BACKGROUND:Postoperative opioids, intended for short-term analgesia, contribute to new persistent opioid use in 1%-7% of patients, adversely affecting outcomes. Oxycodone may carry higher risk than morphine, though long-term data are limited. This prospective comparative sequential cohort study assessed whether replacing from oxycodone with morphine as first-line opioid after orthopaedic surgery affected new persistent opioid use at 6 months and maintained analgesic equivalence. METHODS:Patients ≥18 years undergoing orthopaedic surgery requiring ≥1 night hospitalization were enrolled April 2023 to January 2024. PRIMARY OUTCOME:new persistent opioid use at 6 months, assessed by online survey. SECONDARY OUTCOME:analgesic effectiveness assessed by pain at rest (NRS ≥ 4) at discharge and 6 months, and daily opioid use (oral morphine equivalents) during hospitalization. RESULTS:Of 3675 eligible patients, 1894 (51.5%) completed the survey and were included (mean [SD] age 62.9 [13.1] year; 62.5% female). Among these, 1021 were in the morphine first-line opioid cohort and 873 in the oxycodone first-line opioid cohort. The proportion of new persistent opioid use at 6 months after surgery was 2.5% (morphine) vs. 2.6% (oxycodone) (p = .90). Pain at rest (NRS ≥ 4) was reported by 9.9% vs. 12.5% at discharge, and 19.3% vs. 19.7% at 6 months (morphine vs. oxycodone). Median (IQR) daily opioid dose during hospitalization was 12.3 (0-30) and 15 mg (0-30) (morphine vs. oxycodone). No significant differences were observed. CONCLUSIONS:Replacing oxycodone with morphine as first-line opioid after orthopaedic surgery did not appear to reduce new persistent opioid use (NPOU) and provided comparable analgesia.

Objectives:To explore the implementation of cardiovascular risk management (CVRM) in Dutch RA patients from the perspective of rheumatologists and patients. Methods:An online survey was conducted among Dutch rheumatologists, rheumatology physician assistants (PAs) and RA patients. Healthcare providers completed a 37-item adapted version of the Determinants of Implementation Behavior Questionnaire to assess various aspects of CVRM implementation behaviour on a 7-point Likert scale. Simultaneously, a 13-item questionnaire was administered to RA patients to gather experiences related to CVRM. Data for both surveys were collected online between 23 September and 1 December 2024. Results:A total of 85 healthcare providers [93% rheumatologists, mean age 47.2 years (s.d. 8.8), 72% female] and 145 RA patients [mean age 58 years (s.d. 12.6), 89% female] completed the survey. Providers did not seem to lack (self-reported) knowledge on CVRM, yet significant implementation challenges were identified across several domains, including skills, professional roles and beliefs about capabilities. Time constraints, limited resources, insufficient financial support and the absence of local protocols were cited as major barriers. From the patient perspective, only 39% reported being informed about RA-related cardiovascular risks, mostly by rheumatologists. Rheumatologists frequently provided guidance on physical activity (21%), while general practitioners were more active in managing traditional cardiovascular risk factors, prescribing medications (23%) and offering self-management advice (16%). Conclusion:Our study highlights the main challenges in implementing CVRM in daily practice, indicating the need for the development of targeted strategies to overcome these barriers.

