bluuebunny/crossref_metadata_2025 huggingface dataset:
OA09 Significant association between disease duration in axial spondyloarthritis and the occurrence of uveitis and inflammatory bowel disease, with no such association found for psoriasis
Authors: Dinneen Brona , Kenyon Marcus , O'Shea Finbar
Published: April 2024

Background/Aims

Axial spondyloarthritis is a chronic inflammatory condition primarily impacting the spine and sacroiliac joints. In addition to spinal inflammation and peripheral symptoms, it frequently presents with extra-musculoskeletal manifestations such as inflammatory bowel disease, psoriasis, and anterior uveitis, collectively adding to the overall disease burden. Although existing research has explored the heightened risk of ophthalmological manifestations with prolonged disease duration, there is a paucity of literature examining the association between disease duration in axial spondyloarthritis and the onset of inflammatory bowel disease and psoriasis. Aim: To investigate the relationship between axial spondyloarthritis disease duration and the development of extra-musculoskeletal manifestations.

Methods

This is a retrospective cohort study with data obtained from the Ankylosing Spondylitis Registry of Ireland (ASRI), which is a large cross-sectional, multicentre cohort study. Using both univariate and multivariate regression analyses, we examined the relationship between axial spondyloarthritis disease duration and extra musculoskeletal manifestations. In the multivariate analysis, several covariates including gender, body mass index, smoking, and HLA-B27 status were considered to account for their potential influence on the observed associations.

Results

Demographic details were available for 912 patients included at the time of analysis. The median disease duration in years for our cohort was 16. Table 1 presents relevant general characteristics of the ASRI cohort and the results of our regression analysis. Uveitis exhibited a highly significant association (P < 0.001) with AxSpA duration in both univariate and multivariate analyses, even after accounting for covariates. Inflammatory bowel disease also showed a significant association with AxSpA duration in both univariate and multivariate analyses (P < 0.003). In our analysis, psoriasis showed no significant relationship with AxSpA disease duration in both univariate (P = 0.298) and multivariate analyses (P1 = 0.249).

Conclusion

Our study, using a large data set, reveals distinct patterns of association between axial spondyloarthritis disease duration and inflammatory bowel disease and uveitis. Conversely, psoriasis demonstrates no significant link to disease duration when considering confounding factors. Clinically, these insights are crucial for tailored management strategies, emphasising the need for improved diagnostic time and multidisciplinary care to address the diverse manifestations of AxSpA and optimise patient outcomes.

Disclosure

B. Dinneen: None. M. Kenyon: None. F. O'Shea: None.
OA22 Pregnancy in connective tissue diseases: a 30 year follow-up study of 465 pregnancies from a Spanish monocentric registry
Authors: Santos Cristiana Sieiro , García Paula Pérez , Ordas Martínez Jose , Castro Carolina Álvarez , Díez Álvarez Elvira
Published: April 2024

Background/Aims

Pregnancy in patients with connective tissue diseases (CTDs) are known to be at high risk for the occurrence of adverse pregnancy outcomes. We aimed to evaluate pregnancy outcomes in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), primary Sjögren’s syndrome (pSS) and undifferentiated connective tissue disease (UCTD).

Methods

A retrospective and descriptive study was conducted from 1990 to 2020. All data were collected from the medical records of women of childbearing age with SLE, SSc, SS and UTCD enrolled in our clinic at the time of their pregnancy and childbirth. The obstetric, maternal and fetal outcomes were collected and compared regarding diagnosis and adverse outcomes.

Results

The study group included 295 patients: 125 patients (42%) with SLE; 50 patients (17%) with SSc; 80 patients (27%) with pSS; 40 patients (14%) with UCTD. A total of 465 pregnancies were registered. The mean age at delivery was 31.5±8.5 years and the mean duration of disease was 7.2±5.6 years. Pregnancy loss occurred in 21% of patients, live births in 66% of pregnancies, preterm delivery in 8%, postpartum haemorrhage in 6%, preeclampsia in 5%, placental abnormalities in 4%, ectopic pregnancy in 3%, and premature rupture of membranes in 2%. Treatment with hydroxychloroquine (HCQ) was received in 115 pregnancies in SLE (59%), 21 pregnancies in SSc (24%) 62 pregnancies in pSS (52%) and 32 pregnancies in UCTD (49%). Exposure to corticosteroids and biologics during pregnancy was 23 (18.4%), 6 (12%), 15 (19%) and 3 (7.5%), respectively. Patients with SLE had a higher risk of fetal morbidity, including abortion (p = 0.03), mean abortion rate (p = 0.03), preeclampsia (p = 0.04), ectopic pregnancy (p = 0.03), preterm delivery (p = 0.02) and postpartum haemorrhage (p = 0.01) than patients without SLE. The multivariate model found an association between unfavourable pregnancy outcomes and disease activity (OR 2.4; 95% CI 1.3-7.2; p 0.003), whilst HCQ during pregnancy (OR 0.23; 95% CI 0.03-0.82) had a protective effect.

Conclusion

66% of pregnancies in patients with autoimmune diseases resulted in live births. Patients with SLE had higher rates of fetal and maternal morbidity than SSc, pSS and UCTD. Disease activity was associated with unfavourable pregnancy outcomes. Exposure to HCQ had a protective effect during pregnancy.

