Muhammad K Nisar

Luton and Dunstable University Hospital NHS Foundation Trust · Rheumatology & General Medicine

Background/Aims Centralised phlebotomy services have been an integral part of providing blood monitoring facility for people with chronic diseases prescribed vital therapies. However, the patient experience is not always optimal due to the issues of congestion, parking, long waiting times; this has been accentuated during COVID-19 pandemic with the...

Background Specialist services are heavily reliant on consultant delivered models however lack of sufficient consultant appointments pose a significant operational challenge. Clinical nurse specialists (CNSs) are highly trained and can fill this gap whilst maintaining a high standard of care. Objectives We designed an innovative proof-of-concept o...

Background Since the formal recognition of normocalcaemic hyperparathyroidism (nHPT) as a distinct entity in 2008, several studies have been published describing the characteristics of these individuals. Controversy exists regarding diagnostics and the role of parathyroidectomy in such cases. A chief reason for lack of consensus is the disagreement...

Background Specialist services traditionally rely on a consultant to lead a multidisciplinary team and provide patient facing activities. However, demand outstrips the limited expertise available and therefore significant delays occur in treatment pathways. There is an urgent need to expand the skill set of the employed workforce and think ‘outside...

Background/Objectives: The presence of bony erosions in patients with RA is a marker of disease severity and once present they are largely irreversible. Previous studies have shown that the presence of both rheumatoid factor (RF) and anti-cyclic citrullinated peptide (ACPA) antibodies is associated with erosive burden. The aim of our study is to de...

Background Self care is an important management strategy for people with inflammatory arthritis (IA). Focused education should enable people to manage their life with IA and optimise their health and well-being. Several studies have shown positive effects of dedicated health programs on a range of patient reported outcomes such as self-efficacy, pa...

Background Since the introduction of anti-TNF biosimilars in routine clinical practice, there has been a drive to implement the switch program for all biosimilars at the point of availability. First adalimumab biosimilar was granted marketing authorisation by the EMA in March 2017. Our Trust was aligned to NHS England strategy which required adopti...

Background The presence of bony erosions in patients with RA is a marker of disease severity and once present they are largely irreversible. Previous studies have shown that those who are RF positive have more erosions than those who are RF negative. Likewise, ACPA is associated with increased bone loss and rapid erosive changes. Objectives The ai...

Background Specialist services are heavily reliant on a consultant reviewing a patient and discussing management options. However this can significantly delay treatment pathway owing to lack of sufficient consultant appointments. Clinical nurse specialists (CNSs) are an integral part of a multidisciplinary team employed to provide effective care fo...

Background Teriparatide is an effective treatment option for osteoporosis however NICE restricts its use to patients with high disease burden. This was based on cost effectiveness evaluation of the originator (Forsteo®) and would be different for recently introduced generic preparation. Objectives We wished to evaluate the current prescribing beha...

Abstract Background The presence of bony erosions in patients with RA is a marker of disease severity and once present they are largely irreversible. Previous studies have shown that those who are RF positive have more erosions than RF negative group. Likewise, ACPA is associated with increased bone loss and rapid erosive changes. The aim of our st...

Background Teriparatide is an effective treatment option for osteoporosis, however NICE restricts its use to patients with a high disease burden. This was based on a cost effectiveness evaluation of the originator (Forsteo®) and would be different for recently introduced generic preparation. We wished to evaluate the current prescribing behaviour p...

Background Since the introduction of anti-TNF biosimilars in routine clinical practice, there has been a drive to implement the switch program for all biosimilars at the point of availability. Our Trust was aligned to NHS England strategy which required adoption of biosimilar within three months for new patients and one year for switchers. This cou...

Background NICE guidelines recommend the first line use of DMARDs in psoriatic arthritis (PsA). However, studies show that many conventional treatments like methotrexate are poorly tolerated. There is hitherto no published real-world data addressing the tolerability of DMARDs in PsA. Our objective was therefore to assess the drug management in PsA...

Background Specialist services are heavily reliant on a consultant reviewing a patient and discussing management options. We designed an innovative proof-of-concept osteoporosis service with patients only consulting a metabolic bone CNS and a consultant providing remote oversight. The aim of the project was to improve the efficiency of the service...

Background Biologics have led to a sea change in the management of psoriatic arthritis (PsA) with unprecedented improvement in the signs, symptoms and radiographic damage, resulting in improvement in functionality and quality of life. However longitudinal data for their retention and tolerability is sparse. Our objective was to evaluate real-world...

