Zeitschriftenartikel zum Thema „Garrofon“

A method is described that allows the development of an empirical approach to quantify synergistic interactions and their variations with shear rate. The approach is based on the definition of a viscous synergism index, Iv. The method is applied to xanthan-locust bean gum gels, and an equation is developed for relating the synergism index to shear rate, γ, and the locust bean gum/xanthan gum concentration ratio, z. The value of at which that function has a maximum, IMV, is calculated. This value of z provided an estimation of the proportion of gums at which maximum synergism occurs. A decreasing exponential dependence of these IMV on γ is shown. The influence of the addition of a fixed proportion of a third gum (NaCMC) is also analyzed. The results obtained for the higher γ values are analogous to those of other authors.

IntroductionPatients requiring invasive mechanical ventilation via an artificial airway experience sudden voicelessness placing them at risk for adverse outcomes and increasing provider workload. Infection control precautions during the COVID-19 pandemic, including the use of personal protective equipment (eg, gloves, masks, etc), patient isolation, and visitor restrictions may exacerbate communication difficulty. The objective of this study is to evaluate the acceptability of a codesigned communication intervention for use in the adult intensive care unit when infection control precautions such as those used during COVID-19 are required.Methods and analysisThis three-phased, prospective study will take place in a medical surgical ICU in a community teaching hospital in Toronto. Participants will include ICU healthcare providers, adult patients and their family members. Qualitative interviews (target n: 20–25) will explore participant perceptions of the barriers to and facilitators for supporting patient communication in the adult ICU in the context of COVID-19 and infection control precautions (phase 1). Using principles of codesign, a stakeholder advisory council of 8–10 participants will iteratively produce an intervention (phase 2). The codesigned intervention will then be implemented and undergo a mixed method acceptability evaluation in the study setting (phase 3). Acceptability, feasibility and appropriateness will be evaluated using validated measures (target n: 60–65). Follow-up semistructured interviews will be analysed using the theoretical framework of acceptability (TFA). The primary outcomes of this study will be acceptability ratings and descriptions of a codesigned COmmunication intervention for use during and beyond the COVID-19 PandEmic.Ethics and disseminationThe study protocol has been reviewed, and ethics approval was obtained from the Michael Garron Hospital. Results will be made available to healthcare providers in the study setting throughout the study and through publications and conference presentations.

Background:Nutritional follow-up as part of the integral attention for patients living with rheumatoid arthritis (RA) has been limited due to the COVID-19 pandemic. It made necessary to implement a remote monitoring for the care of the patients and to evaluate the outcomes of the changes in the care model.Objectives:To identify the effects of the telemonitoring intervention within the pandemic scenario and the outcomes of the traditional face-to-face nutrition consultation.Methods:A retrospective analysis of health records and the administrative data base of the patient’s follow-up, between 2019 and 2020, was developed at the arthritis specialized center of the Santa Fe de Bogotá Foundation in Bogotá, Colombia. The outcomes measured include the number of visits per year and the proportion of patients who attend their nutritional follow-up by telemonitoring in 2020 vs patients attending to face-to-face nutrition consultation. Differences in the Body Max Index (BMI) and the changes based on eating habits, defined by the quality of food consumption per day, were also measured.Results:A total of 212 patients from 2020 and 179 from 2019 were analyzed; An increase of 61.5% in the number of consultations, using nutritional telemonitoring per year, was identified in 2020 (n=412) compared to 2019 (n=255). In patients followed from 2019 to 2020, 13% (10/77) experienced an increase of more than 2 units of their BMI, while 22% (17/77) showed a decrease; in 2% of patients was not possible to evaluate their current weight; in the same way, 49% (103/212) in 2020 showed a positive change in their feeding habits compared with a 12% (21/179) in 2019. 