Philip Gardiner - Academia.edu (original) (raw)

Papers by Philip Gardiner

Sensors (Basel, Switzerland), 2021

Wearable sensor technology has gradually extended its usability into a wide range of well-known a... more Wearable sensor technology has gradually extended its usability into a wide range of well-known applications. Wearable sensors can typically assess and quantify the wearer’s physiology and are commonly employed for human activity detection and quantified self-assessment. Wearable sensors are increasingly utilised to monitor patient health, rapidly assist with disease diagnosis, and help predict and often improve patient outcomes. Clinicians use various self-report questionnaires and well-known tests to report patient symptoms and assess their functional ability. These assessments are time consuming and costly and depend on subjective patient recall. Moreover, measurements may not accurately demonstrate the patient’s functional ability whilst at home. Wearable sensors can be used to detect and quantify specific movements in different applications. The volume of data collected by wearable sensors during long-term assessment of ambulatory movement can become immense in tuple size. This...

2020 31st Irish Signals and Systems Conference (ISSC), 2020

The symptoms of (PD) often begins on one side of the body before separating bilaterally. Early sy... more The symptoms of (PD) often begins on one side of the body before separating bilaterally. Early symptoms of PD are rest tremors, bradykinesia and rigidity. Common signs are a decrease in arm swing, shuffling foot movement and slowness arising from a chair. Rigidity of muscles commonly affects a patient limbs, neck and shoulder PD is currently diagnosed after the neuro degenerative process has started. To optimize and improve PD quality of care, it should be diagnosed early in its onset once symptoms are not yet evident. The current gold standard for patient assessment of PD is the completion of symptom diaries. These diaries are subjective and usually do not accurately reflect what is taking place throughout the day. It is exceedingly difficult for an untrained observer such as family members to provide accurate description of movement characteristic in PD. An alternative way to exercise the abnormal movement in PD is to use a wearable technology system which could aid early detectio...

The DAS28 disease-activity score has made the transition from research to clinic, but in some cir... more The DAS28 disease-activity score has made the transition from research to clinic, but in some circumstances it may be misleading. A tool developed by a rheumatologist can help you explore how changes in components like ESR affect the score in unexpected ways.

Saturday, 15 June 2019

and during pregnancy; moreover, in 4 cases AS was interpreted as contraindication to pregnancy. 1... more and during pregnancy; moreover, in 4 cases AS was interpreted as contraindication to pregnancy. 107 (35.4%) respondents believe that AS medications should be discontinued during pregnancy planning and conception, 75 (24.8%) subjects accepted possible use of AS therapy during this period, while 120 (39.8%) didn't know the answer. 15.2% of respondents were ready to continue on NSAIDs, 20 (6.6%)on glucocorticoids and sulfasalazine, and 21 (7%)on biological drugs (GEBD). Of those who are ready to continue on AS medications at conception, 46 women (61.3%) consulted pregnancy planning with a rheumatologist. Respondents with higher education were slightly more likely to continue on AS therapy at conception (29%) compared to women with vocational college education (11.8%). Age, AS duration, or marital status had no influence on patients' attitude to AS therapy during pregnancy planning and conception. Conclusion: The majority of surveyed female patients changed their attitude to pregnancy after establishing AS diagnosis, although only 13% of them were ready to avoid pregnancy due to AS. No more than 50% of respondents were consulted a rheumatologist before planning pregnancy, and up to one third of them were not receive all expected answers to their questions and recommendations. Only 1/4 of participants accept the idea of continuing AS therapy during pregnancy planning and conception.

IEEE Sensors Journal

Arthritis remains a disabling and painful disease, and involvement of finger joints is a major ca... more Arthritis remains a disabling and painful disease, and involvement of finger joints is a major cause of disability and loss of employment. Traditional arthritis measurements require labour intensive examination by clinical staff. These manual measurements are inaccurate and open to observer variation. This paper presents the development and testing of a next generation wireless smart glove to facilitate the accurate measurement of finger movement through the integration of multiple IMU sensors, with bespoke controlling algorithms. Our main objective was to measure finger and thumb joint movement. These dynamic measurements will provide clinicians with a new and accurate way to measure loss of movement in patients with Rheumatoid Arthritis. Commercially available gaming gloves are not fitted with sufficient sensors for this particular application, and require calibration for each glove wearer. Unlike these stateof-the-art data gloves, the Inertial Measurement Unit (IMU) glove uses a combination of novel stretchable substrate material and 9 degree of freedom (DOF) inertial sensors in conjunction with complex data analytics to detect joint movement. Our novel iSEG-Glove requires minimal calibration and is therefore particularly suited to the healthcare environment. Inaccuracies may arise for wearers who have varying degrees of movement in their finger joints, variance in hand size or deformities. The developed glove is fitted with sensors to overcome these issues. This glove will help quantify joint stiffness and monitor patient progression during the arthritis rehabilitation process.

