Introduction Respiratory diseases affect millions of people in the UK, with a disproportionately high burden seen among many marginalised communities. They are the third leading cause of death in the UK and a major driver of morbidity, disability and healthcare service use. Many respiratory conditions cause debilitating symptoms and deterioration in patients’ health and quality of life over time, resulting in substantial increases in National Health Service (NHS) expenditure. Social inequalities, including occupational, housing and environmental disparities, have led to a disproportionate burden of respiratory disease among the Black community. For many Black people living in the UK, respiratory conditions have been under-recognised, misdiagnosed or inadequately treated, further contributing to disparities in health outcomes. Despite the need to address these urgent challenges, research in this area is fragmented and rarely informed by the views and opinions of those most affected. Research prioritisation provides a structured methodology to address this unmet need. The Equal Breath Priority Setting Partnership (PSP) aims to identify the 10 most urgent research priorities in respiratory health for people of Black heritage through meaningful collaboration with people with lived experience of respiratory disease, their caregivers and family members and the healthcare professionals caring for them.Methods and analysis The top 10 research priorities for the Equal Breath PSP will be established using the James Lind Alliance (JLA) method. A steering group comprising approximately 12 people from key stakeholder groups will first be assembled to guide the PSP. Once the context and scope of the PSP has been agreed, the first survey will be developed and disseminated among stakeholder communities to identify evidence uncertainties. Data analysis of the survey responses will create summary questions and critical appraisal of available evidence will verify which of these are evidence gaps. A longlist of approximately 50 summary questions derived from the first survey will be shared with stakeholders in a second shortlisting survey. The highest ranking questions from this survey will be taken into a workshop where the top 10 research priorities will be established through a consensus process.Ethics and dissemination This PSP employs the JLA methodology, which does not constitute research as defined by the Health Research Authority. Survey respondent data will be stored in accordance with UK General Data Protection Regulation by Asthma+Lung UK. The final 10 research priorities will be shared with funders, policymakers, professional bodies and relevant communities to inform future investment and promote equity in respiratory health.

Rheumatoid arthritis (RA) is a systemic, chronic autoimmune disease affecting mainly the joints, often with extra articular manifestations. This review provides an update on RA epidemiological trends and management. PubMed and EMBASE were searched from 2014 to 2024 using rheumatoid arthritis as keyword, combined with incidence, prevalence, diagnosis, classification, and management. Emphasis was on papers published in the past 5 years. Globally, the age-standardised prevalence and incidence rate (ASPR and ASIR) of RA increased with varying figures. The ASPR increased by 0.37%, 14.1%, and 6.4% from 1990 to 2019, 2020 and 2017 respectively; and 9% from 1980 to 2019. The ASIR increased by 0.3% and 8.2% from 1990 to 2019 and 2017 respectively; the disability-adjusted life years (DALY) figures increased 0.12% and decreased 0.36% in the same period from different authors. Reduction in ASIR were reported while ASPR varies. Disease modifying anti-rheumatic drugs (DMARDs) remain the cornerstone of treatment.

Objective: Africa contributes significantly to the increasing global prevalence (>37 %), unmet need and treatment burden for people with osteoarthritis. Despite this, little research has examined the expressed needs of patients with osteoarthritis (OA) and joint pain in West-Africa. This study aimed to explore lived experiences, expressed needs and current care gaps for people living with osteoarthritis in low-health resource contexts using Nigeria as a case study. Design: Qualitative study using Focus Groups. People aged 45 years and over living with osteoarthritis and joint pain were recruited at local health services or via wide advertisements in the community. Discussions were recorded and transcribed verbatim. Data were analyzed using thematic analysis (inductive approach). Results: Three focus groups were conducted with people living with osteoarthritis (n 1/4 30, age range 45-90 years) across socio-demographic strata. Participants described their experiences of living with osteoarthritis as emotionally, physically, and socio-economically challenging. Four main themes (and 14 sub-themes) were identified. Participants expressed the need for an information and health education campaign and access to appropriate health professionals (especially physiotherapists) for providing support, guidance, and assistance with self-management. Conclusions: The provision of an accessible, and contextually appropriate patient education package, in line with evidence-based recommendations is a critical need for people living with osteoarthritis in Nigeria. This will promote evidence-based care for OA in low-resource settings, empowering patients to self-manage and reducing confusion related to inconsistent advice and mixed messages about cause, healthcare access and OA care.