This study aimed to explore the perceptions of patients and rheumatologists about a treat-to-target (T2T) strategy in axial spondyloarthritis (axSpA) and identify the barriers and facilitators to its implementation in clinical practice. A mixed methods design was applied. Patients with axSpA who visited the outpatient clinic with active disease (AxSpA Disease Activity Score [ASDAS] ≥ 2.1), but did not receive a treatment adjustment, were identified. These patient cases were discussed in individual semi-structured interviews with the respective treating rheumatologists, and a subgroup of these patients was also interviewed. In parallel, all interviewed participants completed a quantitative survey. Qualitative and quantitative data were analysed thematically and descriptively, respectively. Twenty-three patients were discussed with 11 rheumatologists, and 16 of these patients were interviewed personally. Barriers to T2T included challenges in the measurement of inflammatory disease activity using the ASDAS, and numerous patient-related factors such as concern about treatment adaptations. The limited number of viable treatment options and scarce amount of evidence supporting T2T in axSpA, as well as logistical challenges, were additional obstacles. Facilitators included patients’ broad knowledge about axSpA, rheumatologists’ awareness of T2T recommendations, and positive doctor-patient relationships with the application of shared decision-making. Moreover, a supporting infrastructure, such as one with high accessibility to the outpatient clinic between scheduled visits, was considered necessary for the application of a T2T strategy. In conclusion, numerous barriers and facilitators to the implementation of a T2T strategy in axSpA are present, which need to be considered when applying this treatment approach in clinical practice.

This study investigated severity, course and patterns of fatigue surrounding subcutaneous biological disease-modifying antirheumatic drug (bDMARD) injection in inflammatory rheumatic disease (IRD) patients using ecological momentary assessments and investigated self-reported adverse drug reactions (ADRs). In this prospective cohort study, IRD patients completed fatigue severity numeric rating scales (0–10) in web-based ecological momentary assessments in three waves of five days surrounding bDMARD injection. The course of fatigue was measured by the change in fatigue from pre-dosing to post-dosing scores and was classified as: worsening, improving or no clinically relevant change. A pattern was defined as a course of worsening, improving or no clinically relevant change in fatigue in at least two out of three waves for patients completing assessments across all three waves. ADRs could be reported on day five of each wave. In total 609 participants completed ecological momentary assessments surrounding 1541 bDMARD injections. Overall average fatigue severity across all three waves was 4.5 (± SD 2.4) and 78

OBJECTIVES:To compare a bDMARD mode of action cycle vs swap treatment strategy in patients with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA) after first tumour necrosis factor inhibitor (TNFi) discontinuation. METHODS:In December 2019, our local treatment protocol for PsA and axSpA changed from a cycle strategy (first TNFi to second TNFi) to a swap strategy (first TNFi to IL-17i). We performed a retrospective comparison of the 3-year drug retention rate using multivariable Cox regression (ref: cycle group) and disease activity (DAS28-CRP for PsA, BASDAI for axSpA) in patients with a clinical diagnosis of PsA and axSpA. For subgroup analyses, Cox regression models were stratified by sex, reason of first TNFi discontinuation, and (non-)radiographic status in axSpA. RESULTS:In PsA patients (n=406), there was no overall significant difference in drug retention between strategies (HR: 1.17 (95% CI: 0.87 to 1.58), p=0.29), but male PsA patients had a significant higher risk for treatment discontinuation following a swap strategy. In axSpA patients (n=335), the swap strategy was overall associated with a higher risk of treatment discontinuation (HR: 1.46 (95% CI: 1.03 to 2.07), p=0.04). Patients who discontinued their first TNFi due to inefficacy and patients diagnosed with radiographic axSpA were at significant higher risk for treatment discontinuation following a swap strategy. No significant differences in disease activity were found for treatment strategies in PsA or axSpA. CONCLUSION:In PsA, the cycle and swap treatment strategy performed similarly, while in axSpA, the cycle strategy was associated with a significant higher drug retention rate.