Arthritis & Rheumatology

on behalf of the TRACE RA Consortium Objective. Rheumatoid arthritis (RA) is associated with incr... more on behalf of the TRACE RA Consortium Objective. Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. Methods. A randomized, double-blind, placebo-controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P < 0.05. RA patients age >50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. Results. A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient-years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low-density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C-reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI −14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. Conclusion. Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists' Collaboration meta-analysis of statin effects in other populations.

Spondyloarthritis – clinical aspects (other than treatment)

Background Rheumatoid arthritis (RA) is characterised by painful, stiff and swollen joints. RA fe... more Background Rheumatoid arthritis (RA) is characterised by painful, stiff and swollen joints. RA features sporadic 'flares' or inflammatory episodes-mostly occurring outside clinics-where symptoms worsen and plasma C-reactive protein (CRP) becomes elevated. Poor control of inflammation results in higher rates of irreversible joint damage, increased disability, and poorer quality of life. Flares need to be accurately identified and managed. A method comparison study was designed to assess agreement between CRP values obtained by dried blood spot (DBS) versus conventional venepuncture sampling. The ability of a weekly DBS sampling and CRP test regime to detect flare outside the clinic was also assessed. Methods Matched venepuncture and finger lancet DBS samples were collected from n=100 RA patients with active disease at baseline and 6 weeks (NCT02809547). A subset of n=30 RA patients submitted weekly DBS samples over the study period. Patient demographics, including self-reported flares were recorded. DBS sample CRP measurements were made by enzyme-linked immunosorbent assay, and venepuncture samples by a reference immunoturbometric assay. Data was compared between sample types by Bland-Altman and weighted Deming regression analyses. Flare detection sensitivity and specificity were compared between 'minimal' baseline and 6 week sample CRP data and the 'continuous' weekly CRP data. Results Baseline DBS ELISA assay CRP measures yielded a mean positive bias of 2.693 ± 8.640 (95% limits of agreement-14.24% to 19.63%), when compared to reference assay data. Deming regression revealed good agreement between the DBS ELISA method and reference assay data, with baseline data slope of 0.978 and intercept-0.153. The specificity of 'continuous' area under the curve (AUC) CRP data (72.7%) to identify flares, was greater than 'minimal' AUC CRP data (54.5%). Conclusions This study indicates reasonable agreement between DBS and the reference method, especially at low to mid-range CRP values. Importantly, longitudinal CRP measurement in RA patients helps to clearly identify flare and thus could assist in remote monitoring strategies and may facilitate timely therapeutic intervention.

this paper outlines the initial ideas surrounding the development of an accurate hand measuring t... more this paper outlines the initial ideas surrounding the development of an accurate hand measuring tool to assist Medical clinicians and Rheumatologists in the accurate measurement of finger and thumb movement of the human hand. Clinicians rely heavily on invasive x-rays or manual evaluation methods which are dependent on training and can vary between observers. Angle measuring instruments, tape measure and

2020 31st Irish Signals and Systems Conference (ISSC)

Journal of Personalized Medicine

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that causes loss of joint func... more Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that causes loss of joint function and significantly reduces quality of life. Plasma metabolite concentrations of disease-modifying anti-rheumatic drugs (DMARDs) can influence treatment efficacy and toxicity. This study explored the relationship between DMARD-metabolising gene variants and plasma metabolite levels in RA patients. DMARD metabolite concentrations were determined by tandem mass-spectrometry in plasma samples from 100 RA patients with actively flaring disease collected at two intervals. Taqman probes were used to discriminate single-nucleotide polymorphism (SNP) genotypes in cohort genomic DNA: rs246240 (ABCC1), rs1476413 (MTHFR), rs2231142 (ABCG2), rs3740065 (ABCC2), rs4149081 (SLCO1B1), rs4846051 (MTHFR), rs10280623 (ABCB1), rs16853826 (ATIC), rs17421511 (MTHFR) and rs717620 (ABCC2). Mean plasma concentrations of methotrexate (MTX) and MTX-7-OH metabolites were higher (p < 0.05) at baseline in rs414...

