Objective.Systemic sclerosis (SSc) is characterized by significant disability because of musculoskeletal involvement. Physical and occupational therapy (PT/OT) have been suggested to improve function. However, the rate of PT/OT use has been shown to be low in SSc. We aimed to identify demographic, medical, and psychological variables associated with PT/OT use in SSc.Methods.Participants were patients with SSc enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort. We determined the rate and indication of PT/OT use in the 3 months prior to enrollment. Multivariable logistic regression was used to identify variables independently associated with PT/OT use.Results.Of the 1627 patients with SSc included in the analysis, 23% used PT/OT in the preceding 3 months. PT/OT use was independently associated with higher education (OR 1.08, 95% CI 1.04–1.12), having moderately severe small joint contractures (OR 2.09, 95% CI 1.45–3.03), severe large joint contractures (OR 2.33, 95% CI 1.14–4.74), fewer digital ulcerations (OR 0.70, 95% CI 0.51–0.95), and higher disability (OR 1.54, 95% CI 1.18–2.02) and pain scores (OR 1.04, 95% CI 1.02–1.06). The highest rate of PT/OT use was reported in France (43%) and the lowest, in the United States (17%).Conclusion.Despite the potential of PT/OT interventions to improve function, < 1 in 4 patients with SSc enrolled in a large international cohort used PT/OT services in the last 3 months. Patients who used PT/OT had more severe musculoskeletal manifestations and higher pain and disability.

Background: Early-stage breast cancer is often treated with breast-conserving therapy (BCT), including lumpectomy with radiation therapy. Patients' expectations of BCT remain largely unknown. Expectations affect perceptions of treatment-related experiences and health-related quality of life (HR-QOL) outcomes. Our primary aim was to describe expectations of BCT among patients with early breast cancer through qualitative methods. Our secondary aim was to inform preoperative patient education and improve the patient experience through knowledge. Methods: We used a grounded-theory approach to investigate a convenience sample of 22 women with stage I and II breast cancer who were treated with BCT at a single hospital in New York City between May and August 2016. Semi-structured interviews were conducted in person and by telephone. Open-ended questions covered participants' expectations of treatment experiences and outcomes. Data was analyzed in a line-by-line approach to identify emergent themes related to patient expectations. Interviews continued until no new themes emerged. Results: Analysis of data identified the following themes related to patient expectations of BCT: experience of cancer care, recovery, appearance, and HR-QOL. Despite preoperative informed consent and teaching, participants expressed few expectations preoperatively, owing to a lack of knowledge about the process of care. Lack of expectations preoperatively was compensated with available care and resources postoperatively. Conclusions: Patients in our sample had a surprisingly limited understanding of what to expect during treatment with BCT. Despite available information and preoperative teaching, patients have a clear knowledge gap regarding BCT. These findings suggest patients often undergo cancer treatment with trust rather than complete understanding of the process. This data may be used to enhance preoperative discussions aimed at preparing patients for surgery and treatment.

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Objective Systemic sclerosis (SSc) has significant psychosocial implications. We aimed to evaluate the proportion of participants in a large international SSc cohort who used mental health services in a 3‐month period and to evaluate demographic, psychological, and disease‐specific factors associated with use. Methods Baseline data of participants enrolled in the Scleroderma Patient‐Centered Intervention Network Cohort were analyzed. We determined the proportion that used mental health services and the source of services in the 3 months prior to enrollment. Multivariable logistic regression was used to identify variables associated with service use. Results Of the 2319 participants included in the analysis, 417 (18%) used mental health services in the 3 months prior to enrollment. General practitioners were the most common mental health service providers (59%), followed by psychologists (25%) and psychiatrists (19%). In multivariable analysis, mental health service use was independently associated with higher education (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03‐1.11), smoking (OR 1.06, 95% CI 1.02‐1.11), being retired (OR 0.60, 95% CI 0.38‐0.93), having limited SSc (OR 1.39, 95% CI 1.02‐1.89), and having higher anxiety symptom scores (OR 1.04, 95% CI 1.03‐1.06) and lower self‐efficacy scores (OR 0.90, 95% CI 0.83‐0.97). Variables not significantly associated included age, race, disease manifestations, depression symptom scores, and body image distress. Conclusion About 18% of participants in a large international cohort received mental health services in a 3‐month period, of whom the majority received these services from a general practitioner.