135 new patients were recruited for nutritional telemonitoring 2020.Conclusion:Nutritional telemonitoring to follow-up patients with RA has increased considerably in terms of consultations per year and changes in the feeding habits. However, more evaluation is required for this model.References:[1]Melanie J Martin, Nora Ng, Laura Blackler, Toby Garrood, P227 Remote monitoring of patients with RA: a user-centred design approach, Rheumatology, Volume 59, Issue Supplement_2, April 2020, keaa111.221, https://doi.org/10.1093/rheumatology/keaa111.221[2]Principio del formularioDisclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) is a chronic autoimmune condition which if not treated can lead to joint destruction and long term disability. In RA, the concept of T2T is recommended as the appropriate method to manage early arthritis 1. It has shown promising results to achieve clinical remission (CR) or low disease activity (LDA) 2.Objectives:The objective of this study was to investigate the potential to achieve remission or LDA according to the Clinical Disease Activity Index (CDAI) for RA, during treatment with Disease-Modifying Anti-Rheumatic Drugs (DMARDs) and Biologics, and the factors that affect the remission/LDA outcome.Methods:We performed an observational prospective study on patients’ data available from our Early Arthritis Cohort. All patients with newly diagnosed RA who met the American College of Rheumatology (ACR) criteria were enrolled. Patients are managed by an Advanced Nurse Practitioner (ANP) with consultant supervision. To assess their response to treatment, we used the Clinical Disease Activity Index3. Analysis was performed using SPSS.Results:Out of a total of 459 patients, 353 completed the programme. 217 patients (61.5%) were female and (136) 38.5 % were male. Mean age was 53.98 (SD 14.66). 195 patients were on monotherapy, 40 on combination DMARDs and 115 were on Biologics/Janus Kinase Inhibitors (JAK-Inh). Remission-rates in the monotherapy and combination DMARDs groups were approximately 60%, whilst the remission rate in the Biologics/JAK-Inh group was 41.7%. Amongst female patients 15.9% had erosions on X-ray at the time of diagnosis whilst the equivalent figure for male patients was 29.6%.Conclusion:An association between male gender and the likelihood of erosions on X-Ray was observed. In addition an association between final medication and outcome was observed. An increased likelihood of non-remission was noted in patients that required escalation to Biologics/JAKs. A possible explanation for the lower levels of remission seen throughout the groups is the difficulty in achieving remission under the CDAI score as compared to DAS-28.References:[1]Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Annals of the Rheumatic Diseases. 2016;75(1):3.[2]Scott IC, Ibrahim F, Panayi G, Cope AP, Garrood T, Vincent A, Scott DL, Kirkham B; TITRATE Programme Investigators. The frequency of remission and low disease activity in patients with rheumatoid arthritis, and their ability to identify people with low disability and normal quality of life. Semin Arthritis Rheum. 2019 Aug;49(1):20-26. doi: 10.1016/j.semarthrit.2018.12.006. Epub 2018 Dec 28. PMID: 30685064.Disclosure of Interests:None declared

Background:Low disease activity (LDA) in patients with rheumatoid arthritis (RA) are usually recognized as stable state. In according to most guidelines for RA, monotherapy of disease modifying anti-rheumatic drug (DAMRD) was recommended for RA patents with LDA. But some of patients with LDA suffer from flare in their disease course. Until now, we don’t have enough data on factors that can predict flare in RA patients with LDA.Objectives:The aim of this study is to evaluate predictor of flare in RA patient with LDA from long-term (3 year) cohort data.Methods:Korean observational study network for arthritis (KORONA) registry is a nationwide Korean RA specific cohort registry that collecting data annually from 5,376 RA patients in 23 centers across South Korea. We include the data from 1, 801 RA patients with LDA (28 –joint disease activity score (DAS 28) < 3.2 at enrollment) who had consecutive data of DAS28 for 3 years. Flare was defined as an increase in DAS28 compared with baseline of >1.2 or >0.6 if concurrent DAS28 ≥3.2. Cox regression analysis was used to identify baseline predictors of flare.Results:Among 1,801 RA patients, 673 patients (37.4%) experienced flare in 3 years. When we compare the baseline characteristics of both flare and non-flare group, more women and more non-adherent patients for medication were observed in flare group. Flare group had longer disease duration, lower EuroQol 5D score, higher health assessment questionnaire (HAQ) score, and higher erythrocyte sedimentation rate (ESR) than non-flare group at baseline. In multivariate analysis, physician’s VAS, HAQ score, ESR, and poor adherence for medication were significant predictors of flare (Table 1).Table 1.Multivariate analysis of prediction of flare with baseline variablesMeasureHazard ratio95% Confidence IntervalP-valueFemale1.1300.906-1.4090.280Age0.9960.988-1.0050.414Physician’s VAS1.0081.002-1.013<0.01Pain VAS1.0020.998-1.0060.34EQ5D0.9520.534-1.6960.87HAQ1.4071.109-1.786<0.01ESR1.0081.002-1.014<0.01Poor adherence1.2721.047-1.545<0.05VAS: Visual Analogue Scale; EQ5D: EuroQol 5D; HAQ: Health Assessment Questionnaire; ESR: Erythrocyte Sedimentation RateConclusion:RA patient who have risk factors for flare, even though their disease activity was low, require more proactive treatment.References:[1]Bechman K, Tweehuysen L, Garrood T, Scott DL, Cope AP, Galloway JB, et al. Flares in Rheumatoid Arthritis Patients with Low Disease Activity: Predictability and Association with Worse Clinical Outcomes. J Rheumatol. 2018;45(11):1515-21.[2]Singh JA, Saag KG, Bridges SL, Jr., Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68(1):1-26.[3]Sung YK, Cho SK, Choi CB, Park SY, Shim J, Ahn JK, et al. Korean Observational Study Network for Arthritis (KORONA): establishment of a prospective multicenter cohort for rheumatoid arthritis in South Korea. Semin Arthritis Rheum. 2012;41(6):745-51.Disclosure of Interests:None declared