Disclosure

C. Sieiro Santos: None. P. Pérez García: None. J. Ordas Martínez: None. C. Álvarez Castro: None. E. Díez Álvarez: None.
OA27 Molecular divergences in CD4+ T Cells between early and refractory rheumatoid arthritis
Authors: Smith Samantha L , Rossi Stefano , Shukla Rudresh , Tan Yvonne , Ariff Amirah , Lazar Ilinca , Patel Khadijah , Yap Chuan F , Nair Nisha , Eyre Steve , Buch Maya H , Buch Maya H , Martin Paul , Orozco Gisela
Published: April 2024

Background/Aims

Up to 21% of rheumatoid arthritis (RA) patients remain refractory to available treatments. This represents a clinical challenge due to the lack of efficacious alternatives for refractory RA (rRA) patients. Although CD4+ T cells are paramount in RA pathogenesis, a comprehensive understanding of their roles in rRA versus non-refractory RA has not been characterised. The aim of this study is to dissect the molecular differences in CD4+ T cells across these patient sub-groups and identify novel mechanisms driving rRA, which may inform tailored therapeutic strategies, using single cell multiomic analysis.

Methods

Primary CD4+ T-cells were isolated from PBMCs obtained from 3 rRA patients (defined as per EULAR definition of difficult-to-treat RA) and 3 treatment-naïve, early RA (ERA) patients, all seropositive with active disease (DAS28-ESR > 3.2), collected as part of the PRECISE-RA programme. Following nuclei extraction, the 10x Genomics Multiome ATAC + Gene Expression assay was used to simultaneously determine the transcriptional and chromatin landscapes from individual cells.

Results

Patient characteristics are reported in Table 1. 8,215 T-cells cells were clustered into 11 distinct cell states, which showed a trend towards diminished Tregs and modulated effector memory (TEM)/Th17 phenotype expressions in rRA compared to ERA patients. In ERA, expression of INPP4B, pivotal for cell growth and survival, was upregulated within naïve CD4+ T-cell subsets. ITGA4, crucial in leukocyte migration and adhesion, was elevated within a subset of naïve CD4+ T cells in early RA. ZEB2 exhibited increased expression within CD4 TEM/Th17 phenotype cells, potentially implicating divergent cellular differentiation, and migratory pathways within early RA contexts. Next, we utilised the multiomic nature of the data to functionally annotate GWAS variants, by creating peak-gene maps and overlaying RA risk SNPs. For example, an RA susceptibility SNP mapping to an intron of ANKRD55, rs7731626, was linked to the novel RA causal gene IL6ST. Furthermore, the RA SNP rs71508903, previously assigned to the ARID5B gene, was linked to the RTKN2 promoter, elucidating potential avenues for further exploration into RA pathogenesis.

Conclusion

These findings, to be validated in a larger cohort, suggest distinct biological mechanisms driving rRA and may help identify novel biomarkers and therapeutic avenues.

Disclosure

S.L. Smith: None. S. Rossi: None. R. Shukla: None. Y. Tan: None. A. Ariff: None. I. Lazar: None. K. Patel: None. C.F. Yap: None. N. Nair: None. S. Eyre: None. M.H. Buch: None. M.H. Buch: None. P. Martin: None. G. Orozco: None.
OA40 Clinical and psychological factors associated with adherence based on a patient self-reported questionnaire: results from the biologics in rheumatoid arthritis genetics and genomics study syndicate (BRAGGS) cohort
Authors: Chong Timothy K Y , Nair Nisha , Morgan Ann W , Isaacs John D , Wilson Anthony G , Hyrich Kimme L , Plant Darren , Barton Anne
Published: April 2024

Background/Aims

To explore the relationship of clinical and psychological factors with adherence based on a patient self-reported questionnaire from a prospective longitudinal study of patients receiving TNFi biologic treatment for rheumatoid arthritis, recruited since 2008.

Methods

Analysis of data collected from a prospective longitudinal UK study (Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate [BRAGGSS]) of patients with moderate to severe RA commencing TNFi biologic treatment. Clinical data including Disease Activity Score-28 (DAS28), serological status (Rheumatoid Factor positivity) and body mass index (BMI) were collected. Patients also completed self-reported questionnaires, the health assessment questionnaire (HAQ), hospital anxiety and depression scale (HAD), beliefs about medicine questionnaire (BMQ), brief illness perception score (B-IPQ) and a self-reported adherence questionnaire. Adherence was defined as any deviation from prescribed medication regime such as altering the dose, forgetting a dose, stopping treatment, missing a dose, and taking less than instructed. Associations between demographic and psychological variables and adherence were evaluated using regression models and a multivariable logistic regression model was used to further evaluate associations, controlling for BMI.

Results

1,513 patients (75.7% female, age 58.1 [IQR 16.0], disease duration 9.6 ± 9.6 years and pre-treatment DAS28 scores 5.7 ± 0.8) were included. 70% of patients self-reported adherence to their medication. When comparing the different TNFi treatments, etanercept had the lowest levels of adherence at the 3 and 6 month time-points. Adherence was higher in those with older age (β = 0.03, p< 0.01), higher baseline CRP levels (β = 0.01, p= 0.03) and higher necessity beliefs (β = 0.04, p= 0.03). Adherence was lower in those with higher tender joint counts at baseline (β=-0.03, p= 0.04) and 3 months (β = 0.03, p= 0.02) (Table I). These associations persisted after controlling for the effects of BMI using a multivariable logistic model.

Conclusion

Self-reported adherence was 70% in this BRAGGS population. Factors associated with non-adherence included higher tender joint counts and lower necessity beliefs pre-treatment, which may allow targeting of interventions to optimise adherence in these groups.

