2020 who provided informed, written consent. Those who consented were provided with a brief, voluntary, and anonymous Qualtrics survey which queried patient-reported prevalence and outcome measures of short and long-term pain relief. 236 RA and 43 PsA patients were enrolled in this study. All subjects met the criteria for Rheumatoid, Psoriatic, or Inflammatory Arthritis (seronegative RA). Subjects’ scores before and after cannabinoid use were compared with a paired T-test after the parametric nature of the data was established. Ethical approval was obtained from the University of Central Florida Institutional Review Board (Study00001041).ResultsCannabis product usage was reported in 16.95% of RA subjects (40/236) and 11.63% of PsA subjects (5/43). Of this group, 71% (RA) and 40% (PsA) endorsed current usage. Inhalation was the most prevalent form used in RA (27.50%). In PsA, the most commonly reported forms were liquid (30%) and topical/skin (30%). On the 10-point pain scale, RA patients reported a significant reduction in average pain by 1.83±1.91 points in the long-term and 2.28±2.10 points in the short-term. Those with PsA reported a significant reduction in average pain by 1.60±0.89 points in the long-term and 1.80±0.84 points in the short term. Stiffness was also reduced in the RA group (7.3%). 17.5% of patients with RA using cannabinoids reported side effects not leading to cessation.ConclusionIn an academic rheumatology practice population, a substantial number of RA and PsA patients are choosing to self-treat with cannabis therapy to manage their pain and other symptoms. Subjects reported significant reductions in both short- and long-term pain; some patients reported total pain resolution with ongoing cannabinoid therapy. Stiffness was also reduced in a subset of RA patients. Subjects that reported adverse effects did not find these severe enough to warrant cessation. These study results may allow for a more open discussion to improve safety and optimize outcomes. Additionally, the significant prevalence of usage and pain reduction reported provide a compelling rationale for further interventional studies in populations with Inflammatory Arthritides.References[1]Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746): 1094-1108. doi: 10.1016/s0140-6736(10)60826-4.[2]Fitzcharles, Mary-Ann et al. “Position Statement: A Pragmatic Approach for Medical Cannabis and Patients with Rheumatic Diseases.” The Journal of Rheumatology vol. 46,5 (2019): 532-538. doi:10.3899/jrheum.181120.Disclosure of InterestsTara Jehu: None declared, Neha Bhaskar: None declared, Shazia Beg: None declared, Kathlyn Camargo Macias: None declared, Sweta Chalise: None declared, Neha Bhanusali Consultant of: healthcare consultant (non-pharmaceutical)