Where people live can present a significant challenge to delivering timely and equitable healthcare. To effectively plan local and national services to meet the needs of people with rheumatic and musculoskeletal diseases (RMDs), we need to understand how many people have these conditions, who they are, where they live and how this relates to existing services. It is also important to understand people’s care priorities, recognising that these might be different for different groups of patients, and what resources and services people feel are important, missing, or could be improved.This report summarises the priorities for care of people living with a broad range of RMDS across the UK and the resources and services needed to meet these needs. It outlines a number of policy and practice recommendations to address the gaps identified.

Introduction Psoriatic arthritis (PsA) affects around 150 000 people in the UK of whom around 50% require treatment with biologics. The most used biologics for PsA target tumour necrosis factor (TNF) or interleukin-17A (IL-17A). About 50% of patients respond to each, but it is not currently possible to predict response for individual patients, necessitating sequential treatment steps. A recent proof of concept study in PsA suggested that using peripheral immunophenotype to choose therapy could improve time to treatment response. This study will test the hypothesis, within an open-label parallel-group biomarker-stratified multicentre randomised controlled trial, which the baseline proportion of CD4+T cells with an activated type 17 immunophenotype (Th17 levels) predicts response to IL-17A or TNF inhibitors in PsA. Additional analyses will identify if the model can be refined by combining additional clinical and immunophenotypic factors. Statistical modelling will be used to predict the likely effectiveness of these approaches compared with standard care. Methods and analysis Patients with PsA eligible to start their first biologic as part of standard care are recruited and baseline blood tests are taken for immunophenotyping. Participants are stratified equally by Th17 levels and randomised 1:1 to receive either TNF (adalimumab) or IL-17A (secukinumab) inhibitors. The primary analysis will establish the interaction between baseline immunophenotype and treatment on the primary outcome (achievement of minimal disease activity criteria at week 24). In secondary analysis, modelling will identify if this prediction model can be optimised further by incorporating clinical phenotypes and additional immunophenotyping techniques. Ethics and dissemination Ethical approval for the study was granted by the North West Preston Research Ethics Committee (ref 21/NW/0016). Dissemination will be via conference presentations and peer-reviewed publications, aiming to impact on treatment guidelines. Trial registration number ISRCTN17228602.

Abstract Background/Aims 1 in 6 of the UK population live in rural areas which can create significant challenges to delivering care. We aimed to understand priorities for care for people with rheumatic and musculoskeletal conditions (RMDs) living in rural and urban areas, and factors predicting care dissatisfaction, to support service planning. Methods A UK cross-sectional web-based survey of people who reported a RMD diagnosis made by a health professional. The survey was co-designed with patient partners and disseminated to charities and social media channels between 30/08/21 and 26/11/21. Using a stepwise logistic regression, independent factors related to dissatisfaction were determined. Associations are described using Odds Ratios (OR) and 95% Confidence Intervals (CIs). Survey free-text responses (n = 390) and qualitative interviews with 15 people with RMDs across the UK were analysed thematically. Results 859 participants were eligible for the current analysis. Compared to urban dwellers, rural dwellers (256 [29.8%]) were older (% ≥ 65 years 39.5% v. 34.8%) and less likely to be from the two highest quintiles of deprivation (15.7% v. 26.9%). Overall, 373 (43%) said that current services accessed did not enable them to meet their own priorities. Rural dwellers were not more likely to express dissatisfaction with services (OR 0.91 95%; CI 0.68, 1.22). Factors significantly associated with service dissatisfaction included: demographic and socio-economic; musculoskeletal health-related factors and those linked to accessing care. The final multivariable model predicting dissatisfaction included: employment status (out of work due to illness OR 1.37); type of RMD (non-inflammatory OR 2.9); not knowing how to access available local services (OR 2.92); difficulties accessing information about their condition (OR 2.03); travel difficulties in attending health services (OR 1.42); difficulties with caring responsibilities (OR 1.59); and services not being available in local trust/health board (OR 2.46). The positive and negative predictive values for the model were both 74%. Whilst those with non-inflammatory RMDs were more likely to be dissatisfied with current services, factors influencing dissatisfaction were similar across those with inflammatory and non-inflammatory RMDs. A personal point of contact was important to facilitate access to local services and condition-specific information when required, and greater support for pain and fatigue management and self-care to meet personal goals. Rural and urban dwellers reported similar travel issues when attending health services: availability of public transport and broadband speed for remote consultations. Conclusion Priorities for care for people with RMDs living in rural and urban areas were similar but we have identified groups with specific needs (non-inflammatory conditions, and those unable to work because of their health). Major factors linked to dissatisfaction were lack of local services (fatigue and pain management), but even when available, access issues often led to dissatisfaction. This provides important guidance to inform service planning. Disclosure R.J. Hollick: None. K. Stelfox: None. L. Bennett: None. K. Lam: None. M. Stevenson: None. L. Moir: None. G. Macfarlane: None.