Disclosure

T.K.Y. Chong: None. N. Nair: None. A.W. Morgan: None. J.D. Isaacs: None. A.G. Wilson: None. K.L. Hyrich: Honoraria; Abbvie. Grants/research support; K.H has grants from BMS and Pfizer. D. Plant: None. A. Barton: Grants/research support; A.B has received funding/speaker fees from BMS, Pfizer and Galapagos.
P003 A fast track giant cell arteritis pathway incorporating ultrasonography improves service provision in a District General Hospital
Authors: Ioannidis Diomidis , Premraj Sara , Ntatsaki Eleana
Published: April 2024

Background/Aims

Giant cell arteritis (GCA) is the most common form of adult vasculitis with comorbidities including blindness. Early identification and initiation of treatment is therefore essential. The 2020 BSR guideline suggests specialist review within three days of suspected GCA. In Ipswich Hospital, there was previously no universal referral pathway for GCA. Patients were referred to the acute medicine, A&E, rheumatology or ophthalmology clinics. An audit in 2018 over 18 months highlighted a significant delay in specialist reviews. In 2021 we designed a rapid access referral pathway for direct specialist review (protected one-stop slots in rheumatology or ophthalmology), including the use of a dedicated score for assessing the risk for GCA (GCAPS) and vascular ultrasonography in specialist clinics. Our aims for this quality improvement project were to: 1) Audit referral times for suspected GCA patients 2) Optimise the percentage of suspected GCA cases receiving a confirmatory test, notably ultrasound or temporary artery biopsy.

Methods

We audited the new GCA referrals from January 2022 to June 2023, and compared to the 2018 data. Data were retrospectively collected from electronic health records.

Results

44 patients were included (women=29, mean age=68). In 2023, 89% of patients were seen within three days, compared to 47% previously. In 2023, patients were reviewed within a median of two days by a specialist compared to 19 in 2018. Finally, 100% of our patients received a diagnostic test, compared to 79% previously (table 1). A total of 34% of new referrals were diagnosed as GCA. 40 patients had an ultrasound which was positive in 27%, equivocal in 25% and negative in 48%. For the remaining four patients, GCA was excluded without imaging tests/biopsy. 17 patients had biopsy, with 24% being positive for GCA. 52% of referred cases had high GCAPs score and 32% normal inflammatory markers.

Conclusion

Our fast-track referral pathway facilitated an earlier review for our patients. These results indicate the enhanced safety afforded for suspected GCA patients via a dedicated Fast Track GCA assessment clinic with access to ultrasonography. This also led to a significant reduction in the number of temporal artery biopsies required.

Disclosure

D. Ioannidis: None. S. Premraj: None. E. Ntatsaki: None.
P012 Health inequalities in the diagnosis and treatment of rheumatoid arthritis
Authors: Jeyaratnam Sangeeta , Fish Sarah , Horton Sarah , Madan Ayesha , Rao Chandini , MacPhie Elizabeth
Published: April 2024

Background/Aims

Patients with chronic diseases, such as rheumatoid arthritis (RA), from socially deprived backgrounds are known to have more severe disease, comorbidity and higher mortality rates. This study used National Early Inflammatory Arthritis Audit (NEIAA) data submitted by Lancashire and South Cumbria Foundation Trust to ascertain if social deprivation influences time to diagnosis and treatment escalation onto a high-cost drug (HCD).

Methods

Patients diagnosed with an inflammatory arthritis were recruited to NEIAA over a five-year period (May 2018 to March 2023). Information on demographics, patient postcodes, duration of symptoms prior to referral, GP referral time and rheumatology waiting time were analysed. Index of Multiple Deprivation (IMD) was derived from patient postcodes and patients divided into three groups based on IMD deciles. Patients with deciles 1-3 were grouped as most deprived, deciles 4-6 as middle and deciles 7-10 as least deprived. A case note review of a subgroup of patients who had been on treatment for 2-5 years was undertaken to investigate whether IMD decile was associated with treatment escalation onto a HCD. Data were analysed using descriptive and inferential statistics on Stata. Results were adjusted for confounders including age and gender.

Results

A total of 265 patients with RA were included, mean age 60 years, 63% female and 10% from ethnic minority groups. There were 31%, 25% and 44% in the most, middle and least deprived groups respectively. There was a higher proportion of patients from minority ethnic backgrounds in the most deprived group (most 21% vs least 3%). Symptom duration at time of presentation to the GP was greater than 3 months in 57% vs 48% of patients in the most and least deprived groups, respectively. Median was used to compare the GP referral times and rheumatology waiting times as there were outliers in the dataset. The most deprived group had longer GP referral times (most 16 days vs least 7 days); however, median rheumatology waiting time was similar across the three groups (most, middle and least deprived 27, 24 and 25 days respectively). There was no difference in escalation onto a HCD across the three groups.

Conclusion

Patients from the most deprived areas presented later and took longer to be referred. However, time to being seen in the rheumatology clinic and escalation onto a HCD was not found to be associated with social deprivation. Exploring this further on a national level will help understand if social deprivation is influencing care elsewhere. This work supports the need to focus more resource on raising public awareness in more deprived areas.

