Background: There is considerable interest within the medical research community in the identification of individuals at risk of developing rheumatoid arthritis (RA), to identify those who may benefit from preventive interventions. However, it is important to understand the views of those who may be candidates for such predictive tests, to inform the development of effective approaches. First degree relatives (FDRs) of patients with RA are at an increased risk of developing RA. RA patients can provide access to FDRs. Qualitative investigations have explored the views of these groups about predictive testing for RA 1,2 , but quantitative approaches are needed to develop a robust understanding. Objectives: To identify predictors of interest in predictive testing for FDRs and patients, and to assess the likelihood of patients communicating information about RA risk to their FDRs. Methods: Surveys were completed by 482 RA patients and 397 of their FDRs. Patients were invited to complete the survey and to provide another to their relatives. Spearman’s Rank Correlations were used to assess relationships between interest in predictive testing/ likelihood of risk communication and potential predictor variables. Results: FDRs had a median age of 41 years, 64% were female. 57% were definitely interested and 36% were probably interested in taking a predictive test for RA. Several predictors were found to be associated with interest (table 1). Table 1. Spearman’s correlations for relatives’ and patients’ interest in predictive testing. After applying a Bonferonni adjustment, p values were taken as statistically significant at p≤0.003. FDRs Patients Predictors of interest in predictive testing rs P rs P Brief Illness Perception Questionnaire 0.11 0.03 0.09 0.05 Consequences 0.16* 0.002* 0.10 0.03 Timeline 0.09 0.07 -0.05 0.28 Personal control -0.03 0.59 -0.02 0.68 Treatment control -0.02 0.76 0.02 0.74 Identity 0.09 0.09 0.12 0.01 Concern 0.21* <0.001* 0.16* <0.001* Coherence 0.11 0.03 0.007 0.88 Emotional 0.12 0.02 0.11 0.02 Information Seeking 0.35* <0.001* 0.22* <0.001* Decision making -0.05 0.33 0.07 0.13 Health literacy 0.03 0.52 0.02 0.62 Health numeracy -0.06 0.23 -0.02 0.72 Brief Avoidance Coping Questionnaire 0.12 0.02 -0.01 0.76 Optimism 0.06 0.26 -0.07 0.12 Health anxiety 0.16* 0.001* - - Perceived risk 0.37* <0.001* - - Rheumatoid Arthritis Impact of Disease - - 0.05 0.31 – not applicable Patients had a median age of 65 years, 71% were female. 47% were definitely interested and 30% were probably interested in their children taking a predictive test. Several predictors were found to be associated with interest (table 1). On a Likert scale from extremely unlikely (0) to extremely likely (4), most patients indicated that they were likely to communicate RA risk information to their children (median score=3). Conclusion: Interest in predictive testing for RA was high amongst FDRs, and factors including information seeking preference, RA risk perception, concern about RA, perceived consequences of RA and health anxiety were significantly associated with interest. Patients were also willing to communicate information about RA risk to their children. These findings increase understanding of perceptual variation in those at risk of RA, and will inform the development of information to support decision making in individuals considering predictive tests and preventive interventions. We are currently extending this preliminary analysis by building multivariate models incorporating a range of attitudes about predictive testing, assessing predictors of patients’ likelihood of communicating to their FDRs about risk, and the relationship between patients’ and FDRs’ responses. References: [1]Stack RJ et al. BMJ open. 2016; 6(6):e010555. [2]Falahee M et al. Arthritis care & research. 2017; 69(10):1558-65. Acknowledgments: This work was supported by Versus Arthritis; Grant reference: 21560. Disclosure of Interests: Imogen Wells: None declared, Gwenda Simons: None declared, Rebecca Stack: None declared, Christian Mallen Grant/research support from: My department has received financial grants from BMS for a cardiology trial., Peter Nightingale: None declared, Karim Raza Grant/research support from: KR has received research funding from AbbVie and Pfizer, Consultant of: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai, Speakers bureau: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai, M. Falahee: None declared