Arthritis is one of the most common disease states worldwide but is still publicly misunderstood and lacks engaging public awareness materials. Within the UK, the most prevalent types of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). The two are commonly mistaken as the same disease but, in fact, have very different pathogenesis, symptoms and treatments. This chapter describes a study which aimed to assess whether an augmented reality (AR) application could be used to raise awareness about the difference between OA and RA.An application was created for Android tablets that included labelled 3D models, animations and AR scenes triggered from a poster. In total 11 adult participants tested the application taking part in a pretest and posttest which aim to measure the usability of the application and the acquisition of knowledge on OA and RA. A T-test was performed to assess the effectiveness of the application from the pretest and posttest questionnaire outcomes. Overall results were encouraging reporting a very significant acquisition of knowledge and a highly satisfactory user experience.

Rheumatic and musculoskeletal diseases are a group of devastating autoimmune disorders that all share a common debilitating symptom fatigue. Fatigue is not widely understood and is often underrepresented in treatment regimes. Fatigue is the least successfully managed symptom of these conditions; however, it can often be the one of the greatest impairments.Augmented reality (AR) enhances a person's reality showing a hybrid environment where real and virtual objects coexist. Currently educational AR applications are saturating the application market, as they have shown great potential for increasing comprehension and understanding of complex concepts. AR expands user engagement by enhancing the learner's enjoyment and enriching their learning environment.This research explores the development and subsequent effect of an AR application on education around fatigue and basic neuroanatomy within the general population. The application was created using medical scan dataset, a variety of 3D modelling software and a game engine to create a functional and interactive augmented application. The application explores the effects of fatigue on a person's daily life while also laying a foundation of basic neuroanatomy. A pilot test conducted on 14 participants (8 males, 5 females and 1 other), with ages ranged 16-64 (4 form range 16 to 24, 5 from range 25 to 34, 1 from range 35 to 44, 3 from range 45 to 54, 1 from 55 to 64), shows the application is highly usable, increases understanding of basic neuroanatomical concepts and has the potential to improve understanding of fatigue. Nonetheless, further development and testing of the application are imperative so that we can gain a better understanding of the usability of the application with wider audiences. Future developments will aim to further aid knowledge acquisition and enhance understanding of fatigue, a complex and widely misunderstood concept.

Rheumatoid arthritis (RA) affects around 1% of the population, which places a heavy burden on society and has severe consequences for the individuals affected. The early diagnosis and implementation of disease-modifying antirheumatic drugs significantly increase the chance of achieving long-term sustained remission. Therefore, raising awareness of RA amongst the general public is important in order to decrease the time of diagnosis of the disease. Augmented reality (AR) can be tremendously valuable in a teaching and learning context, as the coexistence of real and virtual objects aids learners in understanding abstract ideas and complicated spatial relationships. It has also been suggested that it raises motivation in users through interactivity and novelty. In this chapter we explore the useARin public engagement, and detail the design, development and evaluation of a blended learning experience utilising AR. A set of informative printed posters was produced, enhanced by an accompanying interactive AR application. Themain user testing was conducted with 27 participants at a science outreach event at the Glasgow Science Centre. Findings report mean positive attitudes regarding all aspects of the study, highlighting the potential of AR for public engagement with topics such as RA.

