ABSTRACT
Objectives: This is a retrospective study that set out to assess the safety, feasibility and cost savings of temporary relaxed blood test monitoring for patients on MTX under the rheumatology service that was rolled out during the coronavirus pandemic. Methods: This is a single-centre study that reviewed the blood tests of all patients who received an MTX prescription from the trust between December 2019 and November 2020. After the application of inclusion and exclusion criteria, the blood testing intervals and findings were analysed and collated. The cost of the blood tests was obtained from the laboratory. Results: A total of 1194 patients were identified as having received an MTX prescription. After applying inclusion and exclusion criteria, 462 patients were included. Of these, 395 (85%) patients had a blood test within the standard 3-month schedule and 67 had blood tests within the relaxed blood monitoring schedule. Six patients had an abnormality identified on their blood tests, but no harm was caused by any of these abnormalities. The intervention resulted in a cost savings of at least £1187 from the blood test costs alone. Conclusion: MTX is a widely used steroid-sparing agent that requires regular blood test monitoring to reduce adverse outcomes for patients. During extraordinary circumstances such as a pandemic, relaxing the interval between monitoring blood tests in stable patients is a feasible intervention. A relaxed monitoring blood test interval for a set period is safe, achievable and cost effective.
ABSTRACT
Background/Aims With the emergence of the coronavirus vaccine and the clear and important role it provides in maintaining the health of individuals and the population, it is important that our patients receive or are recommended the vaccine. We here document a case series of patients who have long-term quiescent rheumatoid arthritis who then experienced a flare of disease activity after receiving a vaccine. This information is important to understand as it allows informed discussions regarding the side effect profile of the vaccine and also the influence this may have on the patient’s disease control and future management options. Methods Patients were reviewed in clinic as part of standard care. Individuals with rheumatoid arthritis who had experienced a flare defined as a self-reported disease activity score of > 5.1 in otherwise stable disease were noted and their response to treatment reviewed. This was a review of usual clinical practice and did not alter the treatment undertaken or monitoring of the patent. Information obtained was through the consultation with a rheumatologist and the data was collected retrospectively through review of clinical notes and clinic letters. Results Table 1 outlines the patient details and treatment responses. All flares occurred within two weeks of receiving the vaccine. Of the patients who flared, two required short-term steroid treatment;three an increase in the usual medications and one who had been in disease remission to re-start previous therapy. More patients in the Pfizer vaccine group required an escalation of usual care compared to the AstraZeneca vaccine group. Conclusion We report six cases of rheumatoid arthritis flare soon after receipt of the coronavirus vaccine. In all, disease control was returned with minimal changes to treatment, 33% of those requiring either no treatment or an intramuscular steroid injection alone. Therefore, we recommend that clinicians should counsel patients of this potential effect, but continue to advocate the vaccine, as the risk of complications to their underlying arthritis is very low and seemingly easily treatable. P194 Table 1Antibody statusVaccine brandTime since diagnosisTime since last flareFlare after 1st or 2nd doseUsual treatmentFlare managementSeropositive, anti-CCP positiveAstraZeneca13 years3 years1stEtanercept, MethotrexateIntramuscular MethylprednisoloneSeropositive, anti-CCP positiveAstraZeneca11 years4 years1stEtanercept, SulfasalazineIntramuscular Methylprednisolone, local joint injectionSeronegative, anti-CCP negativeAstraZeneca13 years2 years1stMethotrexateIncrease methotrexate doseSeronegative, anti-CCP positivePfizer23 years11 years1stInfliximabLocal joint injection, reduce interval of infusionsSeronegative, anti-CCP positivePfizer7 years3 years2ndSulfasalazine, hydroxychloroquineIncrease Sulfasalazine doseSeropositive, anti-CCP positivePfizer7 years4 years2ndnilRe-start methotrexate, hydroxychloroquine Disclosure R.J. Hayward: None. Z. Farah: None.