Background:Treat-to-target strategies have improved outcomes in patients with RA. Targets based on clinical assessments of tender (TJC) and swollen joints (SJC) were developed when most patients had active inflammatory disease. It is now recognised some patients have pain sensitisation often termed fibromyalgia (FM), making clinical assessment of inflammatory disease more complex. An indicator of pain sensitisation is the difference between TJC and SJC, an observation we described in a pilot study (1).Objectives:To study patients with RA to describe the relationships between enhanced clinical and patient-reported outcome measures (PROMS) and active inflammatory joint disease detected by comprehensive PDUS.Methods:158 sequential patients with RA with a DAS28ESR score >¬3.2 were enrolled from GSTT Rheumatology after informed consent. They were assessed by a rheumatologist for 66SJC, 68TJC, fibromyalgia tender points & physician global. Recorded PROMS were: patient global, widespread pain index (WPI), symptom severity score (somatic & fatigue), FACIT fatigue, HAQ, EQ5D QoL, GAD7, PHQ9 and PHQ15. All patients had a 44 joint US scored for PD and grey scale by the EULAR scale blind to all patient data. Data were recorded on MedSciNet and statistical analysis used STATA.Results:Patients meeting the ACR 2010 criteria for FM2(n=72) vs those that did not(n=86) had similar demographics. SJC and US doppler scores were higher in the non-FM group, whereas rheumatoid factor, DAS28 and PROMs were higher in the FM group. Analysis of group differences using multinomial logistic regression and subsequent regularised (lasso) logistic regression, showed the FM group related to higher 28TJC, FACIT-F and PHQ15, with the non-FM group related to higher 28SJC, logESR, and lower Differences in 28S/TJC, Physician Global and FACIT-F. Patients were divided into four groups based on presence or absence of at least one PDUS+ joint and FM criteria; -FM-PD, -FM+PD, +FM-PD and +FM+PD, data summarised Table 1. The -FM-PD and -FM+PD groups related to Physician Global and negatively related to FACIT-F, Difference in 28S/TJC, and PHQ15 (-FM-PD). The +FM-PD group related positively to FACIT-F, Difference 28S/TJC, PHQ15, and negatively to Physician Global with +FM+PD related to PHQ9, FACIT-F and DAS28ESR.TABLE 1.-FM -PD -FM +PD +FM -PD +FM +PD p-valueFemale34 (79%)33 (77%)35 (83%)22 (73%)0.77Total power doppler score0.0 (0.0-1.0)16.0 (10.0-25.0)0.0 (0.0-0.0)9.0 (8.0-20.0)<0.001Total gray scale score40.0(34.0-48.0)57.5(45.0-82.0)34.5(20.0-43.0)60.0(46.0-84.0)<0.001Total Swollen JC3.0 (1.0-5.0)6.0 (3.0-9.0)2.0 (0.0-5.0)5.5 (2.0-10.5)<0.001Total Tender5.5 (3.0-12.0)8.0 (4.0-11.0)13.0 (8.0-20.0)15.0 (8.0-20.0)<0.001Tender-Swollen JC Difference4.0 (0.0-8.0)2.0 (0.0-4.0)8.0 (4.0-18.0)5.5 (2.5-13.5)<0.001ESR mm/hour10.0 (8.0-16.0)14.0 (10.0-30.0)12.0 (7.0-23.0)19.5 (11.5-42.5)0.021Pain VAS50.0 (40.0-65.0)50.0 (30.0-60.0)60.0 (47.5-77.5)67.5 (55.0-80.0)<0.001Patient VAS50.0 (30.0-70.0)40.0 (30.0-70.0)60.0 (40.0-80.0)65.0 (50.0-80.0)0.006Physician VAS30.0 (20.0-50.0)50.0 (40.0-60.0)30.0 (20.0-40.0)50.0 (32.5-70.0)<0.001DAS28 (ESR)4.2 (3.7-4.9)4.7 (4.1-5.2)4.7 (3.9-5.8)5.6 (4.9-6.6)<0.001Conclusion:These data using comprehensive US assessment to detect inflammatory joint disease, demonstrate that active inflammation defined as at least 1PDUS+ joint, may account for disease activity in slightly less than half of unselected patients with RA with a DAS28ESR score >3.2. This study shows how frequently pain sensitisation accounts for symptoms and signs in RA. We suggest in addition to central sensitisation, often called FM, another group identified here as -FM-PD, may have pain from joint damage or peripheral pain sensitisation of joints, likely due to different mechanisms than central pain sensitisation.References:[1]Mian A et al, BMC Musculoskelet Disord. 2016;17: 404[2]Wolfe F et al, Arth Care & Res 2010; 62:600Disclosure of Interests:Khaldoun Chaabo: None declared, Estee Chan: None declared, Toby Garrood: None declared, Zoe Rutter-Locher: None declared, Alexandra Vincent: None declared, James Galloway Speakers bureau: Dr Galloway has received speaker fees / honoraria from Abbvie, BMS, Celgene, Chugai, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB, Sam Norton: None declared, Bruce Kirkham Speakers bureau: Professor Bruce Kirkham has received speaker fees / honoraria from Abbvie, Gilead, Janssen, Lilly, Novartis, Pfizer,and UCB., Grant/research support from: Professor Bruce Kirkham has received research support from Lilly, Novartis and UCB.Professor Bruce Kirkham has received speaker fees / honoraria from Abbvie, Gilead, Janssen, Lilly, Novartis, Pfizer and UCB.

