POS0309-PARE UNDERSTANDING THE PSYCHOSOCIAL DETERMINANTS OF EFFECTIVE DISEASE MANAGEMENT IN RHEUMATOID ARTHRITIS: A QUALITATIVE STUDY
Authors: N. Stoll, M. Dey, S. Norton, M. A. Adas, A. Bosworth, M. Buch, A. Cope, H. Lempp, J. Galloway, E. Nikiphorou
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Social and psychological factors are associated with disease activity, pain, physical function and mortality in people with Rheumatoid Arthritis (RA)[1,2]. These interact with biological factors in defining outcomes. Much research to date has focused on these latter aspects of disease, but limited qualitative research has been undertaken to explore patients' perspectives on psychosocial contexts in RA. <h3>Objectives:</h3> We aimed to gather in-depth patient perspectives on psychosocial factors that drive persistently active disease in RA, to help guide optimal patient care. The main objective was to gain insights that can provide evidence on how to combine health and social support with pharmacological therapy to improve care, inform resource allocation and redesign services to ensure fair and equal access to all. <h3>Methods:</h3> A qualitative study design was applied, co-developed with patient research partners with lived experience of RA. Patients who met the following criteria were eligible for participation: ≥18 years; confirmed diagnosis of RA; any disease duration or treatment. Patients were purposively invited from a diverse population in London, United Kingdom, ensuring varied ethnicities, primary languages, employment status and occupations. Following a pilot interview, semi-structured interviews and focus groups were conducted online, with questions designed to elicit participants' perceptions on social barriers and facilitators to effective disease management in RA. Interpreters were invited when requested by participants. Data were analysed by an experienced qualitative researcher, using inductive thematic analysis to identify a framework of themes and subthemes exploring barriers and facilitators of optimal outcomes. Following refinement with the research team, themes were agreed and examples of relevant accounts by participants were included. <h3>Results:</h3> A total of 45 patients participated across 28 semi-structured interviews and three focus groups. 47% of patients self-reported that their RA symptoms were not under control and 96% of patients had attended their rheumatology clinic &lt;6 months prior to study participation. Patient characteristics are summarised in Table 1. Six main themes on psychosocial factors that may impact RA management and drive persistently active disease were identified, including twelve sub-themes based on barriers and facilitators impacting on effective management, evidenced by accounts from the interviews' and focus groups' participants. These main themes are summarised in Figure 1. <h3>Conclusion:</h3> This study provides in-depth patient perspectives on the potential role of psychosocial determinants in the management of RA and drivers of persistently active disease. The findings are consistent with previous studies, suggesting that factors such as education, employment, socioeconomic position and social support can play a role in RA disease activity. Our findings suggest that psychosocial factors, alongside biological and personal factors can impact on disease outcomes, and support advancements in social care policies to enable these potentially interacting factors to be assessed and managed holistically. Our study also highlights the importance of health literacy in determining patient outcomes, through better understanding of RA, self-management and engagement with health professionals. The results will inform the development of a national survey to obtain greater insights into bio-psycho-social interactions and their impact on outcomes in people with RA and other long-term conditions. Ultimately, this trajectory of work aims to inform how to tackle health disparities in RA, especially in patients with persistently active disease. <h3>REFERENCES:</h3> [1] Roodenrijs NMT et al. Difficult-to-treat rheumatoid arthritis: contributing factors and burden of disease. Rheumatology (Oxford). 2021 Aug 2;60(8):3778-3788. [2] Dey M et al. Association between social deprivation and disease activity in rheumatoid arthritis: a systematic literature review. RMD Open. 2022 Apr;8(1):e002058. <h3>Acknowledgements:</h3> The design, analysis and interpretation of this study represents part of a project funded as part of a FOREUM ECR 2020 grant awarded to EN. <h3>Disclosure of Interests:</h3> <b>None declared.</b>