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Purpose: To explore how patients with rheumatic musculoskeletal diseases (RMDs) perceive participation in the goal setting process prior to interdisciplinary rehabilitation. Methods: We conducted semi-structured interviews with 22 participants admitted to an interdisciplinary rehabilitation stay for patients with RMDs at two Danish rehabilitation centres. Qualitative content analysis was applied. Results: The participants perceived goal setting as a joint venture between two parties: the health professionals and the participant. Three categories were formed, which described both facilitators and barriers in the process. Responsibility for goal setting described the importance of shared responsibility, or health professionals as experts, taking full responsibility for goal setting. Equipped for goal setting included perceptions of being well prepared for the process, or considerations that goal setting was difficult because of a lack of information. An equal member of the team entailed both the feeling of being recognised as one in the team, or feeling like an outsider. Conclusion: Goal setting is perceived as a challenge by some patients. Participation in goal setting depends on both the capacity and the opportunity to participate which are factors linked to patients' level of health literacy. IMPLICATIONS FOR REHABILITATION: Patients largely perceive goal setting as a joint venture, constituting a partnership aimed at sharing decisions regarding one or more rehabilitation goals, yet, for some patients, active participation in this joint venture poses challenges. When patients perceive a shared responsibility, acquire appropriate and sufficient knowledge prior to the process and feel accepted as whole persons based on a biopsychosocial approach it facilitates goal setting. Health professionals should be aware of barriers perceived by patients, such as abdicating responsibility because they view health professionals as authority figures, feeling uncertain about the purpose of setting goals and having difficulties in receiving and applying information. Patients' health literacy as well health literacy responsiveness may be of importance to the experience of barriers to shared decisions and goal setting among patients with RMDs. [ABSTRACT FROM AUTHOR]

Purpose: To explore what patients with rheumatic and musculoskeletal diseases (RMDs) need and receive of follow-up care after specialized rehabilitation, and whether received follow-up is associated with health outcomes after 1 year. Further, to compare these findings with patients' experiences to improve the understanding of how follow-up takes place. Methods: In a mixed methods study, patients received a rehabilitation programme designed to improve the continuity in rehabilitation across care levels. A total of 168 patients completed questionnaires, of which 21 were also interviewed. Results: At discharge, most patients reported needs for follow-up. These needs were largely met within 1 year, mainly resulting from patients' initiatives to re-connect with previous contacts. The degree of received follow-up was not associated with goal attainment, quality of life, or physical function. Factors related to providers (competence, communication skills), context (delays, limited access to care), and patients (motivation, life situation, preferences) seemed to be decisive for the progress of the rehabilitation process over time. Conclusions: The results provide evidence that access to follow-up care is crucial to patients with RMDs. However, it also highlights several factors that may influence its impact. These results can be used to optimise design and implementation of future follow-up interventions. IMPLICATIONS FOR REHABILITATION: Healthcare providers should take greater responsibility for creating continuity in rehabilitation across levels of care. Follow-up care should be adapted to patients' needs, goals, and preferences as regards content, timing, and mode of delivery. Follow-up should be linked to a rehabilitation plan for each patient to ensure continuity of care. More effective communication systems across service levels should be established. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To (1) estimate the prevalence of (symptoms of) rheumatic and musculoskeletal diseases (RMDs) and (2) explore how (symptoms of) RMDs are identified and documented in studies among nursing home residents. Findings: The prevalence of RMDs in nursing home residents varied to a great extent due to large heterogeneity in documentation of (symptoms of) RMDs. Message: Establishing agreement on a useful and practical classification may ultimately increase identification of RMDs in the nursing home setting. Purpose: The objective of this systematic literature review was to: (1) estimate the prevalence of (symptoms of) rheumatic and musculoskeletal diseases (RMDs) and (2) explore how (symptoms of) RMDs are identified and documented in studies among nursing home residents. Methods: Prevalence data of (symptoms of) RMDs in permanently admitted nursing home residents ≥ 60 years were included. Data extraction, data synthesis and risk of bias assessment were performed by two reviewers independently. Included studies were categorized based on case ascertainment and case definition comprising: (location of) musculoskeletal pain, general terms for RMDs or a specific type of RMD. Results were summarized descriptively. Results: Out of 6900 records, 53 studies were included. Case ascertainment comprised databases (n = 5), physical examination (n = 1), self-report questionnaires (n = 14), review of medical charts (n = 23) and self-report questionnaires combined with review of medical charts (n = 10). Prevalence ranged between 0.9 and 77.0% for (localized) musculoskeletal pain (n = 19) and between 0.6 and 67.5% for RMDs in general (n = 39). Prevalence rates of specific type of RMDs ranged between 0.7 and 47.5% for gout, between 3.3 and 11.0% for rheumatoid arthritis and between 2.8 and 75.4% for osteo-arthritis (n = 14). Heterogeneity with regard to documentation of (symptoms of) RMDs in medical data of nursing home residents was high. Conclusion: The overall prevalence of (symptoms of) RMDs varied to a great extent. This was mainly due to large heterogeneity in documentation of (symptoms of) RMDs. Establishing agreement on a useful and practical classification may ultimately increase identification of RMDs in the nursing home setting. [ABSTRACT FROM AUTHOR]

Rheumatic and musculoskeletal diseases (RMDs) usually lead to morphological and functional deficits of various extend, increased morbidity and a considerable loss of quality of life. Modern pharmacological treatment has become effective and can stop disease progression. Nonetheless, disease progression is often only slowed down. Moreover, pharmacological treatment does not improve functionality per se. Therefore, multimodal treatment of rheumatic disorders with physical therapy being a key element is of central importance for best outcomes. In recent years, research into physical medicine shifted from a sole investigation of its clinical effects to a combined investigation of clinical effects and potential changes in the molecular level (e.g., inflammatory cytokines and the cellular autoimmune system), thus offering new explanations of clinical effects of physical therapy. In this review we provide an overview of studies investigating different heat applications in RMDs, their effect on disease activity, pain and their influence on the molecular level.