Abstract Background Referrals from primary care to rheumatology services have increased significantly in recent years. Many of these patients have non-inflammatory conditions, usually with pain, and may require specialist treatment such as physiotherapy or psychological intervention. If patients could be effectively triaged at the point of referral, clinical services could be better aligned to patients’ needs, but referrals do not always contain enough information to triage patients effectively. Validated patient-completed questionnaires are available which are designed to aid patient identification, for instance for fibromyalgia and inflammatory back pain. We designed an electronic questionnaire for patients to complete prior to their first attendance to inform the clinical consultation and to explore whether they could be more appropriately triaged to specialist clinics. Methods We constructed a questionnaire consisting of the modified ACR diagnostic questionnaire for fibromyalgia, the ASAS screening questionnaire for inflammatory back pain, a validated questionnaire for identification of patients with inflammatory arthritis, PHQ8 (depression) and GAD 7 (anxiety). The questionnaire contained conditional branching to ensure that only relevant questions were answered. A user-centred design approach was taken to optimise patient experience and response rates. A link to the questionnaire was sent via SMS to unselect new patients shortly after receipt of a referral from their GP. Completed questionnaires were imported into the hospital record. Results Initial response rates were around 35%. Through a process of continuous iteration informed by user feedback this increased to 80% over a 4 months period. Key factors in optimisation were the appearance of the text (displaying from ‘NHS’ rather than an apparently random number), the language which was used to maximise patients perception of the value of completion, the use of patients’ first names in the SMS and the content and timing of automated reminder messages. Over a 4 month after optimisation 664 patients completed the questionnaire. Of these 38% and 25% scored in the moderate-severe ranges for depression and anxiety respectively. 74% of patients met the paper criteria for fibromyalgia (which is not diagnostic in itself prior to clinical assessment). Of those patients scoring in the moderate-severe ranges for depression and anxiety, 92% and 88% respectively met the questionnaire criteria for fibromyalgia. Conclusion This work suggests that collecting information prior to the first appointment can add value to the process. In our department screening tools for psychological distress, widespread pain and somatisation are used to inform the consultation. We are currently analysing this data against the patients’ final diagnoses. Combination of screening tools may enable patients to be stratified with enough predictive value into specific pathways for inflammatory and non-inflammatory conditions, some of which could be community-based. We will be applying machine learning tools to determine the optimum predictive value of these questionnaires in combination. Disclosures W. Chen None. M. Thrower None. T. Garrood None.

Abstract Background With increasing pressure on rheumatology services there is a need to identify alternative pathways for patients which are better aligned to their needs. East Surrey CCG is formed of 17 GP practices serving an adult population of 137,000. First Community Health and Care acts as a single point of referral for patients with musculoskeletal conditions. In 2018 a triage service was established, run by a GP with an extended role (GPweR), for patients referred to rheumatology. Analysis of triaged patients was undertaken to explore the feasibility of diverting a subgroup of patients with non-inflammatory conditions into community-based care. Methods Referrals from February 2018 to March 2019 were analysed from the point of triage to confirmation of the diagnosis in secondary care. Triage was undertaken with additional reference to the primary care record in EMIS. For each referral it was recorded whether, according to the available information, this was more likely to be an inflammatory or non-inflammatory condition and whether they could have been seen first in a community GPwER rheumatology clinic. The final diagnosis after their hospital appointment was recorded. A pilot GPweR-led community clinic was established in April 2019 to see those patients selected by the process as suitable for community-based care. Results 407 patients were triaged. 96% were triaged to secondary care. Of these, records from the subsequent rheumatology appointment(s) were available for 312. The final diagnosis was inflammatory in 120 (38%) and non-inflammatory in 192 (62%). 152 patients (49%) were thought to have a non-inflammatory condition at triage which was confirmed in 83% of cases after a consultant appointment. 160 patients (51%) were thought likely to have an inflammatory condition which was confirmed in 59%. Positive predictive value of the triage process for non-inflammatory conditions was 83%, negative predictive value 59%, sensitivity 66%, specificity 79%. 57 patients selected from triage were seen in the pilot community clinic. Final diagnoses were: 53% fibromyalgia, 19% osteoarthritis, 12% soft tissue rheumatism, 14% gout/inflammatory arthritis. 54% of patients needed blood tests and 39% imaging. 31% required a face to face follow up appointment and 47% were referred to physiotherapy. 7% were referred on to rheumatology. Conclusion Referrals to secondary care rheumatology are rising and putting increasing pressure on services and referral to treatment times. There is a need to develop alternative pathways for patients with non-inflammatory conditions who could be managed in community settings. Our work shows that a majority of these can be identified at the point of triage with good specificity. We have also shown that of those seen in a pilot community clinic few needed onward referral. Our work suggests that there is a substantial opportunity to develop alternative and potentially more cost-effective community-based pathways for patients. Disclosures B. Forgie None. T. Garrood None.