Purpose:Effective healthcare professional-patient communication is essential for medication adherence. Conversations about patient's barriers to medication use, for example, could help to enhance adherence and consequently improve treatment outcomes. However, it is unclear whether and how barriers to medication use are discussed during routine rheumatology consultations. The aims of this study were to examine 1) the barriers and facilitators to medication use raised by patients during real-life rheumatology outpatient consultations, and whether the issue of medication (non)adherence was discussed (communication content); and 2) how rheumatologists responded to the barriers (communication process). Methods:A total of 134 audio-recordings of real-life outpatient rheumatology consultations were analysed. Barriers and facilitators for the current use of disease-modifying anti-rheumatic drugs were identified and categorized using a previously adapted Theoretical Domains Framework. The way rheumatologists responded to the barriers brought up by the patients was analysed using relevant parts of the Roter Interaction Analysis System. Results:In 58 of the 134 consultations, at least one barrier or facilitator to current medication use was brought up by the patient; in 31 out of 134 consultations, medication (non)adherence was addressed. Most facilitators were related to the quality of the needles, the use of an injection pen instead of a syringe, dose reduction because of low disease activity and timing of the medication. The majority of barriers were related to experiencing side effects and doubts about efficacy and resistance of (long-term use of) medication. Rheumatologists' responses to barriers related to disease-modifying anti-rheumatic drugs were mostly a combination of instrumental (counselling) and affective (agreement) communication. Conclusion:Barriers to current disease-modifying anti-rheumatic drugs' use raised by patients and discussed during routine rheumatology consultations were primarily related to side effects and concerns about the efficacy and long-term use. Continuous attention of these barriers and tailored responses to patients' concerns are key to promote better adherence to treatment.

Invalidation, both discounting (overt negative social responses) and lack of understanding (absence of positive social responses), is a common problem in fibromyalgia. The ‘Fibromyalgia Imbalance of Threat and Soothing Systems’ (FITSS) model indicates that different neuropsychological processes may underlie these two components of invalidation. Guided by this model, the aim of the current study was to clarify the differentiation between these two components of invalidation by examining their association with fibromyalgia severity, anxiety, and depression. This cross-sectional study included the Illness Invalidation Inventory (3*I), the Fibromyalgia Impact Questionnaire (FIQ), and the Hospital and Depression Scale (HADS). Demographics of the 280 respondents with fibromyalgia were: mean age 42.6 ± 11.8 yrs., 95% female, mean FIQ score 59.1 ± 15,5, possible or probable cases of anxiety and depression, 49% and 42%, respectively. Regression analyses revealed that discounting was associated with severity of fibromyalgia (t = 4.10, β = 0.34, p <.001), anxiety (t = 3.50, β = 0.29, p <.001) and depression (t = 3.64, β = 0.30, p <.001) symptoms. Neither lack of understanding (-1.62 ≤ t ≤.10, -0.13 ≤ β ≤ 0.01, p ≥ 0.11) nor the interaction of discounting and lack of understanding (-0.19 ≤ t ≤ 1.10, -0.01 ≤ β ≤ 0.07, p ≥ 0.27) was related to any of the outcome variables. The total model accounted for 8.8%, 5.3%, and 8.3% (adjusted R 2 ) of variance in fibromyalgia severity, anxiety, and depression, respectively. In relation to both mental and physical health, discounting seems the most toxic dimension of invalidation in fibromyalgia. This suggests that overt negative responses should get attention in its management, especially in more severe fibromyalgia. Both people with fibromyalgia and people in their environment have a role in reducing invalidation.

Although multiple sclerosis (MS) is a common disease of the central nervous system, little is known about behavioral problems, like signs of rigidity, increased disinhibition and apathy. The aim of the present study is to examine whether people with MS (PwMS) report more behavioral problems compared to people with a non-CNS-involved chronic disease (people with rheumatoid arthritis (PwRA)) and the relationship with depression, anxiety, coping and fatigue. Forty-five PwMS and thirty PwRA and informants filled in questionnaires assessing behavioral problems (NPI-Q, BRIEF-A), depression and anxiety (HADS), acceptance (ICQ) and fatigue (CIS-20). Compared to PwRA, PwMS reported significantly more apathy, irritability and aimless repetitive behavior. PwMS also reported higher levels of fatigue and more helplessness. Higher levels of depressive symptoms and lower levels of acceptance were related to higher levels of self-reported apathy. Higher levels of irritability were related to more helplessness and less acceptance. This study indicates that there is a specific pattern of self-reported behavioral problems in PwMS regarding apathy, irritability and repetitive behavior. These results may not solely be explained by psychological factors, but it is hypothesized that this could result from MS related executive disorders.