Disclosure

S. Jeyaratnam: None. S. Fish: None. S. Horton: None. A. Madan: None. C. Rao: None. E. MacPhie: None.
P038 Measuring social engagement in rheumatic and musculoskeletal diseases
Authors: Maciver Alison , Macfarlane Gary , Hollick Rosemary J
Published: April 2024

Background/Aims

Rheumatic and musculoskeletal diseases (RMDs) result in reduced social well-being and social engagement (SE). Despite being an important outcome for patients, SE is rarely measured in studies or clinical practice. Furthermore, social media and COVID-19 has changed how we interact with society. We aimed to evaluate existing SE measures used in RMD populations.

Methods

A systematic review of the qualitative literature and thematic analysis identified key impacts of RMDs and associated treatments on SE [unrestricted date -February 2023]. A systematic review of the quantitative literature [unrestricted date-February 2022] identified existing SE measures validated for use within RMDs, their constructs and compared these to themes identified from the qualitative literature.

Results

From 2601 records screened, we identified 30 eligible qualitative papers. Thematic analysis highlighted barriers and facilitators of SE in RMDs:. Barriers to SE included: 1) Direct effects of RMDs 2) Practicalities of undertaking SE 3) Social networks and roles. Facilitators of SE included: 1) Benefits of SE 2) Resilience & Acceptance 3) Activity Adjustment. From 7772 records screened we identified 15 specific SE measures validated in RMD populations. These measures focused on measuring frequency, satisfaction, difficulty, and modification of SE. Table 1 shows how many of the existing SE measures validated for use in RMDs identified in the quantitative systematic review measure the key impacts of RMDs on SE as identified in the qualitative thematic analysis.

Conclusion

Existing measures of SE do not assess the wide range of impacts identified as important to patients. There is a need for a new SE measure to inform interventions to improve health and social outcomes for people with RMDs. Focus groups involving individuals with RMDs, and key stakeholders are planned to present the findings from the systematic reviews and facilitate discussion to help inform development of a new measure of SE.

Disclosure

A. Maciver: None. G. Macfarlane: None. R.J. Hollick: None.
P040 Obesity and rheumatoid arthritis among individuals with low education
Authors: Khubchandani Jagdish , Banerjee Sri
Published: April 2024

Background/Aims

Poor education is connected to many diseases including cardiovascular diseases (CVD) and some CVD-related risk factors such as obesity. However, precisely how this relationship occurs is unknown. In this research we will be exploring how the connection between obesity and overall mortality is modified by rheumatoid arthritis (RA).

Methods

Our study was conducted on participants that were aged 20 years or older living in the United States with a education level of only some high school. We assessed RA status by using the arthritis question in the National Health and Nutrition Examination Survey (NHANES) survey conducted by the National Center for Health Statistics (NCHS) for the years of 1999 to 2010 with mortality follow-up to December 2019. We determined obesity by calculating BMI and setting a cutpoint at 30 kg/m2. Education level was determined through self-reported data. Chronic Kidney Disease was determined using the Cockcroft-Gault equation. Prospective analysis was performed using complex samples Cox regression with adjustment for known confounders to determine the relationship of obesity and mortality, and if RA has an overall relationship in those with low education.

Results

Among individuals with low education and RA, percent mortality was 32.3% among males and 32.6% among females with mean follow-up of 9.3 years. For overall mortality, the age and sex-adjusted hazard ratio (HR) for obesity was 1.18 (95% confidence interval [CI], 1.05-1.34 p = 0.01). The adjusted HR was elevated, 1.56 (CI 1.06-2.32, p = 0.03), among people with obesity who also had RA but close to 1.0 (1.21 CI 0.99-1.47, p = 0.06) among individuals with obesity who had no RA, after adjusting for medical (chronic obstructive pulmonary disease, history of cancer, cardiovascular disease, chronic kidney disease, and diabetes) and demographic risk factors (poverty-income-ratio, age, military service, citizenship, and gender).

Conclusion

We found that among individuals with low education, not only does obesity lead to 18% higher overall mortality but also RA occurrence impacts the relationship between obesity and overall mortality even after controlling for potential confounders. Education and health literacy are especially important in the preventing and treating RA especially in those who have obesity. With cardiovascular disease having the highest rate of mortality, risk factors for CVD such as obesity must be prevented.

Disclosure

J. Khubchandani: None. S. Banerjee: None.
P049 Genetic liability to rheumatoid arthritis and the risk of cardiometabolic diseases
Authors: Alduhayhi Saleh , Soomro Mehreen , Zhao Sizheng , Barton Anne , Morris Andrew , Bowes John
Published: April 2024

Background/Aims

Patients with rheumatoid arthritis (RA) are at an increased risk of comorbidities. Previous studies have reported a positive association between RA and cardiometabolic disease risk. However, few causal inference studies have addressed the different serological subtypes of RA and their association with cardiometabolic disease risk. This Mendelian randomisation (MR) study was conducted to offer insight into the causal pathway underlying this association.

Methods

A two-sample MR analysis was conducted using genetic variants as instrumental variables (IVs) to estimate the causal effect of genetic liability to RA and its serological subsets (seropositive and seronegative) on cardiometabolic disease risk including hypertension, coronary artery disease (CAD), atrial fibrillation, heart failure, stroke, and type 2 diabetes mellitus (T2DM). IVs were obtained from two genome-wide association studies (GWASs) for RA (53,663 cases and 1,064,978 controls [n =177 IVs]). Summary statistics were stratified for serological status including seropositive RA (RA+; 35,240 cases, [n = 195 IVs]), and seronegative RA (RA−; 8,515 cases, [n = 12 IVs]). Both subsets were compared to 990,155 controls. Summary statistics for cardiometabolic diseases were extracted from GWASs of European ancestries.