Abstract Background Power Doppler ultrasound (PDUS) is superior to clinical examination in detecting synovitis in patients with rheumatoid arthritis (RA). Although dynamic and cheap it is impractical to scan large numbers of joints in routine clinical settings. MRI, whilst sensitive for synovitis, is expensive and routine use is limited to targeted joints. Bone scintigraphy produces whole body images but due to lower specificity is not routinely used. 99mTc-maraciclatide (Serac Healthcare) is a radio-labelled tracer which binds with high affinity to integrin αvβ3 (αvβ3), a cell-adhesion molecule up-regulated on neoangiogenic blood vessels. It therefore has the potential to image synovial inflammation at the whole-body level. We previously showed in a pilot study that uptake was seen in the inflamed joints of 5 RA patients and that this correlated with PDUS. This study explores correlation with PDUS in a larger group of patients with varied disease activities. Methods 50 patients with RA, fulfilling ACR 2010 classification criteria, were recruited. Patients underwent an ultrasound scan of 40 joints with grey scale (GS) and PD quantification. Each joint was scored on a scale of 0-3 for GS and PD with a total score calculated for each patient. Within 3 hours of the ultrasound, patients were injected with 740 MBq of 99mTc-maraciclatide. Using a gamma camera, whole body planar views and dedicated hand and foot views were taken 2 hours after injection. Acquisition time was 20 minutes for whole body, and 20 minutes for hand and foot views. 99mTc-maraciclatide images were scored as positive or negative uptake for each joint (binary score). A quantitative score was also calculated for each joint where there was uptake with this corrected for background muscle uptake. Total binary and quantitative scores per patient were calculated. Ultrasound and 99mTc-maraciclatide scores were tested for correlation with Pearson’s correlation coefficient (r) and the coefficient of determination (r2). Results Strong correlation was seen when total PDUS was compared to binary scores (r = 0.92, r2=0.85) and quantitative scores (r = 0.85, r2=0.72). p was &lt;0.0005 for all results. 99mTc-maraciclatide uptake was also seen in inflamed tendons/tendon sheaths. The imaging procedure was well-tolerated. Conclusion 99mTc-maraciclatide uptake was highly correlated with PDUS highlighting its potential as an alternative imaging modality. 99mTc-based planar imaging has the unique capacity to image the whole body and hence the total synovial inflammatory load in a quick acquisition. The imaging equipment to perform these scans is already widely available in radiology departments. Interpretation of scans is also much simpler compared to US/MRI. It could therefore have a role in key decision-making points in pathways for diagnosis, treatment failure, and remission prior to dose tapering. Disclosures L. Attipoe None. T. Garrood Grants/research support; Serac Healthcare. M. Opena None. C. Blanco-Gil None. S. Subesinghe None. S. Norton None. M. Rosser Other; Serac Healthcare Ltd. G. Cook None. A. Cope Grants/research support; AP received funding for research from BMS.

Abstract Background Patients with rheumatoid arthritis are generally seen at arbitrary intervals in secondary care. Patients with active disease may not always be seen at the most appropriate time and those with low disease activity may be seen more frequently than necessary. The NHS Long Term Plan expects outpatient appointments to be reduced by up to a third, with digital transformation a key enabler. The remote capture of patient-reported outcome measures (PROMs) has the potential to facilitate more flexible and responsive outpatient services. Methods This project aimed to design a digital remote monitoring platform to test the hypothesis that PROMs can be used to proactively monitor and trigger consultations when patients need them most. The Rheumatoid Arthritis Impact of Disease (RAID) questionnaire, a validated multidimensional PROM, was used. Waiting room testing with patients informed the design of an acceptable mobile device format of the RAID. Recruitment criteria and acceptable cut-offs for defining flare were agreed by the rheumatology multidisciplinary team. Patients in low disease activity or remission (DAS &lt;3.2) were invited to the service via SMS. All patients were informed regarding the governance of handling patient data and an opt-out option was offered. Patients were sent an automated monthly SMS with a PROM link and weekly reminder SMS if required. They also had the option to send in SMS messages at other times or add free text comments. Patients submitting a RAID score of ≥ 4 received a SMS with a link to the rheumatology advice service advising a remote consultation. The SMS-based service went live in January 2019 and all incoming communication was monitored on a daily basis. Results 104 RA patients are currently using the remote monitoring service with 10.3% (13/117) opting-out. 847 monthly PROMs have been sent via SMS. The PROM completion rate has been 68.9% (range 59.0-85.1%). 120 RAID (21.8%) scored 2-≤4 indicating low disease activity and 136 RAID (24.7%) ≤ 2 indicating disease remission. 480 SMS have been sent manually to patients who have engaged in two-way communication or returned a RAID score ≥4. 44 telephone advice appointments were triggered through the remote monitoring service by patients in disease flare. 80% (35/44) of remote consultation were considered to have to have averted a face to face consultation with the remaining 20% providing advice alone. Interviews have been conducted with PROM ‘non-completers’ to learn and inform further service design. Conclusion This project has demonstrated how a user-centred design approach to utilising technology can support access to rheumatology care when patients need it most, such as disease flare. The identification of patients self-reporting low disease activity using multidimensional PROMs may enable more efficient utilisation of clinical capacity through patient-initiated appointment deferment and lead to improved patient-centred care. Disclosures M.J. Martin: Honoraria; Novartis, Abbvie. Grants/research support; National Ankylosing Spondylitis Society. N. Ng None. L. Blackler None. T. Garrood None.