Diagnostics

Portable inertial measurement units (IMUs) are beginning to be used in human motion analysis. The... more Portable inertial measurement units (IMUs) are beginning to be used in human motion analysis. These devices can be useful for the evaluation of spinal mobility in individuals with axial spondyloarthritis (axSpA). The objectives of this study were to assess (a) concurrent criterion validity in individuals with axSpA by comparing spinal mobility measured by an IMU sensor-based system vs. optical motion capture as the reference standard; (b) discriminant validity comparing mobility with healthy volunteers; (c) construct validity by comparing mobility results with relevant outcome measures. A total of 70 participants with axSpA and 20 healthy controls were included. Individuals with axSpA completed function and activity questionnaires, and their mobility was measured using conventional metrology for axSpA, an optical motion capture system, and an IMU sensor-based system. The UCOASMI, a metrology index based on measures obtained by motion capture, and the IUCOASMI, the same index using I...

Rheumatology

Objective To evaluate the validity and reliability of inertial measurement unit (IMU) sensors in ... more Objective To evaluate the validity and reliability of inertial measurement unit (IMU) sensors in the assessment of spinal mobility in axial spondyloarthritis (axSpA). Methods A repeated measures study design involving 40 participants with axSpA was used. Pairs of IMU sensors were used to measure the maximum range of movement at the cervical (Cx) and lumbar (Lu) spine. A composite IMU score was defined by combining the IMU measures. Conventional metrology and physical function assessment were performed. Validation was assessed considering the agreement of IMU measures with conventional metrology and correlation with physical function. Reliability was assessed using intra-class correlation coefficients (ICCs). Results The composite IMU score correlated closely (r = 0.88) with the BASMI. Conventional Cx rotation and lateral flexion tests correlated closely with IMU equivalents (r = 0.85, 0.84). All IMU movement tests correlated strongly with BASFI, while this was true for only some of ...

Rheumatology Advances in Practice

Introduction Interstitial lung disease (ILD) can occur in any connective tissue disease, with var... more Introduction Interstitial lung disease (ILD) can occur in any connective tissue disease, with varying degrees of respiratory clinical manifestations. In the majority of cases, patients have an established connective tissue diagnosis that precedes the development of ILD by many years. This discussion will focus on the unusual presentation of an 18 year old female admitted with a short history of weight loss and breathlessness. Investigations showed extensive established ILD with strongly positive autoantibodies, but in the absence of clinical signs of an underlying connective tissue disorder apart from Raynaud’s phenomenon. Case description 18-year-old female presented with a three-month history of unintentional 25kg weight loss, six weeks of fatigue/malaise, and a two-week history of worsening breathlessness. She was a student, non-smoker, with no past medical history except for class I obesity, and not on regular medications. On examination she had fine bibasal end-inspiratory crac...

Rheumatology Advances in Practice

Introduction We present a relapsing case of dermatomyositis in a 73-year-old female with a severe... more Introduction We present a relapsing case of dermatomyositis in a 73-year-old female with a severe disease phenotype involving cutaneous manifestations, severe symmetrical muscle weakness and bulbar involvement. Her case highlights factors associated with poorer prognosis. It further points to the first year post remission as being the highest risk for relapse, during the tapering of immunosuppression. She responded well to treatment with rituximab. Her case also highlights a potential viral trigger in the form of human parechovirus (HPeV), which has been highlighted previously in Japanese literature and is worthy of further consideration. Case description A 73-year-old female with no significant past medical history was transferred from the Cayman Islands with a three-week history of profound muscle weakness, rash and dysphagia. There was a preceding pyrexial illness. Examination demonstrated symmetrical proximal muscle weakness with bulbar involvement, a classical heliotrope rash a...