Results

The inverse-variance weighted (IVW) model showed a positive association between genetic liability to RA and the risk of CAD, heart failure, and T2DM; CAD, (Odds ratio [OR] = 1.04; 95% confidence interval [CI] 1.01-1.06; P-value [P] = 2.7210-3, heart failure, OR = 1.03; 95% CI 1.01-1.06; P = 0.018, and T2DM, OR = 1.08; 95% CI 1.05-1.11; P = 4.6310-8.). A similar association direction was observed between genetic liability to RA+ and the risk of CAD and T2DM; CAD, (OR = 1.02; 95% CI 1.01-1.04; P = 0.009, T2DM, OR = 1.05; 95% CI 1.03-1.07; P = 3.9110-7). Genetic liability to RA− was positively associated with T2DM risk; (OR = 1.09; 95% CI 1.02-1.16; P = 0.011).

Conclusion

In this MR study, a positive association of genetic liability to RA was demonstrated with CAD, heart failure and T2DM risk. Genetic liability to RA+ was associated with an increased risk of CAD and T2DM risk while genetic liability to RA− was positively associated with T2DM risk. Future research should investigate genetic architecture of RA including its serological subsets with cardiometabolic diseases to delineate the genes associated with these comorbidities.

Disclosure

S. Alduhayhi: None. M. Soomro: None. S. Zhao: None. A. Barton: None. A. Morris: None. J. Bowes: None.
P067 Support Programme for Patients Receiving Imraldi or Benepali Therapy for Immune-Mediated Inflammatory Disorders: 12-Month Persistence
Authors: Clark Andrew , Shering Teresa , Addison Janet
Published: April 2024

Background/Aims

Low persistence to long-term therapy for chronic disease is a recognised problem. Evidence suggests that increasing patients’ ability to manage their own health condition may positively impact adherence and persistence, leading to improved clinical outcomes. In 2019, Biogen initiated a patient support programme (PSP), in addition to the pre-existing medication home delivery (‘homecare’) service, to improve the knowledge, skills and confidence of patients self-administering Imraldi (adalimumab ADL) and Benepali (etanercept ETN).

Methods

This real-world, retrospective, database study includes patients enrolled into the PSP within 12 months of ADL/ETN initiation. At first ADL/ETN administration all patients receive a face-to-face nurse training visit, followed by a second nurse training visit or follow-up call to coincide with the second injection. Following this, patients consenting to enrol in the PSP receive nurse coaching calls at Weeks 3, 10, 22 and 34, whilst non-PSP patients self-manage thereafter. The analysis presented here excludes patients who were enrolled into the PSP more than 12 months after ADL/ETN initiation. Data including demographics and type/duration of ADL/ETN therapy was captured by the homecare provider for the PSP cohort from November 2019 to February 2022, and for the non-PSP cohort between February 2016 (ETN) or November 2018 (ADL) and February 2022. Persistence at 12 months post-initiation was estimated using Kaplan-Meier (KM) techniques, overall and by subgroup including indication (rheumatology, dermatology, gastroenterology) and whether biologic naïve or switched from another biologic.

Results

Persistence at 12 months for patients enrolled in the PSP was 77.5% and in the non-PSP cohort was 73.6%. Lowest persistence by prior biologic exposure was 70.9% in the non-PSP biologic naïve cohort. By therapeutic area, the greatest differential between PSP vs non-PSP group (75.7% vs 67.6%) was in the gastroenterology cohort, which also had the lowest non-PSP persistence of any subgroup. (Table)

Conclusion

Compared to the non-PSP cohort, patients enrolled in the PSP had higher persistence at 12 months after initiation, across all indications and regardless of prior biologic exposure. This real-world evidence indicates the benefits of a PSP to patients with chronic diseases, and that particular attention should be paid to biologic-naïve patients.

Disclosure

A. Clark: Corporate appointments; AC is an employee of Biogen Idec Ltd. T. Shering: Corporate appointments; TS is an employee of Biogen Idec Ltd. J. Addison: Corporate appointments; JA is an employee of Biogen Idec Ltd.
P071 Exploring experiences and preferences of people with rheumatoid arthritis for digital interventions to promote physical activity (PA)
Authors: Gerlis Charlotte , Berry Alice , Halls Serena , Loizou Michael , Swales Caroline , Cramp Fiona
Published: April 2024

Background/Aims

Physical activity (PA) is effective for managing symptoms of rheumatoid arthritis (RA) but people with RA are less active than their healthy counterparts. A digital intervention (DI) to promote PA, is a potential solution. There is a paucity of literature available exploring the requirements of people with RA for a digital intervention. It is important to explore experiences and preferences before developing such an intervention. Aims: 1. Identify digital technology currently used by people with RA to support PA. 2. Understand the preferences and acceptability of people with RA for potential DI delivery.

Methods

A survey was developed to address these aims. A patient research partner (CS) and ‘think aloud’ pilots contributed to development. The survey was circulated once to members of the National Rheumatoid Arthritis Society in November 2022. This study was approved by the National Health Service Research Ethics Committee (reference 22/NE/0158).