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and its impact on disease outcome in patients with autoimmune rheumatic disease (ARD) are lacking. Also, whether patients with ARD receiving immunomodulators have different viral loads compared to the general population is unknown.ObjectivesTo compare the viral load of SARS-CoV-2 and its trending between patients without and with ARD.MethodsRetrospectively, patients with ARD infected with SARS-CoV-2 were matched by age and sex at a ratio of 1:2 to patients without ARD and not receiving immunosuppression or immunomodulator drugs. Viral load was determined by the cycle threshold (CT) value measured by a number of platforms: (a) Automated Platforms - the Roche Cobas 6800 system using the Cobas SARS-CoV-2 Test targeting the E and orf1a/b genes (Roche, Switzerland) and the Xpert Xpress SARS-CoV-2 targeting the E and N genes (Cepheid, USA); (b) Manual platforms - EZ1 (QIAGEN, USA), QIAsymphony (QIAGEN, USA), and Bioneer ExiPrepTM 96 Virus DNA/RNA kits Catalogue No K4614 (Bioneer, South Korea) extraction with thermal cycling using TaqPath™ PCR COVID-19 Combo Kit targeting the N, S and orf1a/b genes (Thermo Fisher Scientific, USA) on ABI 7500 thermal cyclers. Independent samples t-test was used to compare the mean CT values of the study groups at baseline and at 5 subsequent intervals (1 – 5.9, 6 – 11.9, 12 – 17.9, 18 – 23.9 and 24 – 30 days).ResultsMean age (SD) of 197 cases and 420 controls were 45.2 (11.8) and 44.1 (12.3) years, respectively. Females were predominant in both groups 60% vs. 52%, P=0.053. The most common ARD was rheumatoid arthritis in 82 cases (41.6%), followed by spondyloarthropathy in 33 (16.8%) and systemic lupus erythematosus in 31 (15.7%). Of the cases, 67% were on conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), 15.2% on biological DMARDs and 4.6% patients were on rituximab. The mean CT values was significantly lower in the ARD group at baseline and persisted till day 24.Table 1.demographic characteristics and comparison of the mean CT values in the study groups at baseline and at different intervals with the corresponding OR (95% CI)Case (N=197)Control (N=420)OR (95% CI)Mean (SD) age, years45.2 (11.8)44.1 (12.3)1.008 (0.994–1.022)Sex, female N (%)120 (60.9%)221 (52.6)0.713 (0.505–1.006)Mean (SD) CT values at Baseline22.9 (5.5)30 (5.2)0.799 (0.745–0.858)1 – 5.9 days22.1 (4.6)25.7 (6.3)0.901 (0.842–0.963)6 – 11.9 days26.9 (4.9)31.5 (3.9)0.802 (0.724–0.888)12 – 17.9 days29.6 (4.1)32.3 (3.2)0.827 (0.743–0.921)18 – 23.9 days32.1 (4)32.9 (2.5)0.903 (0.728–1.119)24 – 30 days31.2 (1.2)32.7 (2.6)0.824 (0.589–1.151)ConclusionCompared to patients without ARD, the viral load of SARS-CoV-2 in patients with ARD is significantly higher at baseline testing and persists till day 24. This finding may indicate that patients with ARD are at higher risk of severe SARS-CoV-2 infection and prolonged potential transmission. Clinical outcome correlation is needed.ReferencesNoneDisclosure of InterestsNone declared

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Background: Autoimmune rheumatic diseases (ARDs) are characterized by immune dysfunction and associated with an increased risk of infections, which were of significant concern during the coronavirus disease 2019 (COVID-19) pandemic. Variable rates of COVID-19 incidence have been reported in patients with ARDs; however, the true effect of this infection on this patient population is still unclear. We, therefore, aimed to evaluate the COVID-19 prevalence among a multiethnic cohort of patients with ARDs in Qatar. Material and Methods: We used telephonic surveys to collect demographic and clinical information of patients with ARD in Qatar between April 1 and July 31, 2020, including any close contact with a COVID-19 case at home or work and polymerase chain reaction (PCR)-confirmed COVID-19 diagnosis. An electronic medical records review was conducted to verify pertinent data collected through the surveys. Prevalence with 95% confidence interval (CI), Student's t-tests, and chi-square/Fisher's exact tests were used for univariate analyses, whereas multivariate logistic regression was used to identify factors associated with COVID-19. Results: The study included 700 patients with ARD (mean age, 43.2 ± 12.3 years), and 73% were female. Until July 2020, 75 (11%, 95% CI 9%–13%) patients had COVID-19. Factors associated with COVID-19 included being a man (adjusted odds ratio [aOR] 2.56, 95% CI 1.35–4.88, p = 0.01) and having close contact with a COVID-19 case (aOR 27.89, 95% CI 14.85–52.38, p = 0.01). Disease severity and rheumatic medications had no significant association with the odds of contracting COVID-19. In the 86 patients with ARD having close contact, the frequency of hydroxychloroquine utilization was lower in patients who contracted COVID-19 than in those who did not (35% vs 72.5%, p = 0.01). Conclusions: In Qatar, patients with ARDs had an overall higher prevalence of COVID-19 than global estimates. Being male and having close contact with a COVID-19 case were strongly associated with COVID-19 as reported globally. The presence of comorbid conditions, disease-specific factors, and rheumatic medications had no significant effect on the risk of COVID-19 in our study suggesting alternative mechanisms to the increased prevalence.