Background: Patients with axial spondyloarthritis (axSpA) who initiate a biological disease-modifying antirheumatic drugs (bDMARD) often experience loss of effectiveness or side effects. The EULAR treatment guidelines then recommend to start another bDMARD, but without preference for cycling within the same bDMARD class or swapping to another mode of action. In the Sint Maartenskliniek (SMK), the Netherlands, the local drug formulary recommended a cycle strategy (TNFi →TNFi) prior to 2019 and a swap strategy (TNFi →IL-17i) after 2019. This resulted in a quasi-experimental study cohort, that allowed us to compare the cycle versus swap strategy. Objectives: (1) to compare the 3-year drug retention rate and 1-year disease activity of a second TNFi (cycle) versus an IL-17i (swap) strategy and (2) to identify patient and disease characteristics associated with the efficacy of cycling versus swapping, in patients with axSpA who failed a first TNFi. Methods: All patients with a clinical diagnosis of axSpA who were prescribed a second TNFi or IL-17i were included from the Integral Rheumatology Information System (IRIS) of the SMK. Patients were grouped as either a cycler or a swapper. Drug retention was based on treatment failure (event) defined as discontinuation due to inefficacy or side effects. Drug retention was analyzed using Kaplan-Meier curve, log-rank test and multivariable cox regression, adjusted for the potential confounding disease and patient characteristics. The mean difference in disease activity (BASDAI) between baseline, 6 months and 12 months was compared between cyclers and swappers using student's t-test. Results: In total, 335 axSpA patients who have visited the SMK between 2012 and 2023 were included. Of them, 270 were cycler and 65 swapper, with similar baseline patient and disease characteristics (Table 1). Overall, 45.2% and 14.4% of the cyclers and 47.7% and 15.4% of the swappers discontinued their second-line bDMARD therapy respectively due to inefficacy and side-effects. At 12 and 24 months, drug retention rates were 80.7% and 64.4% respectively for cyclers, and 64.6% and 55.4% for swappers. Swappers were more likely to experience treatment failure (HR adjusted for sex and discontinuation reason first TNFi: 1.47 (95% CI: 1.04 – 2.09), p = 0.03) (Figure 1). In women and in patients who experienced inefficacy of their first TNFi, swapping resulted in a significant higher risk of treatment failure (HR for women, adjusted for discontinuation reason first TNFi: 1.60 (95% CI: 1.00 – 2.56), p = 0.05 and HR for those with inefficacy of first TNFi, adjusted for sex: 1.76 (95% CI: 1.17 – 2.64), p < 0.01). At 6 months, the mean BASDAI score was 4.48 (sd: 2.10) for cyclers and 4.06 (sd: 2.36) for swappers and at 12 months, this was 4.29 (sd: 2.12) and 3.87 (sd: 2.31) for cyclers and swappers respectively. There were no significant differences in mean difference in BASDAI between cyclers and swappers at any timepoint. Conclusion: After failure to a first TNFi in patients with axSpA, the drug retention rate was higher in the cycle strategy compared to the swap (IL-17i) strategy. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Ilse van Es: None declared, Johanna E. Vriezekolk Received grants from Novartis and Eli Lilly, unrelated to work presented in the current abstract, Nathan den Broeder: None declared, Lisan de Beijer: None declared, A.A. den Broeder Received grants for research and quality of care projects to the institution from Lilly, Abbvie, Galapagos, Novartis, Pfizer, Gilead, Sanofi, Biogen and Celltrion, Noortje van Herwaarden: None declared, E.A.M. Mahler Received grants for research and quality of care projects to the institution from Abbvie, Eli Lilly, Pfizer, Novartis, unrelated to work presented in the current abstract, Emmerik F.A. Leijten Received funding for research grants from Novartis and Eli Lilly, unrelated to work presented in the current abstract.