Gunnhild Berdal,1 Ingvild Kjeken,1 Anita Dyb Linge,2 Ann Margret Aasvold,3 Kjetil Tennebø,4 Siv Grødal Eppeland,5 Anne Sirnes Hagland,6 Guro Ohldieck-Fredheim,7 Helene Lindtvedt Valaas,1,7 Ingvild Bø,8 Åse Klokkeide,9 Maryam Azimi,10 Turid N Dager,1 Anne-Lene Sand-Svartrud1 1Health Services Research and Innovation Unit, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; 2Muritunet Rehabilitation Centre, Valldal, Ålesund, Norway; 3Meråker Rehabilitation Centre, Meråker, Norway; 4Valnesfjord Health Sports Centre, Valnesfjord, Norway; 5Department of Physiotherapy, Sørlandet Hospital, Arendal, Norway; 6Haugesund Hospital for Rheumatic Diseases, Haugesund, Norway; 7Vikersund Rehabilitation Centre, Vikersund, Norway; 8Department of Rehabilitation, Hospital for Rheumatic Diseases, Lillehammer, Norway; 9Rehabilitering Vest Rehabilitation Centre, Haugesund, Norway; 10REMEDY Patient Advisory Board, Diakonhjemmet Hospital, Oslo, NorwayCorrespondence: Gunnhild Berdal, Health Services Research and Innovation Unit, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, P.O. Box 23 Vinderen, Oslo, N-0319, Norway, Tel +47 91 88 71 63, Email Gunnhild.Berdal@gmail.comPurpose: To identify and describe behavior change techniques (BCTs) used in rehabilitation for patients with rheumatic and musculoskeletal diseases (RMDs), according to their own perceptions. Further, to examine patients’ descriptions of their capability, opportunity, motivation, and readiness for health behavior change.Patients and Methods: Patients were adults in need of specialized, multidisciplinary rehabilitation services due to inflammatory rheumatic disease, systemic connective tissue disease, or fibromyalgia / chronic widespread pain. Semi-structured interviews of 21 patients were analyzed with deductive qualitative content analysis applying three theoretical frameworks: the Behavior Change Technique Taxonomy, the transtheoretical model and stages of change, and the capability, opportunity, and motivation model of behavior.Results: Forty-six BCTs aggregated within 14 BCT groups were identified used by either patients, healthcare professionals (HPs), or both. Goals and planning, feedback and monitoring, social support, shaping knowledge, repetition and substitution were most frequently used to facilitate behavior change. Twenty patients had reached the action stage and made specific lifestyle changes concerning more than half of their goals. Concerning other goals, 6 of these patients reported to be contemplating behavior change and 15 to be preparing for it. The rehabilitation process appeared to strengthen capability, opportunity, motivation, and the desired behaviors. Patient-reported barriers to behavior change were connected with restrictions in physical capability resulting from an unpredictable and fluctuating disease course, weakened motivation, and contextual factors, such as lack of access to healthcare support and training facilities, and high domestic care burden.Conclusion: The rehabilitation process seemed to strengthen individual and contextual prerequisites for behavior change and facilitate the use of required techniques and engagement in the desired behaviors. However, patients with RMDs may need prolonged support from HPs to integrate healthy lifestyle changes into everyday life. The findings can be used to optimize rehabilitation interventions and patients’ persistent engagement in healthy behaviors.Keywords: rheumatic diseases, musculoskeletal diseases, rehabilitation, behavior therapy, qualitative research, patient engagement

A growing amount of evidence suggests that gut microbiota plays an important role in human health, including a possible role in the pathogenesis of rheumatic and musculoskeletal diseases (RMD). We analysed the current evidence about the role of microbiota in rheumatoid arthritis (RA), spondyloarthritis (SpA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). In RA, we found a general consensus regarding a reduction of diversity and a specific bacterial signature, with consistent changes according to the different ethnic and geographical areas. The major pathogenetic role in RA is recognised for P. copri, L. salivarius and Collinsella, even if findings become more heterogeneous when considering established disease. In SpA, we found a relative gut abundance of Akkermansia, Coprococcus, Ruminoccocus and a relative reduction in Bacterioides and Firmicutes spp. Human and preclinical data suggest loss of mucosal barrier, increased permeability and Th1- and Th17-mediated inflammation. Additionally, HLA-B27 seems to play a role in shaping the intestinal microbiota and the consequent inflammation. In SLE, the typical gut microbiota signature was characterised by a reduction in the Firmicutes/Bacteroidetes ratio and by enrichment of Rhodococcus, Eggerthella, Klebsiella, Prevotella, Eubacterium and Flavonifractor, even if their real pathogenic impact remains unclear. In SSc, gastrointestinal dysbiosis is well documented with an increase of pro-inflammatory species (Fusobacterium, Prevotella, Ruminococcus, Akkermansia, γ-Proteobacteria, Erwinia, Trabsulsiella, Bifidobacterium, Lactobacillus, Firmicutes and Actinobacteria) and a reduction of species as Faecalibacterium, Clostridium, Bacteroidetes and Rikenella. In conclusion, seems possible to recognise a distinct gut microbiota profile for each RMD, even if significant differences in bacterial species do exist between different studies and there is a high risk of bias due to the cross-sectional nature of such studies. Therefore longitudinal studies are needed, especially on patients with preclinical and early disease, to investigate the real role of gut microbiota in the pathogenesis of RMD. [ABSTRACT FROM AUTHOR]

Objectives: To identify the effectiveness and safety of inactivated SARS‐CoV‐2 vaccines in rheumatic and musculoskeletal diseases (RMDs) patients. Methods: RMD patients with COVID‐19 in Jiangsu Province were polled between December 8, 2022, and February 1, 2023. Information on demographics, disease characteristics, antirheumatic drug use, vaccination status and survival state were collected. COVID‐19‐associated pneumonia was the primary outcome. The effect of COVID‐19 immunization on RMD patients was assessed using multivariate logistic regression, and the adverse events (AEs) following vaccination were evaluated. Results: Among 592 RMD patients with COVID‐19, 276 (46.6%) individuals experienced COVID‐19‐associated pneumonia, and 290 (49.0%) patients were injected with inactivated vaccines. In multivariate logistic regression analysis, vaccines reduced the incidence of COVID‐19‐associated pneumonia, and receiving booster vaccine was an independent protective factor for COVID‐19‐associated pneumonia in RMD patients (OR 0.64, 95% CI 0.41–0.98, p =.034). In particular, inactivated vaccines have a protective impact on RMD patients with a high risk of developing pneumonia, including those aged 45 years and older (OR 0.53, 95% CI 0.34–0.83), and who have lung involvement (OR 0.43, 95% CI 0.23–0.82). The total AEs rate of vaccines was 13.9% (40/290), only 11 (3.8%) experienced the recurrence or deterioration of RMDs, and no serious AEs occurred. Conclusion: Inactivated COVID‐19 vaccines were safe and effective in reducing the risk of COVID‐19‐associated pneumonia of RMD patients in China. [ABSTRACT FROM AUTHOR]

