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11 BSPAR111 NO ASSOCIATION BETWEEN ETANERCEPT AND NEW OR WORSENING ATOPIC DERMATITIS IN CHILDREN WITH JIA: AN ANALYSIS FROM THE BSPAR ETANERCEPT COHORT STUDY T. Begum, R. Davies, L. Kearsley-Fleet, T. R. Southwood and K. L. Hyrich on behalf of the BSPAR Etanercept Cohort Study University of Manchester, Manchester, UK Correspondence to: T. Begum. E-mail: tasleema.begum@student.manchester.ac.uk Introduction: Etanercept (ETN) has significantly improved outcomes for children with severe JIA, but there are concerns regarding its longterm safety. Recently, two case reports have suggested ETN may be associated with a worsening of atopic dermatitis (AD). Aims: The purpose of this analysis is to study the risk of new or flare of AD in ETN vs MTX treated children using data from The British Society for Paediatric and Adolescent Rheumatology (BSPAR) ETN Cohort Study. Method: The BSPAR ETN cohort study, launched in 2004, is prospectively following children with JIA starting either ETN or MTX. Demographic, disease, treatment and adverse events data are collected at regular intervals. Reports of AD both at the time of and after treatment start were identified. Incidence rates of new/worsening AD were calculated for both groups and the risk compared using Cox proportional hazard models adjusted by deciles of propensity score. Results: To 31 May 2013, 680 ETN and 184 MTX treated children were recruited, with 6% recording a history of AD at treatment start. Over 1914 person-years (pyrs) of exposure there were 20 (ETN) and 5 (MTX) first reports of new/flare AD, giving an on-treatment incidence of 1.4 (95% CI 0.8, 2.1) and 1.1 (95% CI 0.4, 2.6))/100 pyrs respectively. The adjusted hazard ratio for risk of new/flare AD in patients receiving ETN compared with MTX was 1.00 (95% CI 0.28, 3.61). Conclusion: Overall, the use of ETN was not associated with new/ worsening AD compared with MTX, although small numbers prevented robust estimates. Disclosure statement: The authors have declared no conflicts of interest. ABSTRACT 12 BSPAR11212 BSPAR112 AN UNUSUAL CASE OF MUSCLE PAIN IN A 15-YEAR-OLD BOY P. George, P. Davis, I. Norton, M. Hofer and R. Jeffery Department of Rheumatology, Northampton General Hospital, Northampton, Department of Paediatric Rheumatology, Birmingham Children’s Hospital, Birmingham and Department of Neuropathology, John Radcliffe Hospital, Headington, Oxford, UK Correspondence to: P. George. E-mail: p.e.george05@gmail.com Introduction: A 15-year-old boy with sclerosing cholangitis and ulcerative colitis presented with sudden onset myalgia and fever. Aims: He was taking mesalazine and AZA having been weaned off steroids 1 month previously. He reported painful calves and was spiking temperatures. He developed back and shoulder pain along with anorexia and weight loss. Initial investigations revealed raised inflammatory markers with a normal full blood count and normal muscle enzymes. Treatment with broad-spectrum antibiotics was started. Method: A full infective screen, including investigations for tuberculosis, was negative. An MRI spine and a bone marrow aspirate were normal. An immunological screen showed an ANA of 1:640 and was ANCA negative. An MRI scan of his calves showed inflammation of the muscles in both calves. A muscle biopsy showed chronic inflammation with a granulomatous component centred on medium-sized vessels in the perimysium. Results: He remained symptomatic, requiring parental nutrition and regular oramorph. He was started on i.v. methylprednisolone for myositis thought to be associated with inflammatory bowel disease. His symptoms rapidly improved, but he then developed sensory loss and weakness in his right foot, with an absent ankle reflex. Nerve conduction studies showed a severe right tibial nerve neuropathy plus neuropathies in the left leg and right arm, representing mononeuritis multiplex. Conclusion: The diagnosis of granulomatous polyangiitis vasculitis was made. Further enquiry revealed nasal crusting and bleeding consistent with the diagnosis. He was treated with IVIG and has received four out of six cycles of i.v. cyclophosphamide. He has had a good response to treatment so far. Disclosure statement: The authors have declared no conflicts of interest. ABSTRACT 13 BSPAR11313 BSPAR113 CONFIDENCE OF UK GENERAL PAEDIATRIC TRAINEES IN MUSCULOSKELETAL CLINICAL ASSESSMENT AND PREFERENCES FOR FUTURE TEACHING RESOURCES E. Smith, M. Cruikshank, H. Dean, H. E. Foster and S. Jandial Great North Children’s Hospital, Newcastle Upon Tyne, UK and Institute of Cellular Medicine, Newcastle University, UK Correspondence to: E. Smith. E-mail: evemdsmith@yahoo.co.uk Introduction: Musculoskeletal (MSK) problems in children and adolescents are common and may represent serious life threatening disease. Many doctors have low confidence in examining children’s joints, stemming from MSK teaching not being core to many training programmes. Paediatric MSK competencies have been introduced into the RCPCH professional clinical examinations, in an attempt to address this. Aims: To examine: self-rated confidence in paediatric MSK clinical assessment in general paediatric trainees (in relation to their ability to undertake the MRCPCH clinical examination), access to MSK teaching and the preferred format for future teaching resources. Method: A Survey Monkey questionnaire was disseminated to paediatric trainees from northeast England and southeast Scotland. Results: 35 trainees completed the survey. Trainee confidence in undertaking the MSK station was lower than for the cardiovascular, TABLE 1 Incidence and hazard ratios of eczema |