Abstract Background/Aims Rheumatoid arthritis (RA) is a chronic inflammatory condition fluctuating between unpredictable episodes of joint pain, stiffness and disability and low disease state or remission. The traditional outpatient model can lead to patients in disease remission being seen more frequently than necessary and with missed opportunity to capture disease flares. A remote monitoring service (RMS) was co-designed with RA patients which uses SMS communication to deliver the Rheumatoid Arthritis Impact of Disease (RAID) tool on a monthly basis whilst offering patients 2-way text message contact outside of hospital-based care. Methods Access to hospital-based rheumatology care was dramatically restricted during the COVID-19 pandemic. 126 patients engaged with the remote monitoring service between January 2019 to September 2020 were sent a satisfaction survey in October 2020. The survey used a combination of 5-point Likert scales and open questions to rate confidence in statements focused on four aspects of the RMS during the COVID-19 pandemic: 1. managing data 2. managing flares 3. managing me 4. managing appointments. Results 48.4% (61/126) patients responded to the survey. Managing data: 93.4% of patients who responded to the question strongly agreed/agreed data was safe and used for the purpose of care. 91.8% strongly agreed/agreed RAID responses were reviewed by the RMS monthly. 90.1% strongly agreed/agreed the RMS would contact them to review care if needed. Managing flares: 85.9% strongly agreed/agreed they could text into the RMS if having a flare of their condition. 75.4% strongly agreed/agreed they received the care needed using the RMS. 61.41% patient strongly agreed/agreed using the RMS helped manage flares better than before using the service. Managing me: 74.0% strongly agreed/agreed the RMS had made access to care easier. 82.0% strongly agreed/agreed the RMS helped them to feel looked after outside of hospital care. 72.0% strongly agreed/agreed the RMS looked after emotional well-being as well as physical health. 80.0% strongly agreed/agreed the RMS helped them to feel cared for during the COVID-19 lockdown period. Managing appointments: 43.8% strongly agreed/agreed rheumatology appointments were not always when needed. 39.6% strongly agreed/agreed they would consider deferring an appointment if well as an appointment approached. 79.2% strongly agreed/agreed they would be offered an appointment when needed. 72.9% strongly agreed/agreed a telephone or video consultation is an acceptable alternative to attending a hospital appointment. Conclusion RA patients using a remote monitoring service during the COVID-19 pandemic rated it highly for supporting flare management and emotional well-being, providing remote care and ensuring data security. Regular, remote capture of asynchronous patient data has the potential to facilitate flexible and responsive appointment scheduling to support the self-management of patients with rheumatoid arthritis and in delivering care when it is needed the most. Disclosure M.J. Martin: None. T. Garrood: None.

Abstract Background/Aims The COVID-19 pandemic has necessitated profound changes to the delivery of healthcare in the UK. Our aim was to analyse whether a move to virtual care is beneficial and sustainable in a rheumatology outpatient setting. Methods Data on volume of unscheduled access to an outpatient rheumatology service and questionnaire feedback responses from patients and rheumatology clinicians on virtual consultations, was analysed. Results During the COVID-19 pandemic period of March - July 2020, our department saw a majority of face to face outpatient rheumatology clinic appointments transferred to virtual (telephone/video) with a significant reduction in the number of scheduled clinics. In addition, the volume of telephone appointments booked online by patients saw a 27.2% rise (n = 2248) compared to March - July 2019 (n = 1767), with a 23.7% increase in telephone helpline calls in the 2020 period (n = 3246) compared to 2019 (n = 2624) and over a 300% increase in email helpline activity. Questionnaire responses were obtained from 382 patients (Table 1). 