Objective: Several seminal studies have suggested that a combination therapy of biologics with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) improve disease outcomes in rheumatoid arthritis (RA). Hence, most guidelines reflect this practice. It has also been shown that methotrexate (MTX) at a dose of 8-10 mg/week is perh...

Background Globally various incentive schemes have been employed in primary care to improve early diagnosis and management of several rheumatic conditions. In the UK, the Primary Care Quality and Outcomes Framework (QOF) rewards general practices for the provision of ‘quality care’ and helps to fund further improvements in the delivery of clinical...

Background There is good evidence that dedicated early arthritis clinics (EACs) improve referral lag time and reduce delay in establishing disease-modifying therapy. However it remains arguable whether such clinics improve outcomes especially for arthritides other than RA. In the UK, only 57% of units have dedicated EACs. Our early arthritis servic...

Background Since the introduction of anti-TNF biosimilars in routine clinical practice, there has been a drive to implement the switch program for all biosimilars at the point of availability. Rituximab biosimilar was granted marketing authorisation by the EMA in February 2017. Our Trust was one of the first centres to embrace a CQUIN which require...

Introduction Early arthritis clinics (EACs) have been well established since 1980s. Most of the data for their effectiveness comes from rheumatoid arthritis (RA) management and is largely limited to process outcomes. There is little evidence that such clinics improve clinical outcomes particularly for psoriatic arthritis (PsA). We examined whether...

There is good evidence that dedicated early arthritis clinics (EACs) improve referral lag time and reduce delay in establishing disease-modifying therapy. However, it remains arguable whether such clinics improve relevant disease outcomes. Nationally, only 57% of units have dedicated EACs. Our rheumatology department established a centralised, pati...

Objectives: Acute gout is traditionally treated with NSAIDs, corticosteroids, and colchicine. However, the presence of comorbid conditions and advancing age, often seen in hospitalised patients, may prevent their use. We reviewed the published data on the use of ACTH in the treatment of acute gouty arthritis. Methods: A search was performed up t...

Background DMARDs remain the mainstay of inflammatory arthritis therapy. Though an effective treatment, these drugs have the potential to cause serious harm. Vigilant drug monitoring, reflected in recently updated BSR guidelines, is necessary to prevent potentially life threatening complications. National Patient Safety Agency has also issued sever...

Background There is an urgent need to look at New Models of Care to improve quality of care for patients whilst providing the best value for money. Community Pharmacy has been an untapped resource which can assist in achieving the goals of managing long term conditions. Psoriasis is one such example affecting 1% to 3% of the population with upto 40...

Background The rheumatology nurse specialist (RNS) plays a central role in the multi-professional rheumatology team. Delivering corticosteroid (CS) therapy to patients is an area where there is little understanding of RNSs confidence in managing them. Objectives Considering CSs are a cornerstone of treating rheumatic diseases where RNSs are invari...

Background Poor adherence to therapy remains a significant barrier to improving clinical outcomes in rheumatic diseases and carries a major financial burden. It has been linked to medication related patient beliefs, which were reported to differ between ethnic groups. Little is known about these variations in biologic therapies cohorts. The purpose...

Background It is widely acknowledged that a multidisciplinary team approach is the best way to care for rheumatology patient group. The rheumatology nurse specialist (RNS) is an integral part of this multidisciplinary team. EULAR has published recommendations for their role in the management of chronic inflammatory arthritis (van Eijk-Hustings Y et...

Background Since the introduction of the Rheumatology nursing in the UK in 1980s, there has been gradual development of the “specialty”. Despite the proven benefits, both clinical and economical, of a well-trained rheumatology nurse specialist and the evolution of the role, there is a lack of a clear career path for the profession. Objectives We u...

Background Patients with rheumatic diseases occupy over 50,000 bed days annually in the National Health Service. Adverse drug events are major causes of harm to patients in hospitals and are associated with prolonged length of stay with higher costs. National Patient Safety Agency has issued several alerts regarding DMARDs and Methotrexate overdose...

Biologic therapies have resulted in a sea change in the management of inflammatory arthritis; however, a higher risk of opportunistic infection, particularly tuberculosis (TB), is well recognised. This has led to the development of TB screening guidelines. The aim of this study was to investigate the prevalence of latent TB in patients prescribed b...

