Arti Mahto

• Doctor of Philosophy
• Consultant at King's College Hospital NHS Foundation Trust

Background/Aims Interstitial lung disease (ILD) is associated with poor survival in patients with idiopathic inflammatory myopathies (IIM). Cyclophosphamide is often used in the management of myositis-associated ILD (IIM-ILD). The EUROLUPUS (0.5g IV fortnightly for 6 doses) regime has previously been shown to be as effective as high dose regimes in...

Background/Purpose: Data from before the COVID-19 pandemic had shown persistently poor care for people with gout in many countries worldwide. Whether this was further exacerbated by the pandemic is not fully understood. Our objective was to investigate the impact of the pandemic on consultations and care quality for people with gout in England, usi...

Introduction Synovial biopsy is a valuable diagnostic tool for investigating unexplained joint swelling, particularly when imaging and clinical evaluations are inconclusive in the context of suspected infection. This procedure is useful for diagnosing tuberculous (TB) arthritis. Whilst sinus tract formation is a known complication of TB, this is no...

Introduction Vanishing bile duct syndrome (VBDS) is a rare, acquired disease presenting with features of cholestasis and loss of bile ducts (>50%) on biopsy. Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening autoinflammatory disorder characterised by excessive activation of the immune system, leading to severe inflammation, pancytopen...

Introduction Systemic lupus erythematosus (SLE) presents substantial challenges, particularly in cases of major organ involvement, particularly within the central nervous system, which may be characterised by acute neurological symptoms including seizures and altered levels of consciousness. These cases often necessitate careful consideration of po...

Introduction Adult-onset Still’s Disease (AOSD) is a rare systemic auto-inflammatory disorder characterised by fever, arthritis and rash. Some patients with AOSD exhibit resistance or intolerance to conventional treatments, necessitating alternative therapeutic strategies. This case series aims to explore the efficacy and safety of JAK inhibitors i...

Introduction Adult-onset Still’s Disease (AOSD) is a rare systemic auto-inflammatory disorder characterised by fever, arthritis and rash. Some patients with AOSD exhibit resistance or intolerance to conventional treatments, necessitating alternative therapeutic strategies. This case explores the efficacy and safety of janus kinase (JAK) inhibitors...

Background Giant cell arteritis (GCA) is a large vessel vasculitis with a predominance affecting elderly Caucasian patients and is a medical emergency requiring prompt diagnosis and intervention. The GCA probability score (GCAPS) is a clinical tool developed to assist GCA assessment in the early stage of disease utilised in fast-track clinics. Obj...

Background/Aims Gout is the most common inflammatory arthritis worldwide, yet one of the worst managed. Few population-level studies have evaluated how the COVID-19 pandemic impacted on incidence, prevalence, management and hospitalisations for people with gout. We investigated this in England using the OpenSAFELY platform. Methods With the approv...

Background: Vaccination against pneumococcus reduces the risk of infective events, hospitalisation, and death in individual with inflammatory arthritis, particularly in those on immunomodulating therapy who are at risk of worse outcomes from pneumococcal disease. The objective of this study was to investigate the serological protection following va...

Objectives The National Health Service in England funds 12 months of weekly subcutaneous tocilizumab (qwTCZ) for patients with relapsing or refractory giant cell arteritis (GCA). During the COVID-19 pandemic, some patients were allowed longer treatment. We sought to describe what happened to patients after cessation of qwTCZ. Methods Multicentre s...

Introduction Scleroderma is a rare autoimmune connective tissue disorder that is largely considered the disease prototype for sclerosing skin conditions. However there are other rare conditions that can mimic scleroderma (1). Differentiating between these can be challenging, especially in the early stages of the disease. However, ascertaining the c...

Introduction Difficult-to-treat rheumatoid arthritis (D2T RA) remains an area of unmet need in rheumatology. Despite the increasing availability of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) choices to treat RA, a significant proportion of patients with D2T RA still fail to achieve low disease activity or remiss...

Background. Gout is the most prevalent inflammatory arthritis, yet one of the worst managed. Our objective was to assess how the COVID-19 pandemic impacted incidence and quality of care for people with gout in England, UK. Methods. With the approval of National Health Service England, we did a population-level cohort study using primary care and h...

Background There are limited real world data on the use of JAK inhibitors (JAKi). In 2022, the EMA suggested that JAKi should only be used if alternative therapies are not available in patients over 65 years, smokers or in those with cardiovascular or cancer risk factors. Objectives We conducted a retrospective study to describe the demographics,...

Background/Aims The impact of the pandemic on the incidence and management of inflammatory arthritis (IA) is not understood. Routinely-captured data in secure platforms, such as OpenSAFELY, offer unique opportunities to understand how IA was impacted upon by the pandemic. Our objective was to use OpenSAFELY to assess the effects of the pandemic on...