To investigate how a quality improvement program (BRIDGE), designed to promote coordination and continuity in rehabilitation services, was delivered and perceived by providers in routine practice for patients with rheumatic and musculoskeletal diseases. A convergent mixed methods approach was nested within a stepped-wedge, randomized controlled trial. The intervention program was developed to bridge gaps between secondary and primary healthcare, comprising the following elements: motivational interviewing; patient-specific goal setting; written rehabilitation-plans; personalized feedback on progress; and tailored follow-up. Data from health professionals who delivered the program were collected and analyzed separately, using two questionnaires and three focus groups. Results were integrated during the overall interpretation and discussion. The program delivery depended on the providers' skills and competence, as well as on contextual factors in their teams and institutions. Suggested possibilities for improvements included follow-up with sufficient support from next of kin and external services, and the practicing of action and coping plans, standardized outcome measures, and feedback on progress. Leaders and clinicians should discuss efforts to ensure confident and qualified rehabilitation delivery at the levels of individual providers, teams, and institutions, and pay equal attention to each component in the process from admission to follow-up. Quality in rehabilitation should be characterized by a continuous and coordinated process from goal setting to follow-up. To improve the quality, sufficient involvement of next of kin and external services is needed. Clinicians may need training to build confidence in motivational interviewing, action- and coping planning, feedback on progress, and follow-up. Leaders should organize education sessions, optimize schedules, insert standardized outcome measures, and facilitate collaboration across levels of care and services. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the clinical features of patients with rheumatic and musculoskeletal diseases (RMDs) infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and the relationship between RMDs relapse and SARS‐CoV‐2 infection. Methods: We carried out a cross‐sectional observational study among 585 patients with RMDs and 619 individuals without RMDs. Data on demographics, the clinical features of coronavirus disease 2019 (COVID‐19), antirheumatic therapy, and RMD relapse were collected. Differences between RMDs and control groups, infected and uninfected groups, relapse and non‐relapse RMDs groups were examined. The influence of COVID‐19 infection on medications and relapse of RMDs was also assessed. Results: Among 1204 participants finally recruited for analysis, 1030 (85.5%) were infected with COVID‐19. Seven hundred and ninety‐five (77.2%) of infected individuals were female, and the median age was 40 years (IQR 33, 50). Patients in the RMD group had a relatively lower risk of COVID‐19 symptoms whereas were significantly more likely to require hospitalization (6.7% vs. 2.2%). In the RMDs group, younger patients who were under the age of 65 were more likely to report more symptoms. More patients with RMD relapse (27, 34.6%) adjusted their medications during the period of COVID‐19 infection than those without relapse (59, 13.2%). Conclusion: Patients with RMDs were at lower risk of symptoms of COVID‐19. Rheumatic and musculoskeletal disease patients experience a higher risk of relapse especially when they adjust medications during COVID‐19 infection. The long‐term prognosis of infected RMDs patients need further investigation. [ABSTRACT FROM AUTHOR]

In the last few years there has been an increased appreciation that pain perception in rheumatic and musculoskeletal diseases (RMDs) has several mechanisms which include nociceptive, inflammatory, nociplastic and neuropathic components. Studies in specific patient groups have also demonstrated that the pain experienced by people with specific diagnoses can present with distinctive components over time. For example, the pain observed in rheumatoid arthritis has been widely accepted to be caused by the activation of nociceptors, potentiated by the release of inflammatory mediators, including prostaglandins, leukotrienes and cytokine networks in the joint environment. However, people with RA may also experience nociplastic and neuropathic pain components, particularly when treatments with disease modifying anti-rheumatic drugs (DMARDs) have been implemented and are insufficient to control pain symptoms. In other RMDs, the concept of pain sensitisation or nociplastic pain in driving ongoing pain symptoms e.g. osteoarthritis and fibromyalgia, is becoming increasingly recognised. In this review, we explore the hypothesis that pain has distinct modalities based on clinical, pathophysiological, imaging and genetic factors. The concept of pain stratification in RMD is explored and implications for future management are also discussed. [ABSTRACT FROM AUTHOR]

This narrative review discusses the importance of rehabilitation in rheumatic and musculoskeletal diseases (RMDs), ultimately aiming to reduce their impact on individuals and society. It specifically emphasizes the need for rehabilitation in inflammatory arthritis (IA), particularly in cases where medical management is insufficient. It acknowledges that the complexity of rehabilitation demands a flexible approach. Thereby, it touches on the various models of rehabilitation, which may include multidisciplinary team care, extended practice models, shared care, remote care, and work rehabilitation. It discusses the challenges in research, practice, and policy implementation. In research, the need for innovative research designs is highlighted, whereas regarding clinical practice the importance of early detection of disability and patient engagement is underlined, as well as the role of telehealth and AI in reshaping the rehabilitation landscape. Financial barriers and work force shortages are identified as challenges that hinder the effective delivery of rehabilitative care. On the policy level, this paper suggests that the allocation of healthcare resources often prioritizes acute conditions over chronic diseases, leading to disparities in care. This paper concludes by emphasizing the critical role of evidence-based rehabilitation in improving the quality of life for people with RMDs, in particular for those with IA, and promoting their healthy aging. It also calls for tailored rehabilitation models and the early identification of persons with rehabilitation needs as future challenges in this field. [ABSTRACT FROM AUTHOR]

Introduction. Early diagnosis and treatment improve clinical outcomes, especially in chronic arthritis (CA) and systemic connective tissue disorders (SCTD). Thanks to clinical research from the 1990s on and innovative drugs, 55 million life-years have been saved. The COVID-19 pandemic brought on medical challenges in rheumathology. Objective. The study objective was to research early diagnosis, time of the introduction of innovative therapy, participation in clinical research, influence of gender, age, and corticosteroid treatment on hospitalization rate due to COVID-19 infection in CA and SCTD patients. Method. In November 2022 we performed the crosssectional study in CA and/or SCTD patients using an online questionnaire. The first part of the analyzed questions referred to sociodemographic characteristics and data concerning rheumatic disease - rheumatoid arthritis (RA) and other rheumatic diseases. The second part referred to COVID-19. Data were analyzed by descriptive statistics and Pearson's Chi-square test using SPSS 29. Results. Out of the total of 176 participants, RA was present in 60,8%. The time from the symptom onset to diagnosis was longer than two years. RA was more frequently diagnosed in the first six months (p < 0,05 - males). The innovative therapy was used by 59,7% of the participants. The majority of RA patients got innovative therapy after five years from disease onset, which is later than in other CAs (p < 0,05 - females). There were 23,3% of the participants who took part in clinical research, more those with RA (p < 0,05 - females). Corticosteroid therapy influenced a higher rate of hospitalization during COVID-19 infection (p < 0,05 - females). Conclusion. Males suffering from RA were diagnosed sooner, while females with RA participated more in clinical research but were later introduced to innovative therapy. The use of glucocorticoid therapy in the treatment of CA and SCTD increased the risk of hospitalization due to COVID-19 infection.

Abstract Background Supporting adherence to medication is an essential part of the treatment and care of patients with rheumatic and musculoskeletal diseases. The Compliance Questionnaire Rheumatology (CQR) measures adherence in rheumatic diseases through 19 items covering drug-taking behaviour to identify the reasons for adhering to treatment and the factors that contribute to suboptimal adherence. The objective of this study was to present the translation of the CQR into Danish and the face validity and reliability test. Methods The CQR was translated into Danish according to international guidelines, followed by a face validity test among 10 patients with rheumatoid arthritis in 2009. The test–retest reliability of the Danish CQR was evaluated in 49 patients with rheumatoid arthritis in 2020 - 2021 using the standard error of the measurement (SEM) converted into the minimally detectable change (MDC) and the intraclass correlation coefficient (ICC). Questionnaires were administered with a minimum of 10 days between assessments. Results The participants in the reliability test had a mean age of 57.4 years (SD 16.1) and a mean disease duration of 1.13 years (range 2 months–2 years). The mean CQR score in the test and retest was 62.7 (confidence interval (CI) 58.8; 66.6) and 62.5 (CI 58.9; 66.1), respectively, with a SEM of 8.59 (7.16; 10.73) and an MDC of 16.83. A satisfactory test–retest reliability was confirmed by an ICC value of 0.79 (CI 0.68; 0.89). Conclusion The Danish CQR has satisfactory test–retest reliability in patients newly diagnosed with rheumatoid arthritis and is considered a reliable tool to measure adherence in this group.

