Journal Article Accepted manuscript Incidence of Uveitis and Inflammatory Bowel Disease in Psoriatic Disease, and Psoriatic Disease in Uveitis and Inflammatory Bowel Disease Get access Jacob Corum Williams, Jacob Corum Williams St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UKLeeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar Uazman Alam, Uazman Alam Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UKDepartment of Medicine, University Hospital Aintree, Liverpool University NHS Foundation Trust, Liverpool, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar Sizheng Steven Zhao Sizheng Steven Zhao Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Correspondence to: Dr Sizheng S Zhao. Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9LJ, UK. Email: [email protected] Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, keaf110, https://doi.org/10.1093/rheumatology/keaf110 Published: 20 February 2025 Article history Received: 14 January 2025 Revision received: 30 January 2025 Accepted: 13 February 2025 Published: 20 February 2025

Journal Article Corrected proof Remotely collected patient-reported data characterises the impact of idiopathic inflammatory myopathy flares upon work productivity Get access Jacob Williams, Jacob Williams Post Graduate Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK Correspondence to: Jacob Williams, Post Graduate Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. E-mail: Jacob.williams@mft.nhs.uk https://orcid.org/0009-0006-3737-557X Search for other works by this author on: Oxford Academic PubMed Google Scholar Suzanne M M Verstappen, Suzanne M M Verstappen Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UKCentre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Search for other works by this author on: Oxford Academic PubMed Google Scholar Niels Steen Krogh, Niels Steen Krogh ZiteLab, Copenhagen, Denmark Search for other works by this author on: Oxford Academic PubMed Google Scholar William G Dixon, William G Dixon Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UKCentre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UKDepartment of Rheumatology, Salford Royal Hospital, Northern Care Alliance, Manchester Academic Health Science Center, Salford, UKNational Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK https://orcid.org/0000-0001-5881-4857 Search for other works by this author on: Oxford Academic PubMed Google Scholar Hector Chinoy, Hector Chinoy Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UKDepartment of Rheumatology, Salford Royal Hospital, Northern Care Alliance, Manchester Academic Health Science Center, Salford, UKNational Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK https://orcid.org/0000-0001-6492-1288 Search for other works by this author on: Oxford Academic PubMed Google Scholar Alexander G S Oldroyd Alexander G S Oldroyd Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UKCentre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UKNational Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK https://orcid.org/0000-0001-5701-6490 Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, kead692, https://doi.org/10.1093/rheumatology/kead692 Published: 23 December 2023 Article history Accepted: 13 December 2023 Published: 23 December 2023 Corrected and typeset: 10 January 2024

Sleep disturbance has been associated with chronic widespread pain (CWP), but their causal relationship remains unclear. We aimed to examine the causal relationship and direction between CWP and sleep traits, namely insomnia, sleep duration and chronotype, using Mendelian Randomization. We used genetic association data from 0.5 million individuals and up to 1.8 million controls from the UK Biobank (UKB). All traits were defined predominantly by self-report. Short sleep duration was defined as average ≤6 hours per 24 hours. Chronotype refers to the inclination to sleep at certain times where some wake and go to bed early (‘morning’ person), and others wake and go to sleep later (‘evening’ person). To permit use of the largest available genetic association data, we used the Causal Analysis Using Summary Effect estimates (CAUSE) method, which allows for sample overlap. Insomnia (OR 1.009, 95

