bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.