Objective To develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). Methods A task force comprising 7 rheumatologists, 15 other healthcare professionals and 3 patients was established. Following a systematic literature review performed to inform the recommendations, statements were formulated, discussed during online meetings and graded based on risk of bias assessment, level of evidence (LoE) and strength of recommendation (SoR; scale A–D, A comprising consistent LoE 1 studies, D comprising LoE 4 or inconsistent studies), following the European Alliance of Associations for Rheumatology standard operating procedure. Level of agreement (LoA; scale 0–10, 0 denoting complete disagreement, 10 denoting complete agreement) was determined for each statement through online voting. Results Four overarching principles and 12 recommendations were developed. These concerned common and disease-specific aspects of non-pharmacological management. SoR ranged from A to D. The mean LoA with the overarching principles and recommendations ranged from 8.4 to 9.7. Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centred and participatory. It is not intended to preclude but rather complement pharmacotherapy. Patients should be offered education and support for physical exercise, smoking cessation and avoidance of cold exposure. Photoprotection and psychosocial interventions are important for SLE patients, while mouth and hand exercises are important in SSc. Conclusions The recommendations will guide healthcare professionals and patients towards a holistic and personalised management of SLE and SSc. Research and educational agendas were developed to address needs towards a higher evidence level, enhancement of clinician–patient communication and improved outcomes.

Background: Despite the availability of effective medication for gout, management of gout remains suboptimal. Gout treatment may be improved by understanding patient’s unmet needs for support in their disease management. Furthermore, eHealth may be suitable to deliver support in a personalized and cost-effective way. However, it is unknown what support gout patients need and how eHealth can support these needs. Objectives: To investigate the support needs of patients with gout using urate-lowering therapy and explore the suitability of eHealth applications to address those needs. Methods: A qualitative focus group study was conducted at the Sint Maartenskliniek, Nijmegen, the Netherlands. A total of 23 gout patients with urate-lowering therapy, treated by a rheumatologist, general practitioner (GP), or no longer under treatment, participated in three 2-hour focus group sessions. Participants were recruited via rheumatologists or among previous study participants based on purposive sampling (age, sex, and disease duration). Initially, patients wrote two tips (points for improvement) and tops (positive experiences) about their care, leading to in-depth discussions on unmet needs. Following this, patients were queried about the suitability and their preferences of eHealth in addressing these needs. Audio recordings were transcribed verbatim and transcriptions were thematically analyzed by two researchers and reflected upon by two other authors, providing a specific story for each generated theme. Results: Gout patients expressed five key support needs (Figure 1): 1) Timely access to healthcare, especially during flares. 2) (Personalized) information regarding diagnosis, medication, and diet. 3) Insight into health through monitoring, where patients desired more insight into treatment (side)-effects by more frequent blood monitoring and periodic follow-up visits with healthcare providers (e.g. GPs or rheumatologists). 4) Active patient engagement, where patients mentioned that they desire an active role in treatment, including the need to be prepared for flares and self-monitoring of serum uric acid (sUA) levels at home. 5) Better coordination across primary and secondary care, emphasizing the need for quicker referrals from GPs to specialized care and clarity on roles and responsibilities. In terms of eHealth related to these support needs, patients suggested digital accessibility to care and ordering and receiving medication (on the weekend), Artificial Intelligence to answer questions, a central platform for uniform and reliable information, digital information sessions and newsletters, self-monitoring sUA and digital medication reminders. Three themes emerged about the suitability of eHealth in gout care (Figure 1): 1) Attitudes towards eHealth in gout care, where patients were positive toward functions like asking questions and communicating with HCPs, and the possibility of accessing a large body of knowledge. Negative attitudes included concerns about: privacy, controllability of digital systems, who is keeping track of patients’ medical records, and differences in the interpretation of digital information between the elderly and young people. 2) Supportive role of eHealth in gout care. While acknowledging potential benefits, eHealth should be viewed as an addition to care, instead of a replacement thereof, due to trust in HCPs and importance of personal contact. 3) Preferences regarding use of eHealth and its functionalities in gout care; preferences included a digital gout platform with up-to-date information and individualized medication information upon logging in and different communication options dependent on the topic and type of question (Figure 1). Conclusion: Based on the results of this study, we have formulated several points to consider to guide the development of a patient-centered eHealth application, taking into account patient’s needs, perspectives and preferences (Figure 1). This may ultimately contribute to more patient-centered, sustainable and affordable gout care. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Jeffrey van der Ven: None declared, Bart van den Bemt: None declared, Floor Ariaans: None declared, Johanna E. Vriezekolk Lilly Netherlands BV, Marcel Flendrie: None declared, Lise M. Verhoef: None declared.Figure 1Focus group themes and eHealth points to consider