86% of patients felt they got a lot out of a virtual appointment, but 13% would prefer not to use it again. Of the 16 healthcare providers that responded, 12 (75%) were satisfied with the virtual clinic set up, but only 2/16 (13%) felt the same could be achieved for patients in a virtual setting compared to a face-to-face visit. The lack of clinical examination was a major limitation for clinicians 12/16 (75%) and was similarly identified amongst patient feedback (42/260) (16%). Conclusion Virtual care with the provision for patient-led care allows convenience for the patient with high patient satisfaction, however this is not necessarily an approach that suits all. Clinicians must beware the non-complaining patient, and careful selection of those suitable for virtual care may be needed. Our model of patient led care using telephone appointments booked online by patients coupled with telephone/email helplines is a potential strategy for other centers to develop. Ongoing patient and healthcare provider feedback, data on the effect on clinical outcomes and detailed quality improvement cycles are vital to adjust services over the coming months. P067 Table 1:Results of patient survey on Virtual Clinic experienceDemographicsGenderFemale293 (77%)AgeAge 16-64269 (70%)Age 65-80+94 (25%)RaceWhite British233 (60%)BAME72 (18%)ConsultationsModeTelephone366 (96%)Video11 (3%)TypeNew45 (13%)Follow up333 (87%)ClinicianDoctor324 (85%)Nurse32 (8%)AHP26 (7%)Time from appointment to contactOn time or early195(51%)Up to 15 minutes57 (15%)15-30 minutes36 (9%)&gt;30 minutes41 (11%)Length of appointment&lt;15 minutes184 (48%)15-30 minutes164 (43%)&gt;30 minutes23 (6%)FeedbackWas the length of the appointment right?About right352 (92%)Too short19 (5%)Did you get everything out of this appointment as you would in a face-to-face session?Yes, definitely206 (54%)Yes, to some extent121 (32%)No49 (13%)Did you feel involved in the decision made about your care?Yes, definitely277 (73%)Yes, to some extent57 (15%)No21 (6%)Did you feel you received the information you required?Yes, definitely251 (66%)Yes, to some extent92 (24%)No16 (4%)How would you rate the appointment?Very good/good327 (86%)Neither good nor poor24 (6%)Poor/very poor14 (4%)Would you prefer to use this again for your next appointment?Yes, definitely124 (32%)Yes, to some extent182 (48%)No61 (16%)*Missing data if patient did not respond to the questions. Disclosure Z. Rutter-locher: None. N. Arumalla: None. Z. Bright: None. T. Garrood: None.

Abstract Background/Aims The objective of this analysis was to describe the upadacitinib (UPA) response rates of patients with psoriatic arthritis (PsA) enrolled in the SELECT-PsA-1 and SELECT-PsA-2 randomised controlled trials according to modified Psoriatic Arthritis Response Criteria (PsARC). The UK National Institute for Health and Care Excellence recommends assessing PsA treatment responses using PsARC (advanced therapy-specific time points: after weeks [W] 12, 16 or 24). Methods PsARC responses were assessed from W2 through W24 post-initiation for patients enrolled in SELECT-PsA-1 (upadacitinib 15 mg once-daily [UPA-15mg], placebo and adalimumab 40 mg every other week [ADA] treatment arms) and SELECT-PsA-2 (UPA-15mg and placebo treatment arms). PsARC responses were derived from tender joint count 68 (TJC), swollen joint count 66 (SJC), patient global self-assessment (PtGA) and physician global assessment (PGA) and analysed using non-responder imputation. Results UPA-15mg PsARC response rates increased progressively from W2 through to W12 in SELECT-PsA-1 (78.3%) and SELECT-PsA-2 (70.6%; see Table). Despite relatively high placebo response rates, UPA-15mg response rates were statistically significantly higher than placebo at all assessments between W2 and W24 in SELECT-PsA-1 and SELECT-PsA-2 and were statistically significantly higher than ADA from W20 (SELECT-PsA-1; see Table). Baseline characteristics (including sex, PsA duration, body mass index, tobacco use, body surface area ≥3%, enthesitis and dactylitis) were generally balanced between W24 PsARC responders and non-responders in each SELECT-PsA-1 and SELECT-PsA-2 treatment arm. Differences in PsARC response rates at W24 for UPA-15mg versus placebo (pooled SELECT-PsA-1 and SELECT-PsA-2 data) and versus ADA (SELECT-PsA-1) were similar in patients stratified by baseline characteristics and in patients receiving UPA-15mg monotherapy versus combination therapy. By W12, UPA-15mg response rates for individual PsARC components (SJC and TJC: ≥30% improvement; PtGA and PGA: ≥20% improvement) ranged between 77.6%-89.5% in SELECT-PsA-1 and between 70.1%-82.5% in SELECT-PsA-2. Conclusion PsARC responses greater than placebo were seen as early as W2, with stable response rates from W12 in both SELECT-PsA-1 and SELECT-PsA-2. Statistically significantly higher response rates versus ADA were observed by W20. Differences in W24 PsARC responses