RMD open, 2017

In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive... more In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive protein (DAS28-CRP) is lower than DAS28 erythrocyte sedimentation rate (DAS28-ESR), suggesting that use of the DAS28-ESR cut-off to assess high disease activity (HDA) with DAS28-CRP may underestimate the number of patients with HDA. We determined the DAS28-CRP value corresponding to the validated DAS28-ESR cut-off for HDA. Baseline data were pooled from 2 clinical studies evaluating etanercept (ETN) plus methotrexate (MTX) or MTX in early RA; DAS28-CRP and DAS28-ESR were obtained, allowing the determination of the DAS28-CRP HDA value best corresponding to the DAS28-ESR cut-off of >5.1. At baseline, as expected, fewer patients had HDA by DAS28-CRP than DAS28-ESR; DAS28-CRP>5.1 and DAS28-ESR>5.1 had only modest agreement (κ coefficients 0.45-0.54). Mean DAS28-CRP and DAS28-ESR were 5.7 and 6.2, respectively, in the ETN+MTX group (n=571), and 6.0 and 6.5 in the MTX group (n=262). ...

RMD open, 2017

In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive... more In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive protein (DAS28-CRP) is lower than DAS28 erythrocyte sedimentation rate (DAS28-ESR), suggesting that use of the DAS28-ESR cut-off to assess high disease activity (HDA) with DAS28-CRP may underestimate the number of patients with HDA. We determined the DAS28-CRP value corresponding to the validated DAS28-ESR cut-off for HDA. Baseline data were pooled from 2 clinical studies evaluating etanercept (ETN) plus methotrexate (MTX) or MTX in early RA; DAS28-CRP and DAS28-ESR were obtained, allowing the determination of the DAS28-CRP HDA value best corresponding to the DAS28-ESR cut-off of >5.1. At baseline, as expected, fewer patients had HDA by DAS28-CRP than DAS28-ESR; DAS28-CRP>5.1 and DAS28-ESR>5.1 had only modest agreement (κ coefficients 0.45-0.54). Mean DAS28-CRP and DAS28-ESR were 5.7 and 6.2, respectively, in the ETN+MTX group (n=571), and 6.0 and 6.5 in the MTX group (n=262). ...

An Evaluation of Bronchoalveolar Lavage Methodology and Its Role in the Investigation of the Pulm... more An Evaluation of Bronchoalveolar Lavage Methodology and Its Role in the Investigation of the Pulmonary Complications of Primary Sjöegren's Syndrome.Philip Victor Gardiner Queen's University of Belfast, 1993.

Sensors (Basel, Switzerland), 2021

Wearable sensor technology has gradually extended its usability into a wide range of well-known a... more Wearable sensor technology has gradually extended its usability into a wide range of well-known applications. Wearable sensors can typically assess and quantify the wearer’s physiology and are commonly employed for human activity detection and quantified self-assessment. Wearable sensors are increasingly utilised to monitor patient health, rapidly assist with disease diagnosis, and help predict and often improve patient outcomes. Clinicians use various self-report questionnaires and well-known tests to report patient symptoms and assess their functional ability. These assessments are time consuming and costly and depend on subjective patient recall. Moreover, measurements may not accurately demonstrate the patient’s functional ability whilst at home. Wearable sensors can be used to detect and quantify specific movements in different applications. The volume of data collected by wearable sensors during long-term assessment of ambulatory movement can become immense in tuple size. This...

2020 31st Irish Signals and Systems Conference (ISSC), 2020

The symptoms of (PD) often begins on one side of the body before separating bilaterally. Early sy... more The symptoms of (PD) often begins on one side of the body before separating bilaterally. Early symptoms of PD are rest tremors, bradykinesia and rigidity. Common signs are a decrease in arm swing, shuffling foot movement and slowness arising from a chair. Rigidity of muscles commonly affects a patient limbs, neck and shoulder PD is currently diagnosed after the neuro degenerative process has started. To optimize and improve PD quality of care, it should be diagnosed early in its onset once symptoms are not yet evident. The current gold standard for patient assessment of PD is the completion of symptom diaries. These diaries are subjective and usually do not accurately reflect what is taking place throughout the day. It is exceedingly difficult for an untrained observer such as family members to provide accurate description of movement characteristic in PD. An alternative way to exercise the abnormal movement in PD is to use a wearable technology system which could aid early detectio...

The DAS28 disease-activity score has made the transition from research to clinic, but in some cir... more The DAS28 disease-activity score has made the transition from research to clinic, but in some circumstances it may be misleading. A tool developed by a rheumatologist can help you explore how changes in components like ESR affect the score in unexpected ways.