In the last few years there has been an increased appreciation that pain perception in rheumatic and musculoskeletal diseases (RMDs) has several mechanisms which include nociceptive, inflammatory, nociplastic and neuropathic components. Studies in specific patient groups have also demonstrated that the pain experienced by people with specific diagnoses can present with distinctive components over time. For example, the pain observed in rheumatoid arthritis has been widely accepted to be caused by the activation of nociceptors, potentiated by the release of inflammatory mediators, including prostaglandins, leukotrienes and cytokine networks in the joint environment. However, people with RA may also experience nociplastic and neuropathic pain components, particularly when treatments with disease modifying anti-rheumatic drugs (DMARDs) have been implemented and are insufficient to control pain symptoms. In other RMDs, the concept of pain sensitisation or nociplastic pain in driving ongoing pain symptoms e.g. osteoarthritis and fibromyalgia, is becoming increasingly recognised. In this review, we explore the hypothesis that pain has distinct modalities based on clinical, pathophysiological, imaging and genetic factors. The concept of pain stratification in RMD is explored and implications for future management are also discussed.

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) evolves, infection management in vulnerable populations requires formalized guidance. Although low-virulence variants of SARS-CoV-2 remain predominant, they pose an increased risk of severe illness in adults with rheumatic and musculoskeletal diseases (RMDs). Several disease-specific (chronic long-grade inflammation, concomitant immunosuppression) and individual (advanced age, multimorbidity, pregnancy, vaccination status) factors contribute to excess risk in RMD populations. Various post-COVID-19 manifestations are also increasingly reported and appear more commonly than in the general population. At a pathogenetic level, complex interplay involving innate and acquired immune dysregulation, viral persistence, and genetic predisposition shapes a unique susceptibility profile. Moreover, incident cases of SARS-CoV-2 infection as a trigger factor for the development of autoimmune conditions have been reported. Vaccination remains a key preventive strategy, and encouraging active education and awareness will be crucial for rheumatologists in the upcoming years. In patients with RMDs, COVID-19 vaccines' benefits outweigh the risks. Derivation of specialized diagnostic and therapeutic protocols within a comprehensive COVID-19 care plan represents an ideal scenario for healthcare system organization. Vigilance for symptoms of infection and rapid diagnosis are key for introducing antiviral treatment in patients with RMDs in a timely manner. This review provides updated guidance on optimal immunization, diagnosis, and antiviral treatment strategies. [ABSTRACT FROM AUTHOR]

Rheumatic and musculoskeletal diseases (RMDs) usually lead to morphological and functional deficits of various extend, increased morbidity and a considerable loss of quality of life. Modern pharmacological treatment has become effective and can stop disease progression. Nonetheless, disease progression is often only slowed down. Moreover, pharmacological treatment does not improve functionality per se. Therefore, multimodal treatment of rheumatic disorders with physical therapy being a key element is of central importance for best outcomes. In recent years, research into physical medicine shifted from a sole investigation of its clinical effects to a combined investigation of clinical effects and potential changes in the molecular level (e.g., inflammatory cytokines and the cellular autoimmune system), thus offering new explanations of clinical effects of physical therapy. In this review we provide an overview of studies investigating different heat applications in RMDs, their effect on disease activity, pain and their influence on the molecular level. [ABSTRACT FROM AUTHOR]

Rheumatic and Musculoskeletal Diseases (RMDs) affect 120 million Europeans and are responsible for joint inflammation, stiffness, pain, and fatigue. Patient-Reported Outcome Measures (PROMs), essential to diagnosis and treatment adjustments, are expected to revolutionise rheumatology care if mobile apps reach clinical practice. However, patients often experience finger dexterity issues that can hinder their interaction with mobile apps. This paper investigates the interaction of patients with RMDs with mobile apps for self-report. We started by reviewing existing iPhone and Android apps for RMDs, to identify common user interface (UI) components, and conducted usability experiments with 20 patients with RMDs to record their performance. The usability experiments showed that in-line selectors are the best-performing UI component and that column selectors are considered the most usable by patients. Sliders perform worse than in-line selectors, with significant differences. Results also showed little difference between test conditions aligned with mobile UI design guidelines and those that provided larger or more spaced targets, leading us to conclude that following existing Apple Human Interface Guidelines and Android Material Design will lead to apps with UIs that are appropriate for patients with RMDs. [Display omitted] • In-line selectors are the UI component that affords the best user performance for patients with Rheumatic and Musculoskeletal Diseases. • Column selectors are perceived as the most usable by patients with Rheumatic and Musculoskeletal Diseases. • Sliders perform worse than in-line selectors, with significant differences. • Following UI Apple and Android guidelines is appropriate for patients with RMDs. [ABSTRACT FROM AUTHOR]

Abstract Background Rheumatic and musculoskeletal diseases (RMDs) cause significant burden to the individual and society, requiring lifelong management and specialist healthcare resource use. Costing over 200 billion euros per year in Europe, RMDs are the most expensive of all diseases for European healthcare systems. The incidence and burden of RMDs are projected to rise with the ageing global population and increase in sedentary, obesogenic lifestyles. In parallel, there is a global crisis in the rheumatology workforce, whereby capacity to deliver specialist care is being exceeded by demand. Pervasive, scalable mobile health technologies, such as apps, are being developed to support the self-management of RMDs and reduce pressure on healthcare services. However, it is unknown whether these apps are informed by theory or their use supported by an appropriate evidence base. The purpose of this review is therefore to provide a comprehensive overview of the development strategies, interventional components and theoretical underpinnings of existing smartphone apps, designed to support the self-management of RMDs. Methods Searches will be conducted within PubMed, Scopus, Web of Science, Embase, MEDLINE and PsycINFO. Reference lists and citing articles of the included studies will be searched. Identified publications will be screened for eligibility by two independent reviewers. Any discrepancies between reviewers will be resolved by consensus, with input from a third reviewer if required. Data will be extracted on study designs, methods, populations, setting, utilised theoretical frameworks, intervention components, behaviour change techniques, methods to evaluate effectiveness and barriers/facilitators to intervention engagement. Exploratory outcomes include reported effectiveness, acceptability and usability. A systematic, narrative synthesis of evidence will be presented. If appropriate (depending on quality and pool of evidence identified), qualitative meta-summary techniques will be used to combine and summarise qualitative findings regarding barriers/facilitators to intervention engagement. Discussion The results of this systematic literature review will provide insights for healthcare professionals, researchers, app designers and policy makers, to inform future development and implementation of smartphone apps to support self-management of RMDs. Evidence gaps for future research will be identified. Findings will be disseminated through a final manuscript/publication of results and via a conference abstract, patient organisations and social media. Systematic review registration PROSPERO CRD42022359704.