versus placebo and versus ADA were generally consistent across baseline characteristics and UPA-15mg mono/combination therapy. P174 Table 1:Modified PsARC response rates at W2 to W24 in SELECT-PsA-1 and SELECT-PsA-2 trialsStudy and week of assessmentTreatment armResponse rate % (95% CI)Response rate difference % (95% CI) UPA-placeboResponse rate difference % (95% CI) UPA-ADASELECT-PsA-1W2Placebo (n = 423)27.2 (22.9-31.4)14.8 (8.5-21.1)*−2.3 (−9.0-4.3)ADA (n = 429)44.3 (39.6-49.0)UPA-15mg (n = 429)42.0 (37.3-46.6)W12Placebo (n = 423)54.6 (49.9-59.4)23.7 (17.6-29.9)*2.8 (−2.8-8.4)ADA (n = 429)75.5 (71.5-79.6)UPA-15mg (n = 429)78.3 (74.4-82.2)W16Placebo (n = 423)55.1 (50.3-59.8)24.4 (18.3-30.5)*1.9 (−3.6-7.4)ADA (n = 429)77.6 (73.7-81.6)UPA-15mg (n = 429)79.5 (75.7-83.3)W20Placebo (n = 423)62.4 (57.8-67.0)21.3 (15.5-27.1)*6.3 (1.0-11.6)*ADA (n = 429)77.4 (73.4-81.3)UPA-15mg (n = 429)83.7 (80.2-87.2)W24Placebo (n = 423)59.3 (54.7-64.0)24.3 (18.5-30.2)*7.0 (1.7-12.3)*ADA (n = 429)76.7 (72.7-80.7)UPA-15mg (n = 429)83.7 (80.2-87.2)SELECT-PsA-2W2Placebo (n = 212)25.5 (19.6-31.3)22.4 (13.5-31.3)*-UPA-15mg (n = 211)47.9 (41.1-54.6)W12Placebo (n = 212)36.3 (29.8-42.8)34.3 (25.4-43.2)*-UPA-15mg (n = 211)70.6 (64.5-76.8)W16Placebo (n = 212)34.4 (28.0-40.8)31.4 (22.4-40.5)*-UPA-15mg (n = 211)65.9 (59.5-72.3)W20Placebo (n = 212)41.5 (34.9-48.1)28.6 (19.6-37.7)*-UPA-15mg (n = 211)70.1 (64.0-76.3)W24Placebo (n = 212)36.3 (29.8-42.8)31.9 (22.9-40.9)*-UPA-15mg (n = 211)68.2 (62.0-74.5)SELECT-PsA-1: randomised controlled trial assessing the safety and efficacy of UPA versus placebo versus ADA in patients with PsA and prior inadequate response or intolerance to ≥ 1 non-biologic disease-modifying antirheumatic drug (DMARD).SELECT-PsA2: randomised controlled trial assessing the safety and efficacy of UPA versus placebo in patients with PsA and prior inadequate response or intolerance to ≥ 1 biologic DMARD.95% confidence intervals (95% CI) for response rates calculated based on normal approximation to the binomial distribution.95% CI for response rate difference based on normal approximation.*Statistically significant at 0.05 level; nominal p values constructed using Cochran-Mantel-Haenszel test adjusting for current disease-modifying antirheumatic drug use (yes/no). Disclosure L.C. Coates: Consultancies; AbbVie, Amgen, Boehringer-Ingelheim, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Sun Pharma, and UCB. Honoraria; AbbVie, Amgen, Boehringer-Ingelheim, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Sun Pharma, and UCB. Member of speakers’ bureau; AbbVie, Amgen, Boehringer-Ingelheim, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Sun Pharma, and UCB. Grants/research support; AbbVie, Amgen, Boehringer-Ingelheim, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Sun Pharma, and UCB. T. Garrood: Consultancies; AbbVie, Pfizer and Gilead. Honoraria; AbbVie, Pfizer and Gilead. Grants/research support; AbbVie, Pfizer and Gilead. N. Gullick: Consultancies; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis and UCB. Member of speakers’ bureau; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis and UCB. Grants/research support; AbbVie, Celgene, Eli Lilly, Izana, Janssen, Novartis and UCB. P. Helliwell: Consultancies; Eli Lilly. Other; fees for educational services from Pfizer, Novartis and Janssen. T. Kent: Corporate appointments; Employee of AbbVie. Shareholder/stock ownership; may own AbbVie stocks. J. Marks: Honoraria; AbbVie, Gilead, Novartis, Pfizer and UCB for participation in advisory boards and to support educational activities unrelated to the publication. W. Tillett: Consultancies; Lilly, Pfizer, AbbVie, Celgene, UCB, and Novartis. Honoraria; Lilly, Pfizer, AbbVie, Celgene, UCB, and Novartis. Member of speakers’ bureau; AbbVie, Janssen and Celgene. Grants/research support; Lilly, Pfizer, AbbVie, Celgene, UCB, and Novartis. D. Kaur-Papadakis: Corporate appointments; Employee of AbbVie. Shareholder/stock ownership; may own AbbVie stocks. H. Tahir: Consultancies; Fees for consultation or participation in advisory boards from AbbVie, Novartis, Pfizer, UCB, Eli-Lilly and Janssen. Other; Education Grants from Novartis and Pfizer. S. van Haaren: Corporate appointments; Employee of AbbVie. Shareholder/stock ownership; may own AbbVie stocks. I. McInnes: Honoraria; Bristol-Myers Squibb, Celgene, Eli Lilly and Company, AbbVie, Gilead, Janssen, Novartis, Pfizer, and UCB. Grants/research support; Bristol-Myers Squibb, Celgene, Eli Lilly and Company, AbbVie, Gilead, Janssen, Novartis, Pfizer, and UCB.