Abstract Background/Aims The Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID-12) was developed and validated to improve assessment of disease activity from the patient’s perspective. Several patient-reported outcome measures (PROMs) are relevant to PsA but completing several questionnaires at each clinic visit creates a time and administrative burden for patients and clinicians. Furthermore, the Minimal Disease Activity (MDA) for assessing disease activity in PsA requires the Health Assessment Questionnaire (HAQ) to be collected; however, a Canadian study found that PsAID-12 can replace HAQ in the MDA using a cut-off of < 3.7. A previous study also found sex-specific differences in PsAID-12 scores, with scores being higher in females. The aim of this study was to assess whether PsAID-12 correlates well and could replace other PROMs in clinical practice, and to validate previously published findings related to the use of PsAID-12 instead of HAQ in determining MDA, and sex-specific differences in PsAID-12 scores. Methods Clinical data were collected from 75 consecutive patients attending a PsA clinic in a tertiary centre at their first review in 2023. Clinical characteristics, PROMs, examination findings, and measures of disease activity were recorded. Correlation with PsAID-12 was assessed using Spearman’s rank correlation coefficient. Sex-specific differences were assessed using Mann-Whitney U tests. Bonferroni correction was used to adjust for multiple comparisons. Results PsAID-12 scores were significantly correlated with all PROMs, and with composite measures of disease activity (DAPSA, MDA), but not with clinical measures of disease activity (TJC, SJC, PASI, BSA), or acute-phase reactants (CRP, ESR). PsAID-12 scores were not affected by age or disease duration. There was no sex-dependent difference in PsAID-12 scores; however, female patients had significantly higher HAQ and HAD scores. MDA scores using PsAID-12 correlated significantly with MDA scores using HAQ. Conclusion PsAID-12 is a suitable replacement for other PROMs in clinical practice, and for HAQ when determining MDA status to reduce the time and administrative burden on patients and clinicians, and to facilitate monitoring of disease activity in patients with PsA regardless of age or disease duration. Contrary to previous studies, there were no sex-dependent differences in PsAID-12 scores. Disclosure R.M. Hum: None. K. Hasanein: None. L.T. Hao: None. J.C. Williams: None. A. Cheung: None. A. Adhikarla: None. A. Choyce: None. A. Newton: None. C. Clegg: None. A. Barton: None. P. Ho: None.

Psoriatic arthritis (PsA) is an inflammatory joint and entheseal disease associated with significant personal and public health burden. PsA has a prevalence of up to 1%, affecting ~20% of people suffering with psoriasis. PsA is frequently accompanied by metabolic syndrome (MetS), and both conditions are characterised by a chronic pro-inflammatory state, with several key cytokines in PsA (interleukin (IL)-17 and IL-23) also elevated in those with MetS. This narrative review aims to provide an update on MetS in PsA, focusing on its prevalence, pathogenesis, prognosis, treatment interactions and future therapeutic options. MetS is particularly prevalent in PsA compared to other inflammatory arthritides. Cohort studies indicate a higher risk of PsA in individuals with obesity, while Mendelian randomization studies link childhood obesity, insulin resistance, and dyslipidaemia to PsA. Weight loss interventions have been shown to reduce disease activity in PsA. Additionally, MetS negatively impacts the efficacy of tumour necrosis factor inhibitor (TNFi) drugs in treating PsA. Drugs given for PsA may also affect the conditions constituting MetS. Leflunomide has been shown to reduce body weight but also increase blood pressure. TNFi drugs lead to weight gain but reduce cardiovascular risk. Janus kinase inhibitors increase lipid levels and cardiovascular risk among high-risk groups. Anti-IL-17 and anti-IL-12/IL-23 drugs may cause a short-term increase in cardiovascular risk, although the long-term effects have yet to be established. Weight loss represents an unexplored avenue for disease modification in PsA, alongside a plethora of general health benefits. Dietary and exercise modifications are the cornerstone of weight management but vary substantially across individuals. Novel therapies to treat weight loss, such as glucagon-like peptide 1 agonists and sodium–glucose cotransporter 2 inhibitors, may prove useful alongside disease-modifying therapies for those with PsA and MetS and should be investigated as potential therapeutic adjuncts.