Background Musculoskeletal conditions (MSC), such as Rheumatoid arthritis (RA), place a heavy burden on society and have severe consequences for the individuals affected. In order to limit this burden of disease, early diagnosis and implementation of treatment are essential and result in a significantly increased chance of achieving long-term sustained remission. The European League Against Rheumatism (EULAR) campaign ‘Don’t Delay Connect Today’ (DDCT) was created in order to educate the general public and primary healthcare providers (such as General Practitioners) about the importance of recognising the early warning signs of MSC’s. Many countries have adopted the campaign across Europe, with groups using new and creative ways to engage local communities with this essential message. In Scotland, the Rheumatosphere team have worked to develop interesting and impactful ways of disseminating this message to the public. Augmented reality (AR) is a potential tool to enhance learning and has already been successfully used as a new and exciting tool for teaching1. However, its role in less formal educational setting, such as public engagement, is still relatively unknown. Objectives The primary objective of this study was to test a new AR modality, assessing its effectiveness in increasing knowledge pertaining to RA and the central message of the DDCT campaign. Methods An interactive AR application was designed for a lay audience, incorporating aspects of RA disease pathogenesis along with the importance of early diagnosis and treatment of disease. The modality consisted of printed posters that were enhanced by an interactive AR application accessed through a hand-held tablet device. Members of the public, visiting the Glasgow Science Centre, were asked to assess our AR application by completing a 5 point Likert scale questionnaire before and after interacting with our posters and AR application. Results In total 27 participants took part in the testing, with the majority being between the age of 25-34 years old, a key target audience for the campaign, as this demographic commonly believe that they are ‘too young’ to develop arthritis2. Overall the testing revealed that the AR application was easy to use, engaging and enjoyable. Further evaluation conducted using a 5-point Likert scale, showed that the AR application was successful in raising awareness of RA, with 81% of the participants reporting that they felt more aware about the pathogenesis, symptoms and treatment of RA after use. Moreover, 55% of the participants thought that they would inform friends and family about the causes, symptoms and treatments of RA, helping to disseminate the campaign message further, enhancing it’s overall reach from a single event. Conclusion Overall the application was well received and indicates that this tool could be used to enhance public engagement moving forward. It would therefore be worthwhile to invest in the development of similar modalities for the EULAR ‘Don’t Delay, Connect Today’ campaign. References [1] Sommerauer, P. and Müller, O. (2014) ‘Augmented reality in informal learning environments: A field experiment in a mathematics exhibition’, Computers and Education. Elsevier Ltd, 79(2014), pp. 59–68. doi: 10.1016/j.compedu.2014.07.013. [2] Doran MF, Pond GR, Crowson CS, O’Fallon WM, Gabriel SE. Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period. Arthritis Rheum 2002;46:625-31.3. Disclosure of Interests Timea Kosa: None declared, Daniel Livingstone: None declared, Brian Loranger: None declared, Carl Goodyear Grant/research support from: AstraZeneca, BMS, Celgene, Janssen, MedAnnex, Pfizer and UCB, Speakers bureau: Abbvie, Louise Bennett : None declared

Objective Proteinase-activated receptor 2 (PAR2) deficiency protects against cartilage degradation in experimental osteoarthritis (OA). The wider impact of this pathway upon OA-associated pathologies such as osteophyte formation and pain is unknown. Herein, we investigated early temporal bone and cartilage changes in experimental OA in order to further elucidate the role of PAR2 in OA pathogenesis.Methods OA was induced in wild-type (WT) and PAR2-deficient (PAR2(-/-)) mice by destabilisation of the medial meniscus (DMM). Inflammation, cartilage degradation and bone changes were monitored using histology and microCT. In gene rescue experiments, PAR2(-/-) mice were intra-articularly injected with human PAR2 (hPAR2)-expressing adenovirus. Dynamic weight bearing was used as a surrogate of OA-related pain.Results Osteophytes formed within 7 days post-DMM in WT mice but osteosclerosis was only evident from 14 days post induction. Importantly, PAR2 was expressed in the proliferative/hypertrophic chondrocytes present within osteophytes. In PAR2(-/-) mice, osteophytes developed significantly less frequently but, when present, were smaller and of greater density; no osteosclerosis was observed in these mice up to day 28. The pattern of weight bearing was altered in PAR2(-/-) mice, suggesting reduced pain perception. The expression of hPAR2 in PAR2(-/-) mice recapitulated osteophyte formation and cartilage damage similar to that observed in WT mice. However, osteosclerosis was absent, consistent with lack of hPAR2 expression in subchondral bone.Conclusions This study clearly demonstrates PAR2 plays a critical role, via chondrocytes, in osteophyte development and subchondral bone changes, which occur prior to PAR2-mediated cartilage damage. The latter likely occurs independently of OA-related bone changes.

Rheumatoid arthritis (RA) affects around 1% of the UK population, places a heavy burden on society and has severe consequences for the individuals affected. Early diagnosis and treatment significantly increase the chance of long-term sustained remission. Raising awareness of RA amongst the general public is important to help decrease the time of diagnosis of the disease. In this poster and demo we explore the use of Augmented Reality (AR) in the creation of interactive print posters for public engagement. Previous studies have shown that AR can be effective in a teaching and learning context, where the coexistence of real and virtual objects aids learners in understanding abstract ideas and complicated spatial relationships. It has also been suggested that it raises motivation in users through interactivity and novelty. We explore the use of AR in public engagement, and outline the design, devel-opment and evaluation of an engagement experience utilising AR. For this, a set of informative printed posters was produced and these enhanced by an accompa-nying interactive AR application. Evaluation involved participants at a science outreach event at the Glasgow Science Centre. The poster includes a demo of the public engagement application: Rheumatosphere AR.