Saturday, 15 June 2019

and during pregnancy; moreover, in 4 cases AS was interpreted as contraindication to pregnancy. 1... more and during pregnancy; moreover, in 4 cases AS was interpreted as contraindication to pregnancy. 107 (35.4%) respondents believe that AS medications should be discontinued during pregnancy planning and conception, 75 (24.8%) subjects accepted possible use of AS therapy during this period, while 120 (39.8%) didn't know the answer. 15.2% of respondents were ready to continue on NSAIDs, 20 (6.6%)on glucocorticoids and sulfasalazine, and 21 (7%)on biological drugs (GEBD). Of those who are ready to continue on AS medications at conception, 46 women (61.3%) consulted pregnancy planning with a rheumatologist. Respondents with higher education were slightly more likely to continue on AS therapy at conception (29%) compared to women with vocational college education (11.8%). Age, AS duration, or marital status had no influence on patients' attitude to AS therapy during pregnancy planning and conception. Conclusion: The majority of surveyed female patients changed their attitude to pregnancy after establishing AS diagnosis, although only 13% of them were ready to avoid pregnancy due to AS. No more than 50% of respondents were consulted a rheumatologist before planning pregnancy, and up to one third of them were not receive all expected answers to their questions and recommendations. Only 1/4 of participants accept the idea of continuing AS therapy during pregnancy planning and conception.

IEEE Sensors Journal

Arthritis remains a disabling and painful disease, and involvement of finger joints is a major ca... more Arthritis remains a disabling and painful disease, and involvement of finger joints is a major cause of disability and loss of employment. Traditional arthritis measurements require labour intensive examination by clinical staff. These manual measurements are inaccurate and open to observer variation. This paper presents the development and testing of a next generation wireless smart glove to facilitate the accurate measurement of finger movement through the integration of multiple IMU sensors, with bespoke controlling algorithms. Our main objective was to measure finger and thumb joint movement. These dynamic measurements will provide clinicians with a new and accurate way to measure loss of movement in patients with Rheumatoid Arthritis. Commercially available gaming gloves are not fitted with sufficient sensors for this particular application, and require calibration for each glove wearer. Unlike these stateof-the-art data gloves, the Inertial Measurement Unit (IMU) glove uses a combination of novel stretchable substrate material and 9 degree of freedom (DOF) inertial sensors in conjunction with complex data analytics to detect joint movement. Our novel iSEG-Glove requires minimal calibration and is therefore particularly suited to the healthcare environment. Inaccuracies may arise for wearers who have varying degrees of movement in their finger joints, variance in hand size or deformities. The developed glove is fitted with sensors to overcome these issues. This glove will help quantify joint stiffness and monitor patient progression during the arthritis rehabilitation process.

Arthritis & Rheumatology

on behalf of the TRACE RA Consortium Objective. Rheumatoid arthritis (RA) is associated with incr... more on behalf of the TRACE RA Consortium Objective. Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. Methods. A randomized, double-blind, placebo-controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P < 0.05. RA patients age >50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. Results. A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient-years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low-density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C-reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI −14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. Conclusion. Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists' Collaboration meta-analysis of statin effects in other populations.

Spondyloarthritis – clinical aspects (other than treatment)

Background Rheumatoid arthritis (RA) is characterised by painful, stiff and swollen joints. RA fe... more Background Rheumatoid arthritis (RA) is characterised by painful, stiff and swollen joints. RA features sporadic 'flares' or inflammatory episodes-mostly occurring outside clinics-where symptoms worsen and plasma C-reactive protein (CRP) becomes elevated. Poor control of inflammation results in higher rates of irreversible joint damage, increased disability, and poorer quality of life. Flares need to be accurately identified and managed. A method comparison study was designed to assess agreement between CRP values obtained by dried blood spot (DBS) versus conventional venepuncture sampling. The ability of a weekly DBS sampling and CRP test regime to detect flare outside the clinic was also assessed. Methods Matched venepuncture and finger lancet DBS samples were collected from n=100 RA patients with active disease at baseline and 6 weeks (NCT02809547). A subset of n=30 RA patients submitted weekly DBS samples over the study period. Patient demographics, including self-reported flares were recorded. DBS sample CRP measurements were made by enzyme-linked immunosorbent assay, and venepuncture samples by a reference immunoturbometric assay. Data was compared between sample types by Bland-Altman and weighted Deming regression analyses. Flare detection sensitivity and specificity were compared between 'minimal' baseline and 6 week sample CRP data and the 'continuous' weekly CRP data. Results Baseline DBS ELISA assay CRP measures yielded a mean positive bias of 2.693 ± 8.640 (95% limits of agreement-14.24% to 19.63%), when compared to reference assay data. Deming regression revealed good agreement between the DBS ELISA method and reference assay data, with baseline data slope of 0.978 and intercept-0.153. The specificity of 'continuous' area under the curve (AUC) CRP data (72.7%) to identify flares, was greater than 'minimal' AUC CRP data (54.5%). Conclusions This study indicates reasonable agreement between DBS and the reference method, especially at low to mid-range CRP values. Importantly, longitudinal CRP measurement in RA patients helps to clearly identify flare and thus could assist in remote monitoring strategies and may facilitate timely therapeutic intervention.