Results

1178 people consented to take part (86% female, 64% aged 55-74). The majority used digital technology every day (97%). 84% anticipated using a potential DI to support PA, most preferably every day (48%) or 2-3 times a week (14%). 16% never anticipated using DI to support PA. 34% reported currently using technology to support PA; mostly an app without healthcare professional (HCP) interaction (42%) or internet videos (40%). A further 27% had tried technology to support PA but discontinued, and 39% had never tried. An app was the most preferable delivery platform (56%), followed by a website (43%) or internet videos (28%). 51% would prefer to be offered or signposted to digital technology to support PA by an exercise professional with specific rheumatology training or a healthcare professional (22%). Potential DI delivery methods were rated on a Likert scale of 1-5 for general acceptability, a score of five indicating highest acceptability: automated response mean[SD] 3.6[0.9], ad-hoc HCP interaction 3.5[0.8] pre-arranged HCP interaction 3.4[1] and no interaction 3.1[1].

Conclusion

People with RA are using digital technology regularly and many anticipated using a DI to support PA. Despite this, only a third are currently using digital technology to support PA. An app or website platform was the preferred delivery method suggesting that an internet delivered intervention is acceptable. Acceptability ratings of DI delivery methods were similar. Further sub-group analysis and exploration of free text responses is planned to inform tailoring of DI delivery.

Disclosure

C. Gerlis: None. A. Berry: None. S. Halls: None. M. Loizou: None. C. Swales: None. F. Cramp: None.
P087 Role of a physiotherapy independent prescriber in a Paediatric Rheumatology setting
Authors: Bhullar Esther
Published: April 2024

Background/Aims

To assess the benefit of having a Physiotherapy Independent Prescriber (PIP) within a Paediatric Rheumatology service at University Hospitals Southampton (UHS). Legislative change in the UK in 2013 enabled physiotherapists to independently prescribe certain drugs that assist in patient management. Independent prescribing by physiotherapists is a relatively contemporary development in role change and purpose. The clients seen by the paediatric rheumatology physiotherapists within our service frequently require medication prescription as part of their review and management. Having the ability to independently prescribe reduces the need for additional medical or nursing input, so improving efficiency and patient experience within the clinic.

Methods

In our Paediatric Rheumatology service within UHS, our PIP is able to assess and manage the repeat prescriptions for routine follow-up patients with Juvenile Idiopathic Arthritis (JIA), plus alter medication prescriptions in response to clinical findings. The medications the PIP can change/prescribe include Methotrexate, Oral steroids, Non-steroidal anti-inflammatory drugs, Folic Acid and proton-pump inhibitors. This facilitates a greater number of patients to be seen as they do not require appointments with multiple professionals at routine reviews. A satisfaction questionnaire was completed by patients who accessed this service over a 6-month period.

Results

Over a six-month period of 25 morning clinics, a total of 23 satisfaction questionnaires were completed by those who had medication prescribed by the PIP. Of these, 100% were satisfied with the service they received and the outcome of the appointment. In particular, highest scores were given for communication by the therapist and having knowledge and understanding of medications prescribed.

Conclusion

Having a PIP in our Paediatric Rheumatology Clinic is well-received by service users and improved patient-experience by limiting the need for multiple appointments and reducing time spent in clinic.

Disclosure

E. Bhullar: None.
P093 What’s in a name? Misnaming and renaming of Juvenile Idiopathic Arthritis has long-term impacts
Authors: Beesley Richard P , Beesley Rebecca M , Middleton Kate , McBride Andrea , Smith Eve M D , Beresford Michael W
Published: April 2024

Background/Aims

Juvenile Idiopathic Arthritis (JIA) is a heterogenous group of disorders characterised by chronic joint inflammation of unknown aetiology lasting 6+ weeks, with onset before the age of 16. Historically, some patients with JIA have been labelled as having adult-onset disorders such as Rheumatoid Arthritis (RA) in order to facilitate access to medication. Some have also been incorrectly reclassified at age 16 (with their JIA being relabelled as RA) due to lack of understanding by some healthcare professionals in adult clinics that children and young people get arthritis too.

Whilst treatments for RA and JIA are broadly similar, important differences in treatment, management, prognosis and extra-articular manifestations remain.

This collaborative study between three patient organisations investigated the extent of the issues arising from misnaming and/or renaming of JIA in a UK population.

Methods

Adults in the UK aged 18+ who had any diagnosis of a musculoskeletal or rheumatic condition (RMD) were invited to complete a voluntary online survey. Surveys were disseminated through webpages, social media and email mailing lists, enabled by the patient organisations Juvenile Arthritis Research, Arthur’s Place and The Wren Project. Respondents provided information about their diagnosis, experiences, and attitudes across a range of themes and topics.

Results

In total, 532 respondents with any form of arthritis, and/or other rheumatic or musculoskeletal condition completed the survey (64% female; 68% White ethnicity; median age 35.5 years), covering a primary diagnosis of different rheumatic conditions; 185 (35%) had a second or subsequent additional rheumatic disease.

Of 169 respondents with a primary diagnosis of JIA and symptom onset prior to age sixteen, 87 (52%) reported that a doctor or healthcare professional has subsequently told them (whilst under adult services) that their condition is now called something other than Juvenile Arthritis once they reached adulthood. In addition, 134 (25%) respondents reported a primary diagnosis of RA; of these 15 (11%) had symptom onset prior to age 16, indicating their diagnosis should have been JIA.

Conclusion

Given the importance of accurate diagnosis for patients, both for a patient’s sense of identity and for treatment, care and prognosis reasons, the name given to a disease matters. With 11% of patients with a diagnosis of RA having paediatric-onset JIA, and 52% with JIA being incorrectly told their diagnosis has changed post-16, there are important implications for patients and caregivers. Improved awareness and understanding of the importance of correct labelling of RMDs may help reduce confusion and uncertainty and improve access to appropriate care.