Background Biologic agents have led to a sea change in the management of inflammatory arthritis however higher risk of opportunistic infections particularly tuberculosis (TB) is well recognised. This has led to the development of TB screening guidelines. Objectives The aim of this study was to investigate the prevalence of latent TB in patients pre...

Background Chikungunya (CKG) virus is an arthritogenic mosquito-transmitted alphavirus which manifests as a febrile illness and often progresses to severe and incapacitating polyarthralgia. Several reports have demonstrated persistent polyarthritis akin to seronegative peripheral arthropathy. However, to our knowledge, imaging confirmed axial disea...

Cupping treatment is on the rise in the Western world as an alternative medicine modality.We present a hitherto unreported complication of bilateral subdural hemorrhage associated with this therapy, highlighting the need for vigilance in patients presenting with headache because they may get misdiagnosed unless history for such therapies is explore...

Background Vitamin D (Vit D) insufficiency has been implicated in a number of autoimmune diseases. Its role in the pathogenesis of juvenile idiopathic arthritis (JIA) however is unclear including its relation to disease subtype and severity. Objectives To establish a link between Vit D insufficiency and JIA Methods We undertook a retrospective coho...

The management of rheumatic conditions, including those occurring in children, has improved dramatically over the last decade following the introduction of biologic disease-modifying anti-rheumatic drugs (bDMARDS) into the therapeutic arsenal. The benefits have been realised in multiple aspects of disease including signs and symptoms, bone and cart...

Over the last decade vitamin D (Vit D) has been the focus of considerable interest as a potential immunomodulator in a variety of conditions including autoimmune disease. Its influence in juvenile idiopathic arthritis (JIA) however is unclear. We therefore wished to clarify a possible link with the currently available evidence. A systematic literat...

Several guidelines recommended routine use of Disease Activity Score-28 (DAS28) to monitor disease and the response to treatment for rheumatoid arthritis (RA). In practice, it may be appropriate to use historical erythrocyte sedimentation rate (ESR) values in place of same-day ESR, thereby preventing unnecessary delay in adjusting intervention. We...

Objectives: Methotrexate (MTX) has become the foundation disease-modifying anti-rheumatic drug (DMARD) for RA. However, concern exists regarding its possible association with infectious complications including varicella zoster virus (VZV) and herpes zoster (HZ). Furthermore, no consensus exists regarding pre-MTX VZV screening or the use of VZV vac...

Interleukin 6 (IL-6) plays a central role in the immunopathogenesis of rheumatoid arthritis (RA) and tocilizumab [TCZ] (an anti-IL-6 receptor antibody) has been shown to be effective in the treatment of the condition. As up-regulation of IL-6 reduces the activity of cytochrome P450 (CYP) enzymes, blockade of this cytokine may enhance CYP function....

A major advance in the treatment of rheumatoid arthritis has occurred following the introduction of tocilizumab (TCZ), an anti-IL-6 receptor antibody, into the therapeutic armory. Improvements in multiple aspects of the disorder including signs and symptoms, radiographic damage, disability and quality of life have been seen following its use. Exten...

Rituximab (RTX), a B-cell depleting mAb, has been reported to cause pulmonary toxicity in many patients. As the use of this biologic is increasing, we have undertaken a systematic review of the literature to gauge the nature and extent of non-infection-related RTX-induced lung disease. A systematic literature review was undertaken to document all r...

Lung disease is commonly encountered in rheumatological practice either as a manifestation of the underlying condition or as a consequence of using disease-modifying therapies. This has been particularly apparent with the TNF-α antagonists and exacerbations of interstitial lung disease (ILD). In view of this, we undertook a review of the current li...

Tocilizumab, a monoclonal antibody targeting the IL-6 receptor, has recently been added to the therapeutic armamentarium against rheumatoid arthritis (RA). Despite its overall safety, concerns have been raised regarding diverticular perforation in patients receiving the drug. The aim of our research was to document the incidence of diverticular dis...

Spontaneous coronary artery dissection (SCAD) is an extremely uncommon condition that can lead to fatal acute myocardial infarction. There have been very few case reports of SCAD in patients with systemic lupus erythematosus (SLE) and even fewer in association with antiphospholipid antibodies - mainly postpartum. This is the first reported case of...

In order to achieve remission, rapid diagnosis of rheumatoid arthritis (RA) is a key priority. The new RA classification system allows a diagnosis to be made much earlier than previously. The criteria focus on clinical, biochemical and immunological features associated with persistent and/or erosive disease. Following presentation to primary care,...