ObjectiveLong-term gout management is based on reducing serum urate by using urate-lowering therapy (ULT). A lifelong treat-to-target approach is advocated, although a ULT (taper to) stop attempt can be considered (treat-to-avoid symptoms approach) during remission. Exploring the beliefs of patients with gout on long-term ULT strategies during remission is important for optimizing gout management. We aimed to identify factors that influence the decision for continuation or discontinuation of ULT and to determine their relative importance according to patients with gout in remission.MethodsA mixed-methods design was used. First, semistructured interviews (substudy 1) were conducted to identify barriers and facilitators for the (dis)continuation of ULT using inductive thematic analysis. Afterwards, these barriers/facilitators were summarized into neutrally phrased items and used in a maximum difference scaling study (substudy 2) to determine their relative importance using the rescaled probability score.ResultsSubstudies 1 and 2 included 18 and 156 patients, respectively. Substudy 1 yielded 22 items within 10 overarching themes. Substudy 2 revealed that the perceived risk of joint damage and gout flares and that ULT use gives some assurance were the most important items. The costs, ease of receiving ULT, and its practical use were the least important items.ConclusionThese results can aid shared decision-making and provide input for what is important to discuss with patients with gout in remission when they consider ULT discontinuation. The emphasis should be on the risk of having gout flares and joint damage, not so much on facilitating how easily medication is received.

Background: A tightly-controlled, treat-to-target (T2T) approach is advocated for the management of axial spondyloarthritis (axSpA) in international guidelines [1]. In practice however, compliance with T2T remains limited in axSpA [2]. It is unknown what the driving factors are behind this poor implementation. Objectives: To explore the perceptions of patients and rheumatologists on a T2T approach in axSpA, and identify the barriers and facilitators of its implementation. Methods: A convergent parallel mixed-methods design using semi-structured interviews and quantitative questionnaires was applied. AxSpA patients visiting the outpatient clinic with an Ankylosing Spondylitis Disease Activity Score (ASDAS) of ≥2.1 for whom medication was not adapted were included, alongside their treating rheumatologists. Interviews revolved around the current management strategies for axSpA in practice and the knowledge and opinions held on T2T. Questionnaires focused on the effectiveness and feasibility of the current instruments for disease activity measurement and the T2T approach as a whole. Quantitative and qualitative data were analysed descriptively and thematically, respectively. Results: Seven patients and five rheumatologists participated (Table 1). The key barriers and facilitators identified are summarised in the Figure. Important facilitators highlighted were the expansive knowledge held by patients about axSpA as a disease, and the familiarity of rheumatologists with T2T. Furthermore, regular monitoring of disease activity supported by consistent instruments, such as validated questionnaires, was found to be favourable. Finally, the widespread application of shared-decision making and positive doctor-patient relationships were valued. A recurrent barrier reflected by patients, however, was difficulty in objectively and accurately answering disease activity questionnaires. This was often due to the presence of comorbidities with overlapping symptoms or prominent non-inflammatory complaints (71%). As such, scores at times exaggerated axSpA disease activity (57%). Resistance to tight monitoring and treatment intensification was also prominent among patients, attributed to satisfaction with current therapies (57%), fear associated with new medications (29%), or the view of axSpA disease flares being self-limiting and temporary (71%). Many patients were additionally observed to lack knowledge on the goals and importance of treatment, which may have contributed to this resistance. In the perspective of rheumatologists, doubts on the effectiveness, feasibility and flexibility of T2T in axSpA were apparent. In particular, while (partially) subjective scoring instruments such as the ASDAS were valued as supporting tools, rheumatologists recounted having difficulty basing treatment decisions on these instruments due to their perceived unreliability in reflecting true disease activity (80%). Rheumatologists were therefore inclined to base such decisions on their own judgement or individual components of the ASDAS rather than only on the calculated score as a whole (100%). Furthermore, some felt restricted by the limited number of treatment options available for axSpA. Finally, time pressure (60%) and the lack of adequate tools to facilitate T2T (80%), such as a digital system to regularly collect disease activity scores over time, were reported as barriers from an organisational perspective. Conclusion: While the foundation for the successful implementation of T2T in axSpA in practice is in place, additional attention is required for the barriers experienced by all stakeholders. Patient education, evaluation of the way active disease is defined and measured, and the facilitation of better management of non-inflammatory symptoms and psychosocial factors are opportunities for future improvement. REFERENCES: [1] Smolen J. et al. Ann Rheum Dis 2018, 77(1):3-17, doi: 10.1136/annrheumdis-2017-211734[2] Beckers E. et al. Rheumatology (Oxford) 2022, 61(4):1396-1407, doi: 10.1093/rheumatology/keab516 Acknowledgements: The authors thank all patients and rheumatologists who participated in this study, and the research nurses in the Maastricht UMC+ for their efforts in facilitating the logistics of the interviews. This study was supported by Novartis. Novartis had no role in the study design, in the collection, analysis or interpretation of the data, or in the writing of this abstract. Disclosure of Interests: Marius Smits: None declared, Casper Webers: None declared, Mirte van Dooren: None declared, Astrid van Tubergen Consulting fees from Galapagos, Johnson and Johnson, Novartis and UCB, Research grants from Novartis, Pfizer and UCB.