this paper outlines the initial ideas surrounding the development of an accurate hand measuring t... more this paper outlines the initial ideas surrounding the development of an accurate hand measuring tool to assist Medical clinicians and Rheumatologists in the accurate measurement of finger and thumb movement of the human hand. Clinicians rely heavily on invasive x-rays or manual evaluation methods which are dependent on training and can vary between observers. Angle measuring instruments, tape measure and

2020 31st Irish Signals and Systems Conference (ISSC)

Journal of Personalized Medicine

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that causes loss of joint func... more Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that causes loss of joint function and significantly reduces quality of life. Plasma metabolite concentrations of disease-modifying anti-rheumatic drugs (DMARDs) can influence treatment efficacy and toxicity. This study explored the relationship between DMARD-metabolising gene variants and plasma metabolite levels in RA patients. DMARD metabolite concentrations were determined by tandem mass-spectrometry in plasma samples from 100 RA patients with actively flaring disease collected at two intervals. Taqman probes were used to discriminate single-nucleotide polymorphism (SNP) genotypes in cohort genomic DNA: rs246240 (ABCC1), rs1476413 (MTHFR), rs2231142 (ABCG2), rs3740065 (ABCC2), rs4149081 (SLCO1B1), rs4846051 (MTHFR), rs10280623 (ABCB1), rs16853826 (ATIC), rs17421511 (MTHFR) and rs717620 (ABCC2). Mean plasma concentrations of methotrexate (MTX) and MTX-7-OH metabolites were higher (p < 0.05) at baseline in rs414...

Diagnostics

Portable inertial measurement units (IMUs) are beginning to be used in human motion analysis. The... more Portable inertial measurement units (IMUs) are beginning to be used in human motion analysis. These devices can be useful for the evaluation of spinal mobility in individuals with axial spondyloarthritis (axSpA). The objectives of this study were to assess (a) concurrent criterion validity in individuals with axSpA by comparing spinal mobility measured by an IMU sensor-based system vs. optical motion capture as the reference standard; (b) discriminant validity comparing mobility with healthy volunteers; (c) construct validity by comparing mobility results with relevant outcome measures. A total of 70 participants with axSpA and 20 healthy controls were included. Individuals with axSpA completed function and activity questionnaires, and their mobility was measured using conventional metrology for axSpA, an optical motion capture system, and an IMU sensor-based system. The UCOASMI, a metrology index based on measures obtained by motion capture, and the IUCOASMI, the same index using I...

Rheumatology

Objective To evaluate the validity and reliability of inertial measurement unit (IMU) sensors in ... more Objective To evaluate the validity and reliability of inertial measurement unit (IMU) sensors in the assessment of spinal mobility in axial spondyloarthritis (axSpA). Methods A repeated measures study design involving 40 participants with axSpA was used. Pairs of IMU sensors were used to measure the maximum range of movement at the cervical (Cx) and lumbar (Lu) spine. A composite IMU score was defined by combining the IMU measures. Conventional metrology and physical function assessment were performed. Validation was assessed considering the agreement of IMU measures with conventional metrology and correlation with physical function. Reliability was assessed using intra-class correlation coefficients (ICCs). Results The composite IMU score correlated closely (r = 0.88) with the BASMI. Conventional Cx rotation and lateral flexion tests correlated closely with IMU equivalents (r = 0.85, 0.84). All IMU movement tests correlated strongly with BASFI, while this was true for only some of ...