BackgroundD-dimer and fibrinogen elevation has been observed in severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection which is associated with higher incidence of venous thromboembolism (VTE) and higher mortality rates. [1-3]. Autoimmune Rheumatic Diseases (ARDs) are associated with higher rates of VTE compared to general population [4]. Whether patients with ARDs infected with SARS-CoV2 have similar D-dimer and fibrinogen trends compared to patients without ARDs is unknown.ObjectivesCompare D-dimer and fibrinogen levels in patients with ARDs infected with SARS-CoV2 to patients without ARDs.MethodsPatients with ARDs infected with SARS-CoV2 were identified retrospectively from the electronic medical records (EMR) of Hamad Medical Corporation and matched (age and sex) to controls (1:3). D-dimer and fibrinogen levels were extracted electronically from EMR and stratified into six-time intervals defined in table 1. Day 0 was defined as the date of positive nasopharyngeal polymerase chain reaction swab test. 2 Independent Samples test (Mann-Whitney U) was used to compare the median (25th - 75th interquartile range [IQR]) level of D-dimer and fibrinogen between both study groups at the defined intervals.ResultsThe study included 203 cases and 551 controls with a mean (SD) age of 45.3 (11.7) and 44 (12.5) years, females were (122 [60.1%] vs. 297 [53.9%], p = 0.129), respectively.Distribution of ARDs was rheumatoid arthritis 86 (42.4%), spondyloarthropathy 33 (16.1%) and systemic lupus erythematosus 31 (15.7%) cases. 67% were on conventional synthetic disease modifying anti-rheumatic drugs (Cs-DMARDs), 15.8% on biological DMARDs and 4.9% on rituximab. About 83% of the ARDs group were in remission or low disease activity and 13% were in moderate or high disease activity.The median (25th- 75thIQR) level of D-dimer and fibrinogen were comparable between study groups in all defined intervals with insignificant p values except at interval 4, fibrinogen was significantly higher in the cases, p 0.006. Table 1ConclusionThere was no significant difference in the trend of D-dimer and fibrinogen levels during SARS-CoV2 infection between patients with ARDs and those without ARDs. Additional studies are needed to quantify the actual risk of VTE in patients with ARDs during SARS-CoV2 in correlation with serum markers of VTE.References[1]Eljilany I, Elzouki AN. D-Dimer, Fibrinogen, and IL-6 in COVID-19 Patients with Suspected Venous Thromboembolism: A Narrative Review. Vasc Health Risk Manag. 2020;16:455-62.[2]Li JY, Wang HF, Yin P, Li D, Wang DL, Peng P, et al. Clinical characteristics and risk factors for symptomatic venous thromboembolism in hospitalized COVID-19 patients: A multicenter retrospective study. J Thromb Haemost. 2021;19(4):1038-48.[3]Zhan H, Chen H, Liu C, Cheng L, Yan S, Li H, et al. Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression. Clin Appl Thromb Hemost. 2021;27:10760296211010976.[4]Lee JJ, Pope JE. A meta-analysis of the risk of venous thromboembolism in inflammatory rheumatic diseases. Arthritis Res Ther. 2014;16(5):435.Table 1.Differences in D-dimer and fibrinogen during SARS-CoV2 infection between patients with ARDs and those without at the defined intervals.Case N = 203Control N = 551P valueMedian (25th - 75th IQR), D-dimer (mg/L)(0 to < 3 days)0.56 (0.34 – 1.31)0.86 (0.54 – 1.41)0.096(≤ 3 to < 6 days)0.67 (0.35 – 2.58)1.11 (0.44 – 1.11)0.340(≤ 6 to < 9 days)0.81 (0.33 – 5.12)1.12 (0.56 – 3.28)0.299(≤ 9 to 12 days)0.94 (0.72 – 5.44)5.20 (1.0 – 15.05)0.058(≤ 12 to < 15 days)2.88 (0.72 – 5.53)4.96 (0.57 – 9.98)0.681(≤ 15 to 18 days)1.81 (0.89 – 2.55)5.56 (2.60 – 15.1)0.086Median (25th – 75th IQR), fibrinogen (mg/L)(0 to < 3 days)6.53 (2.0 - 6.53)5.65 (3.75 – 7.17)1.000(≤ 3 to < 6 days)6.25 (3.72 – 8.3)4.6 (4.1 – 5.6)0.385(≤ 6 to < 9 days)3.53 (3.29 – 4.62)3.4 (3.2 – 3.92)0.328(≤ 9 to 12 days)4.3 (2.82 – 4.78)2.2 (1.65 – 3.05)0.006(≤ 12 to < 15 days)4.4 (2.37 – 5.13)3.1 (1.7 – 4.45)0.170(≤ 15 to 18 days)3.6 (3 – 5.7)3.7 (2.0 – 4.88)0.524Acknowledgements:NIL.Disclosure of InterestsNone Declared.