Background The impact of the COVID-19 pandemic on the incidence and management of inflammatory arthritis is not understood. Routinely captured data in secure platforms, such as OpenSAFELY, offer unique opportunities to understand how care for patients with inflammatory arthritis was impacted upon by the pandemic. Our objective was to use OpenSAFELY...

Objective: To use the OpenSAFELY platform to replicate key metrics from a national clinical audit, and assess the impact of COVID-19 on disease incidence and care delivery for inflammatory arthritis (IA) in England. Design: Population-based cohort study, with the approval of NHS England. Setting: Primary care and linked hospital outpatient data for...

Patients with rheumatoid arthritis (RA) receive highly targeted biologic therapies without previous knowledge of target expression levels in the diseased tissue. Approximately 40% of patients do not respond to individual biologic therapies and 5–20% are refractory to all. In a biopsy-based, precision-medicine, randomized clinical trial in RA (R4RA;...

Case report - Introduction Commonly found in association with lupus, antiphospholipid syndrome (APLS) is a potentially life-threatening disease of which an understanding is essential for rheumatologists. In addition to well-recognised sequelae such as pulmonary embolism and obstetric complications, APLS can provoke thrombi ranging from microscopic...

Background Although targeted biological treatments have transformed the outlook for patients with rheumatoid arthritis, 40% of patients show poor clinical response, which is mechanistically still unexplained. Because more than 50% of patients with rheumatoid arthritis have low or absent CD20 B cells—the target for rituximab—in the main disease tiss...

Case report - Introduction Sjögren’s Syndrome (SS) is a chronic autoimmune inflammatory condition characterized by lymphocytic infiltration of the lacrimal and salivary glands resulting in dry eyes and mouth. One third of patients present with systemic extra glandular manifestations, including neurological symptoms. Sjögren’s syndrome as a paraneop...

Case report - Introduction Bacterial and fungal infections are recognised complications of viral pneumonia, particularly in patients who are critically ill. We describe a case of fungal sacroiliitis complicating severe COVID-19 pneumonia following a prolonged intensive care unit (ICU) admission. Candida albicans sacroilitis is a rarely reported inf...

Abstract Background: Hospitalisations due to gout have increased over the last decade, in direct contrast to declining admissions for other inflammatory arthritides including RA [1]. Gout is a treatable condition with recently published EULAR guidelines [2, 3]. Admissions could be avoided with effective use of urate-lowering therapies (ULT). Objec...

Objectives: To assess whether the histopathological features of the synovium before starting treatment with the TNFi certolizumab-pegol could predict clinical outcome and examine the modulation of histopathology by treatment. Methods: Thirty-seven RA patients fulfilling UK NICE guidelines for biologic therapy were enrolled at Barts Health NHS trust...

Background Clinical outcomes in elderly-onset rheumatoid arthritis (EORA), starting after the age of 60, are conflicting. Thus, we aimed to investigate in a unique biopsy-driven, treatment-naïve early arthritis cohort, the relationship between synovial pathobiology of elderly- (EORA) and younger-onset rheumatoid arthritis (YORA) patients through cl...

Background Biologic therapies have transformed the outlook for RA but the significant health economic impact of these therapies has highlighted the need to define predictive markers of response. Rituximab (RTX) is licensed for use following failure of csDMARDs and TNF inhibitor (TNFi) therapy. However, in this increasing therapeutically resistant c...

Introduction We describe a 29-year-old gentleman with triple-antibody positive primary antiphospholipid syndrome (APS) who presented with recurrent cerebrovascular thrombotic events despite anticoagulation. He was escalated to rituximab. A pre-rituximab chest radiograph was abnormal resulting in a CT-chest which demonstrated bilateral widespread gr...

Background Remission in rheumatoid arthritis (RA) is now achievable in a significant proportion of patients using a combination of a treat to target strategy and biologic therapy. A number of clinical assessment tools exist for assessing remission. Several reports have shown that ultrasound (US) may have a role in better characterising this group o...

Introduction: Avascular necrosis is defined as the death of bone tissues secondary to lack of inadequate vascular supply. Its aetiology is numerous, and sometimes multifactorial, but in essence may be caused by any perturbation in bony vasculature 1. Such examples range from fracture, joint dislocation, slipped and epiphysis, to more complex diseas...

Objective: Magnetic resonance imaging (MRI) has been increasingly recognized as a critical tool for the assessment of patients with rheumatoid arthritis (RA) and is able to reliably identify synovitis, bone marrow edema, bone erosion, and joint space narrowing (JSN)/cartilage loss. Understanding the exact relationship between each MRI feature and...