Rheumatological and musculoskeletal diseases encompass a vast spectrum of increasingly prevalent conditions, which are associated with significant disability and socioeconomic burden. Their impact is pervasive, especially in tropical countries that are still plagued with a myriad of challenges such as limited healthcare infrastructure, workforce shortages and competing prevailing illnesses. Rheumatology education in these countries has largely lagged. Several initiatives have been undertaken to address these shortfalls in rheumatology healthcare workers. Country-specific initiatives and international collaborative efforts have been undertaken to provide education and training in tropical countries. While there is still much to be achieved, these initiatives have significantly contributed to establishing and strengthening rheumatology services in underserved and resource constrained areas.

Objective: The study examined the context, training needs, and extent to which community pharmacists in Nigeria have the knowledge, resources, and capability to manage OA in line with evidence-based recommendations. Methods: Focus group discussions (n ​= ​2) were conducted. Discussions explored current practice, the support needs, and perceptions of a new OA care model where pharmacists could be trained to screen, educate, and refer patients. Data was analyzed thematically, including stakeholder workshops to aid interpretation. Results: Data from two focus groups with 22 healthcare professionals revealed five key themes. Community pharmacies were the first point of call for most patients. Care pathway and navigation onwards were influenced by patient affordability. Radiological examinations and blood tests underpinned diagnosis and care predominantly involved pharmacological approaches. There was no local care pathway agreed/established for health professionals, and multidisciplinary team collaboration/care for OA was limited. Participants expressed the need for professional education and the development of national guidelines to inform osteoarthritis management in primary care. Conclusions: Nigeria's OA care pathway is fragmented, involves overuse of medication, and has limited access to non-pharmaceutical treatments. A unified, evidence-based approach with adequate training and multidisciplinary collaboration is essential for effective primary care and reducing health inequalities.

Social media has transformed communication in academia and medicine, offering stakeholders innovative avenues for knowledge exchange and collaboration. The CORDIALITY review (soCial media fOR aDvancing equIty And coLlaboration In rheumaTologY) examines the impact of social media on education and information dissemination, patient education and empowerment, networking and mentorship, and research collaboration within rheumatology, when effectively used. In this narrative review, we consider the opportunities as well as the challenges related to each of these facets of social media use. With a focus on inequities faced globally, we give particular consideration to disparities by gender as they relate to the rheumatology workforce, and issues pertaining to lower-income and middle-income countries such as limitations of digital access and digital literacy. To maximise the potential of social media in rheumatology, we propose a strategic framework that encourages innovation, responsible practices and support from rheumatology organisations.

ObjectiveTo increase awareness and understanding of the principles of Equity, Diversity, and Inclusivity (EDI) within Outcome Measures in Rheumatology's (OMERACT) members. For this, we aimed to obtain ideas on how to promote and foster these principles within the organization and determine the diversity of the current membership in order to focus future efforts.MethodsWe held a plenary workshop session at OMERACT 2023 with roundtable discussions on barriers and solutions to increased diversity within OMERACT. We conducted an anonymous, web-based survey of members to record characteristics including population group, gender identity, education level, age, and ability.ResultsThe workshop generated ideas to increase diversity of participants across the themes of building relationships [ 12 topics], materials and methods [5 topics], and conference-specific [6 topics]. Four hundred and seven people responded to the survey (25% response rate). The majority of respondents were White (75%), female (61%), university-educated (94%), Christian (42%), spoke English at home (60%), aged 35 to 55 years (50%), and did not report a disability (64%).ConclusionOMERACT is committed to improving its diversity. Next steps include strategic recruitment of members to the EDI working group, drafting an EDI mission statement centering equity and inclusivity in the organization, and developing guidance for the OMERACT Handbook to help all working groups create actionable plans for promoting EDI principles.

Purpose (the aim of the study): In Nigeria, community pharmacies (CPs) are the most frequently visited healthcare practitioner, due to ease of accessibility and affordability, especially among low-income earners and older adults. CPs are trained to mitigate against minor ailments by making informed suggestions to patients on medications. Subsequently, most people living with osteoarthritis (OA) and joint pain are usually placed on over the counter medications at CPs, focusing mainly on relieving pain symptoms.