Disclosure

R.P. Beesley: None. R.M. Beesley: None. K. Middleton: None. A. McBride: None. E.M.D. Smith: None. M.W. Beresford: None.
P097 Launching the Juvenile Idiopathic Arthritis VIP Research Panel - an innovative and unique way to engage with the Juvenile Idiopathic Arthritis community
Authors: Beesley Richard P , Beesley Rebecca M
Published: April 2024

Background/Aims

The volume of survey-based research targeting families affected by Juvenile Idiopathic Arthritis (JIA) has been increasing, leading to respondent fatigue, reduced response rates, repetitive data collection, and consequential reduced robustness of data. In addition, poor quality surveys with no anticipated research outcomes of benefit to the community have further added to the burden on families.

There is also increased interest in recruiting patient representatives to help shape and steer research through appropriate Patient and Public Engagement and Involvement (PPIE), but without a robust structure in place the numbers of families involved has been small and their representativeness questioned.

This project improves research quality, accessibility for researchers to access motivated survey respondents, reduces the burden on participants, and provides a central solution for accessing JIA research participants.

Methods

Juvenile Arthritis Research is a charity in the UK, with considerable experience of developing research projects and engaging in PPIE activities, and a highly-engaged network of families affected by JIA. The charity launched the JIA VIP Research Panel in September 2023, inviting members of their network to join. Participants give fully informed consent upon sign-up, and provide demographic details. These are held securely and anonymously.

New research, developed in-house or with academic, clinical or industry partners, is shared with the JIA VIP Research Panel. Participants are invited to complete surveys, knowing they have been quality assured and verified, and without the need to re-submit the same demographic data repeatedly over time.

The Panel is also available for PPIE activities, with researchers able to access members of the Panel based on diagnosis, demographic or other criteria.

Results

Within 3 days of launch, over 100 families joined the JIA VIP Research Panel, with a representative spread of participants; recruitment is an ongoing and continuous process.

Conclusion

The JIA VIP Research Panel (www.jarproject.org/vip) is an innovative resource enabling faster, more flexible, and more efficient access to families with JIA in the UK both for survey-based research and involvement in PPIE. The Panel has begun to improve the quality of research, building upon previous success and continuing to develop high levels of engagement with participants.

Disclosure

R.P. Beesley: None. R.M. Beesley: None.
P099 Progression of psychological distress in inflammatory arthritis patients
Authors: Rutter-Locher Zoe , Arumalla Nikita , Norton Sam , Garrood Toby , Taams Leonie , Bannister Kirsty , Kirkham Bruce
Published: April 2024

Background/Aims

Patients with inflammatory arthritis (IA) often present with mental health concerns at the time of diagnosis. Yet, the onset and progression of these psychological challenges throughout the disease’s trajectory remain unclear. Gaining insights into the evolution of mental health issues is crucial, as they can potentially lead to suboptimal disease management, amplified pain experiences, and a diminished quality of life. Our objective was to assess mental health co-morbidity and fibromyalgia severity status in patients with inflammatory arthritis before diagnosis, immediately after, and six months post-diagnosis in order to trace the natural progression of these conditions over time.

Methods

In this prospective observational study, we collected mental health (GAD7 for anxiety, PHQ8 for depression) and fibromyalgia criteria measures (WPI: Widespread pain index, SSS: symptom severity score) pre-diagnosis (via online form whilst awaiting initial appointment), immediately following diagnosis and six months post-diagnosis. Eligibility criteria were subsequent diagnosis of IA and pain rating ≥3/10 at Guy’s Hospital, London. In addition, demographic data and clinical assessment (DAS28, pain score) were collected immediately following diagnosis.

Results

20 patients were recruited between April and November 2022. 50% were female, 65% had RA, and mean age was 51±14 years. Mean DAS 28 was 3.7 ± 1.1, mean fatigue score 39/100 ±31 and mean pain score was 5.3/10 ± 2.1. Mean MSK HQ was 31.2 ±12.7 and mean RAID was 3.9 ±2.5. The time from diagnosis to post-diagnosis assessment averaged 1.6 ±3.4 months, while from pre-screen to post-diagnosis assessment it was 2.9 ±3.7 months. Immediately following diagnosis, 10 patients (50%) screened positive for anxiety and 11 (55%) for depression. Anxiety significantly increased following diagnosis, and then returned to pre-diagnosis levels at six months. Depression and fibromyalgia severity remained similar to pre-screen following diagnosis, but at six months had significantly dropped from pre-screen levels (Table 1).

Conclusion

Rates of mental health comorbidity in IA at diagnosis are high. Receiving a diagnosis of IA may contribute to heightened anxiety, which reduces again by six months. Depression symptoms and fibromyalgia severity, including widespread pain, remain high following diagnosis but improve after six months, possibly as disease activity improves.

Disclosure

Z. Rutter-Locher: None. N. Arumalla: None. S. Norton: None. T. Garrood: None. L. Taams: None. K. Bannister: None. B. Kirkham: None.
P100 Clinical Indications Associated with New Opioid Use for Pain Management in the United Kingdom: Using National Primary Care Data
Authors: Lyon Max , Medina Carlos Raul Ramirez , Davies Elinor , Jani Meghna
Published: April 2024

Background/Aims

Prescription opioids for non-cancer pain in the UK have increased over the past two decades, alongside associated harms. There is an increasing recognition that policies to address opioid prescribing need to be tailored according to individual patient needs with specific indications and disease systems. This study aimed to evaluate clinical indications associated with new opioid initiation in non-cancer pain using UK large-scale data.