Abstract Background Immunosuppressive medication reduces the immunogenicity of the coronavirus disease 2019 (COVID‐19) vaccines in patients with rheumatic and musculoskeletal diseases (RMDs). However, the underlying mechanism remains unclear. The primary aim of our study was to dissect the impact of immunosuppressive medication on cellular and humoral immune responses in RMD patients receiving the inactivated COVID‐19 vaccine. Methods A total of 28 RMD patients and five healthy controls (HCs) receiving two doses of the inactivated COVID‐19 vaccine (Sinovac‐CoronaVac) were prospectively enrolled. Blood samples were collected before the primary vaccination (Week 0) and one week after the second vaccination (Week 5). Neutralizing antibody (nAb) titers and autoantibody titers were measured by a pseudovirus‐based neutralization assay and enzyme‐linked immunosorbent assay, respectively. CD4+ T‐cell and CD19+ B‐cell subsets and serum cytokines were analyzed by flow cytometry. Results The inactivated COVID‐19 vaccine was immunogenic in RMD patients and HCs after the second vaccination, but the nAb titers were lower in RMD patients than those in HCs. Only patients with systemic lupus erythematosus (SLE) had notably increased nAb titers. Remarkably, IgG+CD27+, IgG+IgG1+, and IgG+IgG1− B cells were reduced, whereas IgG−IgG1+ B cells, and total IgA and IgG titers were markedly increased. However, Tfh cell and Tfr cell subsets and cytokines produced by Tfh cells were not increased. The flare rate was low in RMD patients with comparable autoantibody titers, unchanged CD4+ T cell subsets and serum pro‐inflammatory cytokines (interleukin [IL]‐6, IL‐17, interferon‐γ, and tumor necrosis factor‐α) after the second vaccination. Conclusions Immunosuppressive therapy decreased the immunogenicity of the vaccine and maintained a low flare rate by selectively modulating B cell but not CD4+ T cell responses in RMD patients receiving the inactivated COVID‐19 vaccine. Optimization of the treatment regimen might ensure a durable and robust COVID‐19 vaccination response.

Objective: To compare the effectiveness of a structured goal-setting and tailored follow-up rehabilitation intervention with existing rehabilitation in patients with rheumatic and musculoskeletal diseases. Design: A pragmatic stepped-wedge cluster randomized trial. Setting: Eight rehabilitation centers in secondary healthcare, Norway. Participants: A total of 374 adults with rheumatic and musculoskeletal diseases were included in either the experimental (168) or the control group (206). Interventions: A new rehabilitation intervention which comprised structured goal setting, action planning, motivational interviewing, digital self-monitoring of goal progress, and individual follow-up support after discharge according to patients' needs and available resources in primary healthcare (the BRIDGE-intervention), was compared to usual care. Main measures: Patient-reported outcomes were collected electronically on admission and discharge from rehabilitation, and after 2, 7, and 12 months. The primary outcome was patients' goal attainment measured by the Patient Specific Functional Scale (0–10, 10 best) at 7 months. Secondary outcome measures included physical function (30-s Sit-To-Stand test), health-related quality of life (EQ-5D-5L-index), and self-assessed health (EQ-VAS). The main statistical analyses were performed on an intention-to-treat basis using linear mixed models. Results: No significant treatment effects of the BRIDGE-intervention were found for either primary (Patient Specific Functional Scale mean difference 0.1 [95% CI: −0.5, 0.8], p = 0.70), or secondary outcomes 7 months after rehabilitation. Conclusion: The BRIDGE-intervention was not shown to be more effective than existing rehabilitation for patients with rheumatic and musculoskeletal diseases. There is still a need for more knowledge about factors that can improve the quality, continuity, and long-term health effects of rehabilitation for this patient group. [ABSTRACT FROM AUTHOR]

Background: Rheumatic and musculoskeletal diseases (RMDs) cause significant burden to the individual and society, requiring lifelong management and specialist healthcare resource use. Costing over 200 billion euros per year in Europe, RMDs are the most expensive of all diseases for European healthcare systems. The incidence and burden of RMDs are projected to rise with the ageing global population and increase in sedentary, obesogenic lifestyles. In parallel, there is a global crisis in the rheumatology workforce, whereby capacity to deliver specialist care is being exceeded by demand. Pervasive, scalable mobile health technologies, such as apps, are being developed to support the self-management of RMDs and reduce pressure on healthcare services. However, it is unknown whether these apps are informed by theory or their use supported by an appropriate evidence base. The purpose of this review is therefore to provide a comprehensive overview of the development strategies, interventional components and theoretical underpinnings of existing smartphone apps, designed to support the self-management of RMDs. Methods: Searches will be conducted within PubMed, Scopus, Web of Science, Embase, MEDLINE and PsycINFO. Reference lists and citing articles of the included studies will be searched. Identified publications will be screened for eligibility by two independent reviewers. Any discrepancies between reviewers will be resolved by consensus, with input from a third reviewer if required. Data will be extracted on study designs, methods, populations, setting, utilised theoretical frameworks, intervention components, behaviour change techniques, methods to evaluate effectiveness and barriers/facilitators to intervention engagement. Exploratory outcomes include reported effectiveness, acceptability and usability. A systematic, narrative synthesis of evidence will be presented. If appropriate (depending on quality and pool of evidence identified), qualitative meta-summary techniques will be used to combine and summarise qualitative findings regarding barriers/facilitators to intervention engagement. Discussion: The results of this systematic literature review will provide insights for healthcare professionals, researchers, app designers and policy makers, to inform future development and implementation of smartphone apps to support self-management of RMDs. Evidence gaps for future research will be identified. Findings will be disseminated through a final manuscript/publication of results and via a conference abstract, patient organisations and social media. Systematic review registration: PROSPERO CRD42022359704. [ABSTRACT FROM AUTHOR]

Alors que les solutions de santé numérique sont de plus en plus largement disponibles dans le monde de la rhumatologie, il reste difficile pour les médecins et les personnes porteuses de rhumatismes inflammatoires chroniques de trouver l'application pour smartphone ou l'objet connecté idéal pour l'autogestion ou le suivi de leur maladie. Ce manuscrit décrit les avancées récentes et les barrières à l'intégration des solutions digitales dans notre pratique en rhumatologie. While digital health solutions are becoming wildly available in the field of rheumatology, it can be difficult for physicians and people living with rheumatic and musculoskeletal diseases to find the perfect smartphone app or connected device. This manuscript is summarizing the latest evidence and remaining challenges in the implementation of digital health in rheumatology. [ABSTRACT FROM AUTHOR]

