Muhammad K Nisar

• MBBS, FRCP
• Consultant at Luton and Dunstable University Hospital NHS Foundation Trust

Background/Aims Romosozumab has been approved by NICE for high risk osteoporosis patients. The device training for administration is part of a bundled homecare package funded by the manufacturer. The default model is online training; however, a concern was raised as to whether older patients would be able to engage in this way or would instead pref...

Introduction Methotrexate (MTX) is the bed rock of inflammatory arthritis management. However, intolerance is a limiting factor for drug optimisation and retention. There is data to suggest subcutaneous (SC) MTX is better tolerated. It is less clear whether this strategy is effective in those where the oral preparation is inefficacious and its pote...

Background From early in the COVID-19 pandemic, evidence suggested a role for cytokine dysregulation and complement activation in severe disease. In the TACTIC-R trial, we evaluated the efficacy and safety of baricitinib, an inhibitor of Janus kinase 1 (JAK1) and JAK2, and ravulizumab, a monoclonal inhibitor of complement C5 activation, as an adjun...

Objectives: Aromatase inhibitor induced bone loss (AIBL) is a recognised adverse event with resultant increase in fracture risk. We aimed to determine the real-world impact of the 2017 consensus guidelines on AIBL and it is effective in fracture prevention. Methods: Over a 7-year study period, 1001 women prescribed AI were split in two groups. Firs...

Background The global impact of COVID-19 on elective rheumatology services is unprecedented, [1,2] and the number of people on waiting lists for consultant-led elective care in the UK has almost doubled. [3] Implementation of patient support programmes that provide an individualised nurse-led service, such as You First, may help to reduce the strai...

Background Since the availability of anti TNF biosimilars and the push from reimbursement panels to use them first line, real world data regarding therapeutic choice in biologic naive population is sparse. Objectives Evaluate the reasons for nurse led service choosing IL17 antagonists in biologic naïve SpA patients, in a shared decision making mod...

Background Rheumatoid arthritis (RA) is a chronic inflammatory disease that is associated with joint pain and stiffness. Biologics represent some of the most effective treatments for RA, but previous guidance from the National Institute for Health and Care Excellence (NICE) has limited their use to patients with severely active disease. This has me...

Background: We aimed to evaluate the use of baricitinib, a Janus kinase (JAK) 1–2 inhibitor, for the treatment of patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple possible treatments in patients hospitalised wit...

Background We aimed to evaluate the use of baricitinib, a Janus kinase (JAK) 1–2 inhibitor, for the treatment of patients admitted to hospital with COVID-19. Methods This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple possible treatments in patients hospitalised with...

Background 2,261,419 women were diagnosed with breast cancer worldwide in 2020. For postmenopausal women with hormone sensitive disease, aromatase inhibitors (AI) are recommended for their mortality benefit. However, AI bone loss (AIBL) is a recognised adverse event with resultant increase in fracture risk. In 2017, a consensus statement of 7 inter...

Background 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 and have been accentuated during COVID-19 pandemic with the need f...

Background Breast cancer remains the most common cancer diagnosed in women worldwide. Aromatase inhibitors (AI) are employed for hormone sensitive disease in mainly postmenopausal women. AI related bone loss (AIBL) is a known complication; although data regarding the natural history in the real-world, long-term outcomes and the role of bone active...

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...

p>Background: Casirivimab and imdevimab are non-competing monoclonal antibodies that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike glycoprotein, blocking viral entry into host cells. We aimed to evaluate the efficacy and safety of casirivimab and imdevimab administered in combination in patients admitted to hosp...

Background Casirivimab and imdevimab are non-competing monoclonal antibodies that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike glycoprotein, blocking viral entry into host cells. We aimed to evaluate the efficacy and safety of casirivimab and imdevimab administered in combination in patients admitted to hospit...

Objective: Even though disease-modifying antirheumatic drugs (DMARDs) are well established in routine clinical practice, longitudinal real-world data for their retention and tolerability are sparse, especially in psoriatic arthritis (PsA) patients. Our objective was to describe the characteristics of our large PsA cohort including the comorbiditie...

Background: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19. Methods: We retrospectively included patients hospitalized for COVID-19 from 10 centers. Clinical, biochemical, electrocardiographic, and imaging data...

Background Aspirin has been proposed as a treatment for COVID-19 on the basis of its anti-thrombotic properties. We aimed to evaluate the efficacy and safety of aspirin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, platform trial, several possible treatments were compared with usual care in pa...

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 Interstitial lung disease is a well described extra-articular manifestation in a range of rheumatic diseases. It carries significant morbidity and mortality. Management of rheumatic diseases associated ILD (r-ILD) requires expertise as the needs of such patients are complex and treatment options limited. Historically, such complex ILD ha...

Background Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVER...

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients ho...

Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECO...

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 Most 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. Objectives Our objective was therefore to assess the drug manage...

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 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. Objectives Our objective was to evaluate...

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...

Background Interstitial lung disease is a well described extra-articular manifestation in a range of rheumatic diseases. It carries significant morbidity and mortality. Management of rheumatic diseases associated ILD (r-ILD) requires expertise as the needs of such patients are complex and treatment options limited. Historically, such complex ILD ha...

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...

A 68-year-old gentleman presented to hepatology department with asymptomatic year-long history of stably deranged liver function tests. His peak alkaline phosphatase (ALP), was 828 with alanine transaminase (ALT) of 141. Full liver workup was negative; hence, a liver biopsy was organised, which confirmed giant cell hepatitis (GCH). A computed tomog...

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 explor...

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...