Abstract Introduction Post stroke elbow spasticity (PSES) affects over a third of individuals following stroke and negatively impacts on functional recovery, comfort and quality of life. Drug therapies have limited efficacy and unwanted side effects, botulinum toxin, although effective, is costly, and conventional electrical stimulation therapies are limited long term by habituation. We aim to investigate the efficacy of Sheffield Adaptive Patterned Electrical Stimulation (SHAPES), that delivers temporally and spatially varying pattern of electrical stimulation, against transcutaneous electrical stimulation (TENS) and standard care at reducing PSES. Methods and design Overall, 297 people with PSES will be randomised (1:1:1) to one of 3 arms: Standard care (no electrical stimulation), TENS (conventional patterned electrical stimulation) or SHAPES (adaptive patterned electrical stimulation). Both SHAPES and TENS are delivered using a specially designed electrical stimulation sleeve used for 60 min each day for 6-weeks. Outcome measures are completed at baseline, end of treatment (EOT 6 weeks) and then 6-weeks, 12-weeks and 24-weeks after the end of treatment. Efficacy will be determined based on the proportion of participants experiencing meaningful improvement (18%) in the 7-day Numerical Rating Scale (NRS-S) for PSES, compared between both intervention arms and standard care, and between the two intervention groups. Measures of arm motor function (Action Research Arm Test, MRC scale), and quality of life (SQoL-6D, EQ-5D) will also be measured along with a parallel health economic evaluation. Discussion The results of the SHAPES trial will inform management of elbow spasticity after stroke. The SHAPES intervention is a low cost, self-administered intervention for the management of spasticity that can be used repeatedly, and if found to be more effective than TENS or control has the potential to be widely implemented in the UK NHS healthcare setting. Furthermore, despite the wide use of TENS in the management of spasticity, this study will provide critically required evidence regarding its efficacy. The trial has been registered with the ISRCTN registry (ISRCTN26060261).

•The OMERACT SDM Working Group aims to identify candidate instruments for a Core Outcome Measurement Set.•Our scoping review includes 99 articles reporting on 220 candidate instruments for SDM in RMDs.•We identified evidence gaps and inconsistent reporting of measured constructs and measurement properties.•Only approximately 10% of instruments matched with a criterion of our adapted Summary of Measurement Properties table.•Next steps include matching candidate instruments with Core Domains and assessing feasibility.

Purpose (the aim of the study): Africa contributes significantly to global prevalence (>21%), unmet need & treatment burden for osteoarthritis (OA). Public contributors and research corroborate poor experience and low-quality care, difficulty accessing appropriate joint-pain management advice, prevailing cultural conventions/misconceptions, self-medication with unsafe pharmacological approaches/over the counter medicines - further predisposing patients to unintended harms/socioeconomic difficulties.

OBJECTIVE:The Outcome Measures in Rheumatology (OMERACT) Shared Decision Making (SDM) Working Group aims to determine the core outcome domain set for measuring the effectiveness of SDM interventions in rheumatology trials.METHODS:A white paper was developed to clarify the draft core domain set. It was then used to prepare for interviews to investigate reasons for lack of consensus on it and to suggest further improvements.RESULTS:OMERACT scientists/clinicians (n = 13) and patients (n = 10) suggested limiting the core domain set to outcome domains, removing process domains, and clarifying remaining domains.CONCLUSION:A revised core domain set will undergo further consensus-building.

Patient and public involvement is an idea whose time has firmly come. It is the views of these Guest Editors that it is the right thing to do morally and improves research quality and applicability.

Objective Development and test of a culturally sensitive intervention for rheumatology healthcare professionals (HCPs). Methods Using a before and after study design, 15 HCPs were recruited to undertake the bespoke intervention from four National Health Service sites across England, in areas serving a diverse population. The intervention was evaluated using two validated outcomes: (i) Patient Reported Physician Cultural Competency (PRPCC); and (ii) Patient Enablement Instrument (PEI), measuring patients’ perceptions of their overall healthcare delivery. Additionally, HCPs completed the COM-B questionnaire for capability (C), opportunity (O) and motivation (M) to perform behaviour (B), measuring behaviour change. Results Two hundred patients were recruited before HCPs undertook the intervention (cohort 1), and 200 were recruited after (cohort 2) from 15 HCPs; after exclusions 178 patients remained in cohort 1 and 186 in cohort 2. Sixty percent of patients identified as white in both recruited cohorts, compared with 29% and 33% of patients (cohorts 1 and 2, respectively) who identified as being of South Asian origin. After the intervention, the COM-B scores indicated that HCPs felt more skilled and equipped for consultations. No significant differences were noted in the average overall cultural competency score between the two cohorts in white patients (57.3 vs 56.8, P = 0.8), however in the South Asian cohort there was a statistically significant improvement in mean scores (64.1 vs 56.7, P = 0.014). Overall, the enablement score also showed a statistically significant improvement following intervention (7.3 vs 4.3, P < 0.001) in the white patients and in the South Asian patients (8.0 vs 2.2, P < 0.001). Conclusion This novel study provides evidence for improving cultural competency and patient enablement in rheumatology settings.