Investigating unmet needs and identifying the necessary interventions for patients affected by rheumatic and musculoskeletal diseases (RMDs) may help significantly to ensure the continuity and quality of the chronic care pathway. To this aim, the contribution of rheumatology nurses requires further evidence. The aim of our systematic literature review (SLR) was to identify the nursing interventions directed towards patients with RMDs undergoing biological therapy. To retrieve data, a search was carried out in the MEDLINE database, the Cumulative Index to Nursing and Allied Health Literature (CINAHL database), the APA PsycINFO database and the Excerpta Medica Database (EMBASE) from 1990 to 2022. The systematic review was carried out in accordance with the relevant PRISMA guidelines. Inclusion criteria were as follows: (I) adult patients with RMDs, (II) undergoing therapy with Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs), (III) original and quantitative research papers in English with available abstract, (IV) specific to nursing interventions and/or outcomes. Two independent reviewers screened the identified records for eligibility according to their title and abstract, full texts were subsequently assessed and, finally, data was extracted. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of the studies included. Among the 2348 records retrieved, 13 articles met the inclusion criteria. These consisted of six randomised controlled trials (RCTs), one pilot study and six observational studies on RMDs. In a total population of 2004 patients, 43% (862/2004) of the cases concerned rheumatoid arthritis (RA) and 56% (1122/2004) of the cases concerned spondyloarthritis (SpA). Three major nursing interventions were identified, namely education, patient-centred care and data collection/nurse monitoring, which were correlated with high satisfaction rates regarding care, increased self-care capacity and treatment adherence among patients. All interventions followed a protocol defined in collaboration with rheumatologists. The large degree of heterogeneity in the interventions did not allow the performance of a meta-analysis. Rheumatology nurses are part of a multidisciplinary team caring for patients with RMDs. Following an accurate initial nursing evaluation, rheumatology nurses can plan and standardise their interventions focusing primarily on patient education and personalised care based on actual needs, such as psychological well-being and disease control. However, the training for rheumatology nurses should define and standardise, as much as possible, the competencies required for the detection of disease parameters. Key Points • This SLR provides an overview of nursing interventions for patients with RMDs. • This SLR considers the specific population of patients on biological therapies. • Training for rheumatology nurses should standardise, as much as possible, the knowledge and methods required for detecting disease parameters. • This SLR highlights the various competencies of rheumatology nurses. [ABSTRACT FROM AUTHOR]

Introduction: Telemedicine (TM) reported a great increase from 50% to 150% in health care to RMDs patients during the COVID-19 period, but conflicting opinions in the literature are still present. Aim: to investigate the results of literature on TM in terms of feasibility (patients’ satisfaction, accessibility, clinical outcomes and barriers), discussing its integration for the future in a nursing perspective during and after COVID-19 period. Methods: the team that conducted the narrative review was composed by two rheumatology and research nurses (MRM, KEA) and a rheumatologist (MMC), who discussed the relevance of the research question and agreed on the search strategy. Pubmed and Google Scholar databases were searched. The inclusion criteria were: original and quantitative research papers in English with available abstract/full text, on adult patients with RMDs in accordance with the American College of Rheumatology (ACR) and/or European Alliance of Associations of Rheumatology (EULAR) classification criteria, exposed to any kind of technologies during and after COVID19 period, investigating any kind of patient/clinical reported outcomes. Results: TM could be considered as an integration to standard clinical care in Rheumatology, especially for patients with a stable or low disease activity and rheumatic diagnosis. The choice of the candidates and the assessment of their E-health literacy level are necessary prior including them in TM programs. In addition, healthcare professionals need to be trained in this new modality of providing care. Conclusion: hybrid models of telehealthcare might be a balanced solution, improving efficiency of the consultation, continuity of care and providing a patient-centred approach.

Follow-up care (FU-care) and self-management are recognized as important to ensure prolonged effects of rehabilitation. Objectives of this study were to explore current FU-care and self-management after specialized rehabilitation for patients with rheumatic and musculoskeletal diseases. This multicentre cohort study included 523 patients who self-reported need and plans for FU-care and plans for self-management activities (SMAs) at rehabilitation discharge. The FU-care received and adherence to SMA were self-reported after 4-, 8-, and 12-months. Predictors for received FU-care and adherence to SMA were explored in multiple logistic regression models. Plans for FU-care were significantly associated with received FU-care. Younger age, better coping skills, and performing regular social activities and hobbies were significant predictors for received FU-care. Throughout the follow-up year, 221 (51%) participants had adherence to their SMA plans. Older age, regular physical activity, more severe pain, and performing regular social activities and hobbies were significant predictors for adherence to SMA. Participants with SMA adherence more often reported planned FU-care, and more frequently received the FU-care they needed. Planning FU-care should be integrated in specialized rehabilitation. Patients with poor coping skills and sedentary lifestyle may need more support over longer time to implement behavioral changes for healthy self-management. Planning follow-up should be integrated in specialized rehabilitation as it supports self-management and receiving follow-up at home. Patients with sedentary lifestyle, poor coping skills, and depression may need more support over longer time to implement healthy self-management. Structure and routines in daily life enhance self-management. [ABSTRACT FROM AUTHOR]

We explored the content and attainment of rehabilitation goals the first year after rehabilitation among patients with rheumatic and musculoskeletal diseases. Participants (n = 523) recorded goals in the Patient Specific Functional Scale at admission and reported goal attainment at admission, discharge, and 12 months after rehabilitation on an 11-point numeric rating scale. Goal content was linked to the ICF coding system and summarized as high, maintained, or no attainment. Changes in absolute scores were investigated using paired samples t-tests. Goals had high attainment with a significant positive change (–1.83 [95% CI −2.0, −1.65], p > 0.001) during rehabilitation, whereas goals had no attainment with a significant negative change (0.36 [0.14, 0.57], p > 0.001) between discharge and 12 months after rehabilitation. Goals focusing on everyday routines, physical health, pain management, and social or work participation were highly attained during rehabilitation. Goals that were difficult to enhance or maintain after rehabilitation addressed everyday routines, physical health, and work participation. The positive changes in goal attainment largely occurred during rehabilitation, but they appeared more difficult to maintain at home. Therefore, rehabilitation goals should be reflected in the follow-up care planned at discharge. The contents of rehabilitation goals reflect the complexity and wide range of challenges patients with rheumatic and musculoskeletal diseases experience. Positive changes in goal attainment largely occur during rehabilitation and appear to be more difficult to enhance or maintain at home. Rehabilitation interventions and follow-up care should be tailored to support patients in maintaining their attained goals for healthy self-management. Rehabilitation goals should be reflected in the follow-up care planned at discharge. [ABSTRACT FROM AUTHOR]

Objectives: To explore the content of, and adherence to, self-management activities reported by patients with rheumatic and musculoskeletal diseases (RMDs), and whether adherence to self-management activities is associated with changes in self-reported health and function over a 1-year period following rehabilitation in specialized healthcare. Methods: Participants (n = 523) reported function and health outcomes at admission, discharge, and 4, 8 and 12 months post-rehabilitation. Self-management activities reported at discharge were self-evaluated as adherence level at home. Self-management activity content was linked to the International Classification of Functioning, Disability and Health coding system, and summarized as high or low adherence. Associations between adherence to self-management activities and change in outcomes were investigated using a linear mixed model approach with repeated measures. Results: Self-management activities focused mainly on enhanced physical health and managing everyday routines, and seldom addressed work participation. Adherence to self-management activities was challenging with regard to structure and daily life routines, mental health, and the application of knowledge and coping strategies. Adherence to self-management activities was significantly associated with improvements in all outcomes, except for mental health and activities of daily living. Conclusion: Adherence to self-management activities, and creating structure and setting everyday routines at home, appear to be important for maintaining health and function over time. Rehabilitation should include a greater focus on mental health challenges and work participation. LAY ABSTRACT The aim of this study is to explore the self-management plans reported by patients with rheumatic and musculoskeletal diseases, and whether these plans influenced patients’ health and function after rehabilitation. The participants were followed for 1 year after undergoing rehabilitation and into their home settings. They self-reported their self-management plans, and self-evaluated their adherence to these plans at home. The plans focused mainly on physical health and managing everyday routines. It appears that creating structure and setting routines at home are important for maintaining health and function over time. It was notable that mental health challenges and plans for work participation were seldom prioritized or improved, suggesting a need for greater focus on these issues by healthcare professionals during rehabilitation and in the community.