Methods

National primary care electronic health records from 01/01/2006 to 31/20/2021 were used from the Clinical Research Practice Datalink. Codelists for opioid-related conditions based on literature and experts in pain management, primary care, rheumatology, and pharmacy were applied to a one-year period before first opioid prescription for surgical indications (given the acute nature) and five-years prior for chronic conditions. Descriptive statistics were used for data analysis, accounting for overlapping indications.

Results

A total of 3,031,950 new opioid users were identified. Opioids were initiated more commonly in women (60.7%), people in age groups: 45-64 (40.0%) and ≥65 years (37.0%). Nine systems associated with opioid-initiation were identified. The most common were musculoskeletal (74.0%), respiratory (53.1%), infections (25.7%), trauma/injury (16.1%), neurology (16.0%), gastrointestinal (4.2%) within five years prior to the opioid prescription date and post-surgical within one-year prior (3.8%). Musculoskeletal conditions most frequently associated with opioid use were osteoarthritis (n = 1,536,338, 50.7%), low back pain (1,094,163, 36.1%), other non-inflammatory musculoskeletal conditions 344,3412 (11.4%), rheumatoid arthritis 63,365 (2.1%) and fibromyalgia 56,038 (1.9%). Post-surgical indications were associated with 3.8% of all prescriptions, with orthopaedic surgeries being the most common: 42.1% of all post-surgical indications, including total knee replacements (n = 31,944; 27.6%) and total hip replacements (n = 17,863; 14.5%).

Conclusion

This is the first study in the UK evaluating large scale national data to assess indications associated with opioid initiation. Almost three quarters of the new prescriptions of opioids for non-cancer pain were in people with a diagnosis of a musculoskeletal condition. Orthopaedic surgeries contributed to a third of all post-surgical indications. These findings could help inform prioritisation of targeted interventions in opioid de-prescribing, clinical vigilance, and policy development to support non-pharmacological interventions in patients with musculoskeletal conditions.

Disclosure

M. Lyon: None. C. Ramirez Medina: None. E. Davies: None. M. Jani: None.
P116 Effectiveness and safety of biosimilar etanercept GP2015 in patients with rheumatoid arthritis in the UK: results from the COMPACT study
Authors: Askari Ayman , Both Charlotte , Martin Angela , Walsh David A , Sheeran Tom
Published: April 2024

Background/Aims

COMPACT is a non-interventional, multinational cohort study to evaluate effectiveness, safety and quality of life (QoL) outcomes in patients with rheumatic diseases treated with GP2015, an approved etanercept (ETN) biosimilar, under real-world conditions. Here, we present data from patients in the UK with rheumatoid arthritis (RA) enrolled in the COMPACT study, focusing on those who switched to GP2015 from reference ETN or another biosimilar ETN.

Methods

The COMPACT study included patients (≥18 years of age) with rheumatic diseases treated with GP2015. This analysis includes patients from the UK diagnosed with RA who were in treatment Group A (patients in clinical remission or low disease activity under treatment with reference ETN or other biosimilar ETN, who switched to GP2015 prior to study enrolment). Effectiveness and QoL outcomes were assessed using Disease Activity Score 28-joint count (DAS28) and health assessment questionnaire-disability index (HAQ-DI), respectively, and are presented up to Week 24. Safety outcomes were assessed, including rates of adverse events (AEs) and serious AEs (SAEs).

Results

A total of 112 patients with RA who switched to GP2015 from reference ETN or another biosimilar ETN (Group A) were enrolled in the UK. The mean ± standard deviation (SD) age was 62.9 ± 11.3 years and 74.1% of patients were female. The mean ± SD DAS28 score remained unchanged from baseline (2.6 ± 1.3) to Week 24 (2.5 ± 1.6). The mean ± SD HAQ-DI score displayed no major difference between baseline (1.2 ± 0.8) and Week 24 (0.9 ± 0.8). Overall, 67.9% (n = 76) of patients experienced ≥1 AE and 9.8% (n = 11) of patients experienced ≥1 SAE (Table).

Conclusion

Over 24 weeks of treatment with GP2015, disease activity remained low and stable in patients with RA previously switched from reference ETN or from another biosimilar ETN, with no new safety concerns observed. These results from a cohort of patients with RA treated in the UK are consistent with effectiveness, QoL and safety data reported previously for the total population in the COMPACT study.

Disclosure

A. Askari: None. C. Both: None. A. Martin: None. D.A. Walsh: Consultancies; Consultancy fees paid to University of Nottingham: Contura International A/S, Glaxo SmithKline, AKL Research and Development Ltd, Consultancy fees paid to University of Nottingham: Pfizer Ltd, Abbvie Ltd, Ely Lilly & Co.Ltd, Galapagos Ltd., Reckitt Benckiser Health Ltd. Honoraria; Speaker fees paid to David Walsh: Irish Society of Rheumatology, Speaker fees paid to University of Nottingham: Medscape International, Pfizer Ltd, Abbvie Ltd. Grants/research support; Grants paid to University of Nottingham: Versus Arthritis, UKRI, NIHR, Nuffield Foundation, Pfizer Ltd, Ely Lilly & Co Ltd, UCB Pharma, Grants paid to University of Nottingham: GlaxoSmithKline Research and Development, Orion Corporation. T. Sheeran: None.