Purpose (the aim of the study): Knee osteoarthritis (OA) causes pain in the knee and interferes with daily life mobility. Previous studies found weak associations between retrospective pain reports and gait outcomes during short walking tests in individuals with knee OA. To increase ecological validity of these measures, wearable sensors can be employed to monitor walking continuously during daily life. Likewise, pain reports can be sampled repeatedly over multiple days (ecological momentary assessment; EMA).

Background: Little is known about the extent of impairments in work and activities of daily life (ADL) in patients with psoriasis, and the influence of contextual factors such as disease-related characteristics and treatment. Therefore, this study aimed to assess these impairments in patients with psoriasis who started using biologicals/small molecule inhibitors.Methods: Using data from the prospective BioCAPTURE registry, we collected patient, disease, and treatment parameters, as well as work/ADL impairments at baseline, 6 and 12 months. Changes in impairment parameters and correlations between impairment and patient/disease characteristics were assessed using generalized estimating equations.Results: We included 194 patients in our analysis. After biological initiation, disease activity decreased significantly (PASI 11.2 at baseline versus 3.9 at 12 months, p < 0.001). Work-for-pay in this cohort was lower than in the Dutch general population (53% versus 67%, p = 0.01). In patients who had work-for-pay, presenteeism improved over time (5% at baseline versus 0% at 12 months, p = 0.04). Up to half of the patients reported impairments in ADL, which did not change over time. Associations between impairments and contextual factors varied, but all impairments were associated with worse mental/physical general functioning.Conclusion: Patients with psoriasis using biologicals are less likely to have work-for-pay. Treatment improves the work productivity of employed patients, but we were unable to detect changes in ADL performance.