Vaccination against SARS-CoV-2 to prevent COVID-19 is highly recommended for immunocompromised patients with autoimmune rheumatic and musculoskeletal diseases (aiRMDs). Little is known about the effect of booster vaccination or infection followed by previously completed two-dose vaccination in aiRMDs. We determined neutralizing anti-SARS-CoV-2 antibody levels and applied flow cytometric immunophenotyping to quantify the SARS-CoV-2 reactive B- and T-cell mediated immunity in aiRMDs receiving homologous or heterologous boosters or acquired infection following vaccination. Patients receiving a heterologous booster had a higher proportion of IgM+ SARS-CoV-2 S+ CD19+CD27+ peripheral memory B-cells in comparison to those who acquired infection. Biologic therapy decreased the number of S+CD19+; S+CD19+CD27+IgG+; and S+CD19+CD27+IgM+ B-cells. The response rate to a booster event in cellular immunity was the highest in the S-, M-, and N-reactive CD4+CD40L+ T-cell subset. Patients with a disease duration of more than 10 years had higher proportions of CD8+TNF-α+ and CD8+IFN-γ+ T-cells in comparison to patients who were diagnosed less than 10 years ago. We detected neutralizing antibodies, S+ reactive peripheral memory B-cells, and five S-, M-, and N-reactive T-cells subsets in our patient cohort showing the importance of booster events. Biologic therapy and <10 years disease duration may confound anti-SARS-CoV-2 specific immunity in aiRMDs. [ABSTRACT FROM AUTHOR]

Anne Courbalay,1 Romane Jobard,1 Martin Descarreaux,2 Béatrice Bouvard3,4 1Institut de Formation en Education Physique et en Sport d’Angers (IFEPSA-UCO), APCoSS, Les Ponts de Cé, France; 2Department of Human Kinetics, Université du Québec à Trois-Rivières Québec, Trois-Rivières, Canada; 3Univ Angers, GEROM, SFR ICAT, Angers, France; 4CHU Angers, Service de Rhumatologie, Angers, FranceCorrespondence: Anne CourbalayInstitut de Formation en Education Physique et en Sport d’Angers (IFEPSA-UCO), APCoSS, 49 rue des Perrins - BP 40071, Les Ponts de Cé, 49136, FranceTel +33 2 41 45 26 40Fax +33 2 41 45 26 44Email anne.courbalay@uco.frIntroduction: Using a network analysis, the present study investigated the extent to which physical activity (PA), objective fitness level, kinesiophobia, and health-related quality of life (HRQoL) interact in patients with rheumatic and musculoskeletal diseases. The objectives were twofold: 1) to clarify the direct and indirect relationships between these variables while controlling for the shared variance between them, and 2) to establish a potential ranking of influence among them.Methods: This cross-sectional design study involved patients recruited from a rheumatology unit. One hundred and twenty patients completed self-reported measures of PA, the Tampa scale of kinesiophobia and the 36-item Short-Form Health Survey, and ninety-seven of those patients performed the six-minute walking test and the thirty-second sit-to-stand test. Network analyses were conducted using bootnet and qgraph packages.Results: Weekly time spent on PA, as well as physical fitness measures, were directly linked to kinesiophobia and the HRQoL physical dimension, but indirectly linked to HRQoL mental dimension through the mediation of kinesiophobia. Specifically, weekly PA time had direct relationships to physical functioning, vitality, and role limitations due to physical and emotional problems. Fitness measures had direct relationships with physical functioning, bodily pain, and mental health. The analyses did not clearly highlight one variable as the most influential in the network.Discussion: The study highlights the complexities of direct and indirect biopsychosocial relationships that are at the core of patients’ daily functioning. Measurement of PA, use of a longitudinal design, and interventions are discussed.Keywords: rheumatic and musculoskeletal diseases, health-related quality of life, physical activity, fitness level, kinesiophobia

Purpose: This study analysed the longitudinal associations of physical fitness and affect with depression, anxiety and life satisfaction at 2- and 5-year follow-up. Methods: In 312 adult women with fibromyalgia, physical fitness was measured by performance-based tests and affect, depression, anxiety and life satisfaction were self-reported using the Positive and Negative Affect Schedule (PANAS), Beck Depression Inventory-second edition (BDI-II), State Trait Anxiety Inventory-I (STAI) and Satisfaction with Life Scale (SWLS), respectively. We conducted sequential linear regression analyses adjusted for baseline levels of depression, anxiety, life satisfaction, age, body fat percentage and education. Results: At the 2-year follow-up, all the associations under study were significant. At the 5-year follow-up, a number of associations remained significant. First, lowering negative affect was independently associated with lower depression, anxiety and higher life satisfaction (β's from 0.14 to 0.31). Second, favourable changes in positive affect were independently associated with lower anxiety (β = 0.21) and higher life satisfaction (β = 0.28). Third, enhancing physical fitness was related to higher life satisfaction (β = 0.16). Conclusion: Reductions in negative affect were associated with more favourable depression, anxiety and life satisfaction at the 2- and 5-year follow-up. Improvements in positive affect were associated with more favourable anxiety and life satisfaction and enhancements in physical fitness were associated with higher life satisfaction. If corroborated in clinical–experimental research, these findings may guide the development of interventions that are tailored to the levels of physical fitness, affect and the outcome of interest (i.e. depression, anxiety or life satisfaction) in women with fibromyalgia. [ABSTRACT FROM AUTHOR]