Background/Aims The Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID-12) was developed and validated to improve assessment of disease activity from the patient's perspective. Several patient-reported outcome measures (PROMs) are relevant to PsA but completing several questionnaires at each clinic visit creates a time and administrative burden for patients and clinicians. Furthermore, the Minimal Disease Activity (MDA) for assessing disease activity in PsA requires the Health Assessment Questionnaire (HAQ) to be collected; however, a Canadian study found that PsAID-12 can replace HAQ in the MDA using a cut-off of<3.7. A previous study also found sex-specific differences in PsAID-12 scores, with scores being higher in females. The aim of this study was to assess whether PsAID-12 correlates well and could replace other PROMs in clinical practice, and to validate previously published findings related to the use of PsAID-12 instead of HAQ in determining MDA, and sex-specific differences in PsAID-12 scores. Methods Clinical data were collected from 75 consecutive patients attending a PsA clinic in a tertiary centre at their first review in 2023. Clinical characteristics, PROMs, examination findings, and measures of disease activity were recorded. Correlation with PsAID-12 was assessed using Spearman's rank correlation coefficient. Sex-specific differences were assessed using Mann-Whitney U tests. Bonferroni correction was used to adjust for multiple comparisons. Results PsAID-12 scores were significantly correlated with all PROMs, and with composite measures of disease activity (DAPSA, MDA), but not with clinical measures of disease activity (TJC, SJC, PASI, BSA), or acute-phase reactants (CRP, ESR). PsAID-12 scores were not affected by age or disease duration. There was no sex-dependent difference in PsAID-12 scores; however, female patients had significantly higher HAQ and HAD scores. MDA scores using PsAID-12 correlated significantly with MDA scores using HAQ. Conclusion PsAID-12 is a suitable replacement for other PROMs in clinical practice, and for HAQ when determining MDA status to reduce the time and administrative burden on patients and clinicians, and to facilitate monitoring of disease activity in patients with PsA regardless of age or disease duration. Contrary to previous studies, there were no sex-dependent differences in PsAID-12 scores. Disclosure R.M. Hum: None. K. Hasanein: None. L.T. Hao: None. J.C. Williams: None. A. Cheung: None. A. Adhikarla: None. A. Choyce: None. A. Newton: None. C. Clegg: None. A. Barton: None. P. Ho: None.

Abstract Introduction Idiopathic inflammatory myopathies (IIM) are a group of conditions characterised by immune-driven muscular inflammation, often in the presence of specific autoantibodies. NXP2 dermatomyositis is a subtype of IIM characterised by antibodies to nuclear matrix protein 2. NXP2 dermatomyositis is associated with calcinosis, especially in younger patients and with malignancy, especially in older patients. We report a case of NXP2 dermatomyositis in a female patient of West African descent presenting with a periorbital and upper back rash which was initially misdiagnosed as an allergic reaction. Images of darker skin are underrepresented in medical education around dermatomyositis. Case description A 49-year-old female office worker presented to A&E with a two-week history of arthralgia and fatigue. Over the past two days, she had also noticed the development of periorbital swelling and a rash on her eyelids and her upper back. On examination in A&E, the rash was considered minor and it was noted that she had difficulty taking off her coat due to pain in her arms. She was discharged home with a working diagnosis of an allergic reaction, with advice to see her GP if symptoms persisted. She was reviewed by her GP, who suspected a vasculitic rash. She was found to have a significantly raised ANCA-MPO antibody titre and was referred to the acute medical take where she was seen urgently by rheumatology on-call. On assessment, she was noted to have pain and morning stiffness in her hands and wrists, with swollen DIPJ, MCPJ and wrists on examination. On assessment by a rheumatologist aware of the skin manifestations of dermatomyositis, she was also noted to have a heliotrope rash, shawl sign, periungual erythema, and a V sign rash and was suspected to have dermatomyositis. Her CK was raised at 3000, and she was found to have NXP2 autoantibodies which confirmed the diagnosis. She was started on hydroxychloroquine whilst an MR scan of her arms and legs was organised, which revealed evidence of myositis in the proximal muscles. Following MR scanning, she was started on high dose corticosteroids. Azathioprine was subsequently initiated as a steroid sparing agent, but was not tolerated due to nausea and so she was switched to subcutaneous methotrexate. Her CK has now normalised, and her skin lesions are healing. Discussion One of the key issues highlighted by this case is the lack of awareness of rashes associated with dermatomyositis generally, and especially in diverse skin types. We suspect this is because of a lack of education and exposure to skin rashes in diverse skin types, especially in highly melanated skin types. On her initial assessment in A&E, her rash was misdiagnosed as an allergic reaction. We suspect a lack of familiarity with skin rashes in darker skin types contributed to this initial misdiagnosis. However, we believe it was clear that the patient’s rash and history on initial presentation were not in keeping with urticaria, or an allergic skin rash. However, a further point to consider is that dermatomyositis is rare, and so those working in primary care are less familiar with its manifestations. Medical resources have historically had a tendency to use images of people with lighter skin tones to demonstrate skin diseases. Over the last few years, several textbooks and online resources have become available specifically showing skin conditions in different skin tones, for example, the Mind the Gap handbook. These resources are generally excellent; however, they tend to focus on common skin disorders. In addition, images of dermatomyositis in medical textbooks are predominantly of white skin. If medical education resources were to include examples of dermatomyositis in a variety of skin tones it is possible that diagnostic confidence and proficiency would improve, and racial disparities would be reduced. This is especially important in a multicultural society like the United Kingdom. Key learning points Lack of awareness of skin rashes in diverse skin types contributes to misdiagnosis and worse outcomes for patients with ethnic minority backgrounds, including those with dermatomyositis. Increasing awareness and education surrounding the skin manifestations in diverse skin types is a key priority for medical education, including in rheumatology. New initiatives aimed at improving our understanding of skin manifestations in diverse skin types are underway.