OBJECTIVE:This study aimed to identify modifiable determinants of self-management behavior in patients with gout. METHODS:Four databases (Medline, Embase, PsycINFO, and CINAHL) were searched using terms related to gout, self-management, and determinants of behavior as described in the Theoretical Domains Framework (TDF). Two reviewers independently selected relevant studies via screening of title/abstract and full text. Thematic synthesis was performed for qualitative data; quantitative data were summarized using cross-tabulation displaying the investigated associations of determinants with self-management behavior. The TDF facilitated identification and grouping of determinants. RESULTS:From 2,087 unique articles found, 56 studies were included in this review, of which there were 27 qualitative and 29 quantitative studies. Eight themes were identified: knowledge and skills for self-management, acceptance of disease, beliefs about necessity of self-management to improve gout-related health, resistance and reluctance for medication adherence and dietary alteration/changes, negative emotions influencing self-management, social support and interactions, environmental context, and self-regulation of behavior. Quantitative determinants associated with self-management behavior, predominantly medication adherence, were mapped to 12 of the 14 domains of the TDF. No determinants regarding skills and goals have been identified in quantitative research. CONCLUSION:Intervention targets for self-management behavior in patients with gout mainly included determinants related to knowledge, implicit and explicit beliefs and attitudes, the environmental context and resources, and (social) support and reinforcement.

Following orthopaedic surgery, medication is vital for recovery and preventing complications, however drug-related problems (DRPs) can hinder medication use. The prevalence, types, and impact of DRPs on patients' activities of daily living (ADL) and the medication involved are unknown. Insight is needed for targeted interventions. Aim Our study had four aims to assess 1) the prevalence and types of DRPs with postoperative medication in orthopeadic patients 6 weeks after discharge; 2) the perceived impact of the reported DRPs on patients' ADL; 3) the postoperative medication most frequently causing DRPs; and 4) the association between DRP numbers and patient- and disease-related characteristics. Methods A cross-sectional study at a tertiary centre surveyed adult orthopaedic surgery patients 6 weeks post-surgery. Patients reported on demographics, DRPs and their ADL impact, health literacy, and medication beliefs. Clinical factors and medication use were extracted from medical records. Descriptive statistics and linear hierarchical regression analysis were conducted. Results Out of 484 patients (mean (standard deviation (SD)) age 61.1 (+/- 12.7) years, 61.6% female), 87.4% reported at least one DRP, with 39.7% indicating it impacted ADL. The most frequent DRPs involved inadequate drug use, including intentionally used less (49.8%) and stopped earlier (44.6%). The most impactful DRPs involved negative experiences, including insufficient effect (69.3%) and side effect (57.6%). Opioids caused the most DRPs, averaging 1.8 per patient. Impactful DRPs were associated with female sex, knee and spine surgery, medication concerns, and younger age. Conclusion Most patients experienced at least one DRP within 6 weeks post-discharge, with nearly half reporting an impact on ADL. Inadequate drug use and negative experiences, particularly with opioids, are the most urgent DRPs to address.

Objectives: To explore the within-person fluctuations of fatigue in systemic sclerosis and its association with negative affect, positive affect, pain, perceived exertion of physical activity and quality of sleep. Methods: We performed an ecological momentary assessment study in adult patients with a clinical diagnosis of systemic sclerosis. During 14 days, patients completed daily assessments of fatigue severity, negative affect, positive affect, pain, quality of sleep and perceived exertion of physical activity at four fixed time points. The day-to-day fluctuations in fatigue were quantified by the intra-individual variance and probability of acute change, capturing the magnitude and frequency of clinical relevant within-person day-to-day fluctuations, respectively. Using multilevel models, the within-person association between fatigue and the daily assessments were analysed. Results: Fifty-seven patients with systemic sclerosis participated. The mean (standard deviation) intra-individual variance was 1.08 (0.42) and the probability of acute change was mean (standard deviation) 0.40 (0.14), ranging from 0.08 to 0.77. For fatigue, a within-person variation of 51% was observed. Multilevel analyses showed that higher average levels and daily increases in negative affect, pain and perceived exertion of physical activity were associated with more fatigue, while the opposite was observed for positive affect and quality of sleep. Positive affect demonstrated the strongest association with fatigue fluctuations. Conclusion: This is the first quantitative study showing that fatigue in systemic sclerosis is characterized by a dynamic course and that approximately half of the day-to-day fluctuations within persons are clinically meaningful. Furthermore, our results indicate that integrating activities with positive impact on mood into fatigue treatment strategies might reduce the frequency of fatigue fluctuations.