Rheumatology Advances in Practice

Introduction Interstitial lung disease (ILD) can occur in any connective tissue disease, with var... more Introduction Interstitial lung disease (ILD) can occur in any connective tissue disease, with varying degrees of respiratory clinical manifestations. In the majority of cases, patients have an established connective tissue diagnosis that precedes the development of ILD by many years. This discussion will focus on the unusual presentation of an 18 year old female admitted with a short history of weight loss and breathlessness. Investigations showed extensive established ILD with strongly positive autoantibodies, but in the absence of clinical signs of an underlying connective tissue disorder apart from Raynaud’s phenomenon. Case description 18-year-old female presented with a three-month history of unintentional 25kg weight loss, six weeks of fatigue/malaise, and a two-week history of worsening breathlessness. She was a student, non-smoker, with no past medical history except for class I obesity, and not on regular medications. On examination she had fine bibasal end-inspiratory crac...

Rheumatology Advances in Practice

Introduction We present a relapsing case of dermatomyositis in a 73-year-old female with a severe... more Introduction We present a relapsing case of dermatomyositis in a 73-year-old female with a severe disease phenotype involving cutaneous manifestations, severe symmetrical muscle weakness and bulbar involvement. Her case highlights factors associated with poorer prognosis. It further points to the first year post remission as being the highest risk for relapse, during the tapering of immunosuppression. She responded well to treatment with rituximab. Her case also highlights a potential viral trigger in the form of human parechovirus (HPeV), which has been highlighted previously in Japanese literature and is worthy of further consideration. Case description A 73-year-old female with no significant past medical history was transferred from the Cayman Islands with a three-week history of profound muscle weakness, rash and dysphagia. There was a preceding pyrexial illness. Examination demonstrated symmetrical proximal muscle weakness with bulbar involvement, a classical heliotrope rash a...

RMD open, 2017

In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive... more In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive protein (DAS28-CRP) is lower than DAS28 erythrocyte sedimentation rate (DAS28-ESR), suggesting that use of the DAS28-ESR cut-off to assess high disease activity (HDA) with DAS28-CRP may underestimate the number of patients with HDA. We determined the DAS28-CRP value corresponding to the validated DAS28-ESR cut-off for HDA. Baseline data were pooled from 2 clinical studies evaluating etanercept (ETN) plus methotrexate (MTX) or MTX in early RA; DAS28-CRP and DAS28-ESR were obtained, allowing the determination of the DAS28-CRP HDA value best corresponding to the DAS28-ESR cut-off of >5.1. At baseline, as expected, fewer patients had HDA by DAS28-CRP than DAS28-ESR; DAS28-CRP>5.1 and DAS28-ESR>5.1 had only modest agreement (κ coefficients 0.45-0.54). Mean DAS28-CRP and DAS28-ESR were 5.7 and 6.2, respectively, in the ETN+MTX group (n=571), and 6.0 and 6.5 in the MTX group (n=262). ...

RMD open, 2017

In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive... more In most patients with rheumatoid arthritis (RA), Disease Activity Score 28-joint count C reactive protein (DAS28-CRP) is lower than DAS28 erythrocyte sedimentation rate (DAS28-ESR), suggesting that use of the DAS28-ESR cut-off to assess high disease activity (HDA) with DAS28-CRP may underestimate the number of patients with HDA. We determined the DAS28-CRP value corresponding to the validated DAS28-ESR cut-off for HDA. Baseline data were pooled from 2 clinical studies evaluating etanercept (ETN) plus methotrexate (MTX) or MTX in early RA; DAS28-CRP and DAS28-ESR were obtained, allowing the determination of the DAS28-CRP HDA value best corresponding to the DAS28-ESR cut-off of >5.1. At baseline, as expected, fewer patients had HDA by DAS28-CRP than DAS28-ESR; DAS28-CRP>5.1 and DAS28-ESR>5.1 had only modest agreement (κ coefficients 0.45-0.54). Mean DAS28-CRP and DAS28-ESR were 5.7 and 6.2, respectively, in the ETN+MTX group (n=571), and 6.0 and 6.5 in the MTX group (n=262). ...

An Evaluation of Bronchoalveolar Lavage Methodology and Its Role in the Investigation of the Pulm... more An Evaluation of Bronchoalveolar Lavage Methodology and Its Role in the Investigation of the Pulmonary Complications of Primary Sjöegren's Syndrome.Philip Victor Gardiner Queen's University of Belfast, 1993.