Abstract Background/Aims The digital healthcare revolution provides the opportunity for clinicians and researchers to collect useful data on a frequent and remote basis. Work ability is impacted by many rheumatic diseases, including the idiopathic inflammatory myopathies (IIMs), however, methods to assess the real-time impacts are limited. This study aims to explore the impact of IIM flares and symptoms upon employment using frequently collected data via a smartphone-based app. Methods The Myositis Physical Activity Device Study recruited a UK-based adult IIM cohort who completed weekly employment and flare questions via a specially designed smartphone-based app throughout a 91 day period in 2019/20. Employment-related questions were assessed every week (see Table 1 for details). Flares were reported via a weekly question. Employment variables were compared between flare and non-flare weeks using descriptive statistics. The relationship between flares and work productivity was assessed using multi-level mixed effects logistic regression modelling, adjusted for age and sex. Results Data on 13 (69% female) employed participants was analysed. A median of 5 flares were reported per patient during the three month period (IQR 3, 9). Summary employment results are displayed in Table 1. Participants reported greater impact of IIM upon employment, lower productivity and fewer hours worked during a flare week, compared to a non-flare week. There was a significant association between flares and detrimental impact upon work productivity (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03, 1.12, p < 0.01). Flares were also significantly associated with an increased number of work hours missed due to IIM (OR 1.04, 95% CI 1.01, 1.08, p = 0.02) P156 Table 1:- Summary employment parameters compared between flare and non-flare weeksEmployment parameterAnswer formatWhole study period (159 weeks)Flare weeks (60 weeks)Non-flare weeks (99 weeks)p-value*Number of weeks’ work productivity affected by IIM (%)Dichotomous - “yes”, “no”54 (34.0)33 (55.0)21 (21.2)<0.01Mean effect of IIM upon work productivity (SD)Visual analogue scale - “Myositis had no effect on work" (0);“Myositis completely prevented me from working” (100)29.8 (28.8)46.2 (33.3)19.9 (20.0)<0.01Mean number of scheduled work hours per week per participant (SD)Numerical33.2 (15.8)36.9 (19.33)31.0 (13.0)<0.01Mean number of hours worked per week per participant (SD)Numerical23.5 (15.1)18.86 (17.1)26.23 (13.2)<0.01Proportion of hours worked per week per participant / % (SD)Calculated by research team73.7 (38.7)55.9 (43.2)84.7 (31.1)<0.01Mean number of hours of weekly work missed due to IIM per participant (SD)Numerical6.6 (16.6)14.9 (23.4)1.5 (6.6)<0.01Proportion of hours of weekly work missed due to IIM per participant / % (SD)Calculated by research team12.7% (29.5)29.2 (41.1)2.6 (10.0)<0.01SD = standard deviation *Categorical variables were compared using the Chi-squared test and continuous variables compared using the student t-test. Conclusion Our study has demonstrated that IIM flares are significantly associated with detrimental impact upon employment ability. On average, patients lost 15 hours of work a week during a flare compared to less than 2 hours outside a flare. The economic and personal impact of flares highlights the need for research in this area, with the aim of allowing early identification and instigation of treatment and possible need for supported work. Smartphone based remote monitoring of flares and other pertinent variables could enhance digital consultations, which may become more common in the post COVID-19 setting. Disclosure J.C. Williams: None. A.G.S. Oldroyd: None. W.G. Dixon: None. H. Chinoy: None.