Background A range of clinical symptoms can be present in people at risk of rheumatoid arthritis (RA). However, information on location, timing, severity and predictive value of symptoms is still largely lacking. The Symptoms in Persons At Risk of Rheumatoid Arthritis (SPARRA) questionnaire has been developed with support of EULAR to provide more insight into these symptoms1,2. Objectives To validate the SPARRA questionnaire in an international group of arthralgia patients at risk of RA. Methods Questions on presence, severity, impact and location of 13 symptoms were derived from a qualitative study in seropositive arthralgia patients1. The items are: joint pain or swelling, joint stiffness, burning and tingling sensations, numbness, change in skin colour, muscle cramps, weakness, fatigue, emotional distress, concentration difficulties and sleep problems. Answers are given on an ordinal scale. The number of days with a symptom per month (0, 1–5, 6–15, 16–30 days), severity (none, mild, moderate and severe) and influence on daily activities (no, small, moderate or high impact) were recorded. Finally, patients were asked to describe the pattern of symptom development over time. For this initial analysis of validity, patients were selected from the Dutch arthralgia cohort. We first administered the questionnaire to 30 patients to ask for ambiguities. Thereafter, 46 patients did a test-retest within one week to assess intra-rater agreement using the % agreement and the kappa score. Results Feedback on the questionnaire was received from 5/30 patients. There were only minor comments that did not lead to adaptations, such as difficulty distinguishing pain from stiffness (n=1) and difficulty describing muscle cramps (n=1). 46 arthralgia patients were assessed at 2 time points. The rater agreement was moderate to good for most items with kappa9s of 0.42 to 0.93. We also found acceptable percentages of agreement of 65 to 91 (Table 1). Only tingling sensations and numbness scored low in agreement, with kappa9s of 0.37 and 0.15, respectively. The kappa9s were good across the presence, severity and impact of the item categories. Data on clinical variables and follow-up questionnaires to assess the construct and criterion validity will be presented at the congress. Conclusions The SPARRA questionnaire seems to be a reliable scale for evaluating symptoms in persons at risk for RA. More follow-up and data from collaborating centers within Europe is necessary for assessment of the construct, criterion and external validity. References Stack, Rheumatology 2014; van Tuyl, Musculoskel Care 2015 Disclosure of Interest None declared

Background Understanding the persistence of biologic treatment in different ethnic groups is important for efficient healthcare delivery. We previously reported that patients with Rheumatoid Arthritis (RA) from South Asian background had high level of side effect concerns about conventional DMARDs (cDMARDs) compared with patients of White British origin. These concerns may have an impact on treatment persistence; however, there is little data on biologic DMARDs (bDMARDs) treatment persistence among different ethnic groups. Objectives To investigate biologic DMARDs treatment persistence and reasons for switching among patients with RA from South Asian and White British background. Methods This service evaluation project identified 336 patients with active RA diagnosed by Consultant Rheumatologists at the Sandwell and West Birmingham Hospitals NHS Trust, UK. All patients were commenced on bDMARDs according to NICE guidelines between May 2001 and August 2013. Frequency of loss of efficacy, number of bDMARDs switches and treatment duration for each bDMARD, were compared between South Asian and White British patients. Loss of efficacy was defined as a drop of DAS-28 score ≤1.2 after at least three months of therapy, or by loss of efficacy in the opinion of the treating physician. Results The sample included 77 (23%) South Asian and 259 (77%) White British patients with active RA commencing bDMARDs therapy. The frequency of side effects was similar in both groups. Loss of efficacy was more common among South Asian compared with White British patients (65.6% vs. 52.2%; p=0.03). Regarding the number of biologic DMARDs switches, South Asian patients switched bDMARDs more frequently compared to their White British counterparts (South Asian vs White British; one switch: 24.7% vs 21.6%; two switches: 19.5% vs 15.8%; ≥3 switches 13.0% vs 5.8%; p=0.01). The first biologic drug survival times of infliximab and adalimumab were significantly longer in the White British group compared to the South Asian group (South Asian vs. White British; median time on infliximab: 10 months vs. 26 months; p=0.032, median time on adalimumab; 9 months vs. undefined p=0.006; proportion of South Asian vs. White British group on adalimumab after 60 months; 27.3% vs. 57.4%). There were no significant differences in the first biologic drug survival times of etanercept and certolizumab between the two groups (White British vs. South Asian median time on etanercept: 50 months vs. 55 months; p=0.593; median time on certolizumab: 25 months vs. 13 months, p=0.860). There was no significant difference in the DAS28 score between the two groups after three months of biologic therapy [South Asian vs White British, median (IQR); 5.2 (4.2-6.1) vs 4.8 (3.4-6.0)]. Conclusions Our data indicates that there are ethnic differences in the persistence of bDMARDs among patients with RA. This has clinical implications when determining the choice of biologic therapy for patients from different ethnic backgrounds. Disclosure of Interest K. Kumar: None declared, I. Sahbudin: None declared, A. Filer Grant/research support from: Pfizer, C. D. Buckley: None declared, K. Raza Speakers bureau: K Raza has received honoraria from Pfizer, AbbVie and BMS., R. Stack: None declared, P. Nightingale: None declared, A. Deeming: None declared, D. Situnayake: None declared, P. de Pablo: None declared

Background: Rheumatoid arthritis (RA) causes progressive joint damage and functional disability. Studies on factors affecting joint damage as clinical outcome are lacking in Africa. The aim of the present study was to identify predictors of joint damage in adult South Africans with established RA.