Objectives: Ultrasound-guided synovial biopsy (UGSB) is a minimally-invasive procedure capable of retrieving good quality tissue from small and large joints. The use of UGSB in prospective clinical trials poses a dilemma as to whether biopsied joints may be later included in core data sets for clinical or imagining response, as the procedure itsel...

Background Predicting response to biologic therapies in RA remains a clinical challenge. The anti-CD20 monoclonal antibody Rituximab effectively depletes peripheral blood B-cells, however response rates are approximately 60%. We hypothesized that expression of CD20 in diseased tissue may be an important predictor of response, since up to 40% of pat...

Background Psoriatic arthritis (PsA) is an inflammatory joint disease associated with psoriasis. With biologics entering the therapeutic scene, treatment outcome has dramatically improved; nonetheless, pathogenesis of the condiiton is still under investigation. Exploring the biological differences between PsA and RA at tissue level may help in unde...

Neovascularization contributes to the development of sustained synovial inflammation in the early stages of Rheumatoid Arthritis. Ultrasound (US) provides an indirect method of assessing synovial blood flow and has been shown to correlate with clinical disease activity in patients with Rheumatoid Arthritis. This study examines the relationship of U...

Because limited data currently support the clinical utility of peripherally expressed biomarkers in guiding treatment decisions for patients with rheumatoid arthritis, the search has turned to the disease tissue. The strategic aim of the Outcome Measures in Rheumatology (OMERACT) synovitis working group over the years has been to develop novel diag...

Background Although the pathogenesis of psoriatic arthritis is well-explored, the mechanisms underlying patients' differential response to disease-modifying treatment remains unknown. Objectives This analysis was undertaken to explore the potential utility of synovial tissue examination in measuring and predicting response to disease-modifying trea...

Background Elderly-onset rheumatoid arthritis (EORA), starting after the age of 60, is a subset of disease with different characteristics from the classic younger-onset RA (YORA). There are conflicting results regarding disease outcomes in both groups. Objectives We aimed to compare clinical, pathological and ultrasound (US) features between these...

Background and objectives Elderly-onset rheumatoid arthritis (EORA), starting after the age of 60, is a subset of disease with different characteristics from the classic younger-onset RA (YORA). We aimed to compare clinical and pathological features between these two disease subsets in the Barts Early Arthritis Cohort (BEAC). Material and methods W...

Background Predicting prognosis in patients with early RA remains a challenge. There is currently limited data from early arthritis cohorts examining the relationship between synovial pathotype, clinical phenotype and clinical outcome, including tissue obtained from small joints biopsy. Objectives The aim of this study was to evaluate in an early R...

Background Musculoskeletal ultrasound (US) is a reliable imaging tool, which complements clinical assessment of rheumatic conditions and can be used to guide a variety of interventions1. US-guided synovial biopsy (UGSB) is a minimally invasive, safe and well-tolerated procedure2 which facilitates the retrieval of synovial tissue for basic research...

Background Although many observations have suggested that ectopic lymphoid structures within the inflamed synovium are immunologically functional and can support chronic inflammation, their clinical significance is still controversial. Moreover, most of data comes from patients with long standing disease activity, while data in early arthritis is s...

Background B-cells are key mediators in RA pathogenesis through the initiation of several pathways that lead to the perturbation of the immune system. Rituximab, an anti-CD20 monoclonal antibody is recommended for use after failure with traditional disease modifying agents and anti-TNF therapy. Despite using peripheral blood B-cells as a marker to...

Background Increased rates of morbidity and mortality in rheumatoid arthritis have been attributed to higher risk of cardiovascular events.1-3 For this reason, patients should be assessed annually to calculate, address and minimise their cardiovascular risk factors. The European League of Action against Rheumatism has 10 recommendations in the asse...

We report the case of a young woman with a background history of discoid lupus who presented with abdominal pain, vomiting and intermittent diarrhoea. Physical examination revealed tenderness in the right upper quadrant with a palpable right inguinal lymph node without any other clinical signs of active lupus. Laboratory investigations showed norma...

Background: IgG4 related fibrosclerosis is rare multi-system disease, characterised by IgG4+ plasma cells and T-lymphocytic infiltration of affected organs. Patients present to various specialties with a wide range of symptoms depending on the organ involved. Patients may present to rheumatologists with raised inflammatory markers or symptoms mimic...

An increased prevalence of both hypertension and cerebrovascular stroke is apparent in growth hormone (GH) deficiency whilst hypertension is a frequent complication in acromegaly. This has suggested a possible link between GH, stature and arterial function. Since the risk of both hypertension and stroke also appears to be inversely correlated with...