Introduction Objective information on longitudinal disease progression in inclusion body myositis (IBM) is lacking. Methods Longitudinal dynamometry and functional status data were collated from a cohort of IBM patients. Annual change was calculated by means of linear modeling. Trajectories of change in grip, knee extension, IBM Functional Rating Scale (IBM-FRS) and Neuromuscular Symptom Score (NSS) were identified by means of latent growth mixture modeling. Results Data were collated from 75 IBM patients (348 person-years follow-up). Annual strength loss was greatest for pinch (-10%) and knee extension (-4%). Functional deterioration was greatest for males. Three distinct trajectory groups were identified. Rapid deterioration trajectory for grip strength was associated with younger diagnosis age. Rapid deterioration for knee extension strength was associated with older age of diagnosis. Discussion This study has quantified strength change in IBM and identified distinct trajectory groups, which will aid prognostication and stratification for inclusion into future clinical trials.

Abstract Background Sporadic inclusion body myositis (IBM) is a muscle wasting disorder usually affecting those aged over 50 years, characterised by slowly progressive weakness of the distal upper limbs and proximal lower limbs. Particular weakness of pinch, knee extension and ankle dorsiflexion result in functional decline and disability. Weakness-associated functional decline differences between genders has not previously been investigated. This study aimed to investigate for differences of functional decline in men and women with IBM. Methods A cohort of verified adult IBM patients were followed at a single specialist neuromuscular clinic (Royal Victoria Infirmary, Newcastle-upon-Tyne, UK) between 2004-15, with data collected at each clinic visit. Strength of 11 movements was measured via dynamometry at each clinic visit. Patient-reported function was measured via the Neuromuscular Symptom Score (NSS). Generalised linear modelling, adjusted for disease duration, was carried out to identify associations between strength and function (NSS). Pinch, knee extension and ankle dorsiflexion strength measurements were analysed. Modelling was carried out separately for male and female cohorts. Results Data of 75 participants (47% female) was analysed. A total of 591 measurements were taken. Median age at time of IBM diagnosis was 68.8 years. Median baseline NSS score was 45 (IQR 37, 54) for the male cohort and 40 (IQR 29, 45) for the female cohort. The median disease duration of the study cohort was 2.6 years. Reduced function (NSS) was significantly associated with reduced pinch, knee extension and ankle dorsiflexion strength in the male cohort only (Table 1). No significant associations were observed in the female cohort. Conclusion This is the first study to demonstrate that the progression of weakness, in the characteristic muscle groups affected in IBM, impacts on function differently in men and women. These results illustrate the importance of functional assessment in patients with IBM and the importance of focused physiotherapy upon function-dependent muscle groups. Further, potential gender-based differences of weakness-related function in IBM should be considered when designing clinical trials. Disclosures J. Williams None. A. Oldroyd None. J. Lilleker None. H. Chinoy None. J. Miller None.