Introduction: Sexual health, pleasure, justice (equity in sexual rights and experiences), and well-being are crucial determinants of health and life quality, yet often overlooked in the rheumatic and musculoskeletal diseases (RMD) field. However, this topic has received more attention recently, and there is a need to map the current literature to inform the direction of future studies. Hence, this protocol outlines a scoping review to systematically map existing evidence on sexual health in people with RMD, exploring key themes and identifying evidence gaps across multiple dimensions, including sexual well-being, justice and pleasure., Method and Analysis: This scoping review will follow the methodological guidance of the Joanna Briggs Institute and be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. The search strategy will involve PubMed, Embase, Cochrane Central, CINAHL, PsychInfo, LGBTQIA+ Source, Web of Science, and the grey literature. Identified articles will be reviewed based on the eligibility criteria. The results will be narratively synthesised and aligned with the framework proposed by Mitchel et al. (2021), identifying four pillars of comprehensive public health for sexuality: 'Sexual Health', 'Sexual Pleasure', 'Sexual Justice', and 'Sexual Well-Being'., Dissemination: The scoping review will synthesise the scientific literature published on sexual health, pleasure, justice and well-being in people with RMD. This review will provide an understanding of how sexual health is addressed in the literature to inform future research and clinical practices. The findings will be disseminated as research publications, including peer-reviewed article(s), conference abstract(s)/presentation(s), and plain language summaries., (© 2025 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Background: Vaccine-induced immunity is essential for controlling the COVID-19 pandemic. Data on humoral and cellular immunogenicity and safety of different SARS-CoV-2 vaccines in patients with autoimmune rheumatic and musculoskeletal diseases (RMDs) are limited. Methods: A single center observational study evaluated the immunogenicity and safety of the two-dose regimen of the BBIBP-CorV inactivated, Gam-COVID-Vac and AZD1222 adenovirus-based, and BNT162b2 and mRNA-1273 mRNA-based vaccines in patients with RMDs (n = 89) compared with healthy controls (n = 74). Neutralizing anti-RBD (receptor binding domain) specific antibodies and SARS-CoV-2 specific T-cell response were measured one and four months after the second vaccine dose in parallel with vaccination efficacy and safety. Results: Disease-specific comparison showed that antibody response at four months was higher in spondylarthropathies compared to rheumatoid arthritis and autoimmune RMDs. Risk factors for reduced immunogenicity included longer disease duration, positive immunoserological profile and anti-CD20 therapy of patients. The rate of positive anti-RBD antibody response for healthy controls versus patients after 4 months post vaccination was 69% vs. 55% for the inactivated viral vaccine BBIBP-CorV, 97% vs. 53% for the pooled data of adenovirus vector-based vaccines Gam-COVID-Vac and AZD1222, or 100% vs. 81% for the pooled data of mRNA vaccines BNT162b2 and mRNA-1273, respectively. Patients who received the Gam-COVID-Vac or mRNA-1273 vaccines had a higher proportion of TNF-α producing CD4+ T-cells upon SARS-CoV-2 antigen stimulation compared to the inactivated viral vaccine. Conclusion: All five investigated vaccines were immunogenic in the majority of patients and healthy controls with variable antibody and T-cell response and an acceptable safety profile. [ABSTRACT FROM AUTHOR]

BackgroundVaccine-induced immunity is essential for controlling the COVID-19 pandemic. Data on humoral and cellular immunogenicity and safety of different SARS-CoV-2 vaccines in patients with autoimmune rheumatic and musculoskeletal diseases (RMDs) are limited.MethodsA single center observational study evaluated the immunogenicity and safety of the two-dose regimen of the BBIBP-CorV inactivated, Gam-COVID-Vac and AZD1222 adenovirus-based, and BNT162b2 and mRNA-1273 mRNA-based vaccines in patients with RMDs (n = 89) compared with healthy controls (n = 74). Neutralizing anti-RBD (receptor binding domain) specific antibodies and SARS-CoV-2 specific T-cell response were measured one and four months after the second vaccine dose in parallel with vaccination efficacy and safety.ResultsDisease-specific comparison showed that antibody response at four months was higher in spondylarthropathies compared to rheumatoid arthritis and autoimmune RMDs. Risk factors for reduced immunogenicity included longer disease duration, positive immunoserological profile and anti-CD20 therapy of patients. The rate of positive anti-RBD antibody response for healthy controls versus patients after 4 months post vaccination was 69% vs. 55% for the inactivated viral vaccine BBIBP-CorV, 97% vs. 53% for the pooled data of adenovirus vector-based vaccines Gam-COVID-Vac and AZD1222, or 100% vs. 81% for the pooled data of mRNA vaccines BNT162b2 and mRNA-1273, respectively. Patients who received the Gam-COVID-Vac or mRNA-1273 vaccines had a higher proportion of TNF-α producing CD4+ T-cells upon SARS-CoV-2 antigen stimulation compared to the inactivated viral vaccine.ConclusionAll five investigated vaccines were immunogenic in the majority of patients and healthy controls with variable antibody and T-cell response and an acceptable safety profile.

Patients and health workers were at high risk of infection during the Sars-Cov-2 pandemic lockdown. For this reason, other medical and clinical approaches such as Telemedicine were necessary. Despite Telemedicine was born before COVID-19, the pandemic was the opportunity to accelerate a process already underway for at least a decade and to blow all the barriers away. Our aim is to describe the experience of Telemedicine during and immediately after the first lockdown to assure the follow-up in a 'virtual' outpatient clinic dedicated to Rheumatic and Musculoskeletal Diseases (RMDs) and to give an overview of Telemedicine in the rheumatology field. We retrospectively evaluated the patient flow to our rheumatology division from March to September 2020 and, in accordance with local restrictions, three periods were selected. In the 1st period, 96.96% of the outpatient clinic cases were shifted to Telemedicine; these decreased to 52.45% in the 2nd period, while the 3rd period was characterized by the return of the patients at the clinic (97.6%). Diagnostic procedures were postponed during the 1st period, reduced drastically during the 2nd and performed regularly during the third period. Intravenous infusions were maintained as much as possible during the three periods, to assure therapeutic continuity. Shifting stable patients to Telemedicine has the potential to allow continuity of care, while reducing the risk of contagion during a pandemic. In the next future, the integration of Telemedicine as standard of care for specific clinical applications might assure assistance for RMDs patients also in non-pandemic conditions. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is associated with autoimmunity and systemic inflammation. Patients with autoimmune rheumatic and musculoskeletal disease (RMD) may be at high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this review, based on evidence from the literature, as well as international scientific recommendations, we review the relationships between COVID-19, autoimmunity and patients with autoimmune RMDs, as well as the basics of a multisystemic inflammatory syndrome associated with COVID-19. We discuss the repurposing of pharmaceutics used to treat RMDs, the principles for the treatment of patients with autoimmune RMDs during the pandemic and the main aspects of vaccination against SARS-CoV-2 in autoimmune RMD patients. [ABSTRACT FROM AUTHOR]

OMERACT uses an evidence-based framework known as the 'OMERACT Filter Instrument Selection Algorithm' (OFISA) to guide decisions in the assessment of outcome measurement instruments for inclusion in a core outcome set for interventional and observational clinical trials. A group of OMERACT imaging and patient-centered outcome methodologists worked with imaging outcome groups to facilitate the selection of imaging outcome measurement instruments using the OFISA approach. The lessons learned from this work influenced the evolution to Filter 2.2 and necessitated changes to OMERACT's documentation and processes. OMERACT has revised documentation and processes to incorporate the evolution of instrument selection to Filter 2.2. These revisions include creation of a template for detailed definitions of the target domain which is a necessary first step for instrument selection, modifications to the Summary of Measurement Properties (SOMP) table to account for sources of variability, and development of standardized reporting tables for each measurement property. OMERACT Filter 2.2 represents additional modifications of the OMERACT guide for working groups in their rigorous assessment of measurement properties of instruments of various types, including imaging outcome measurement instruments. Enhanced reporting aims to increase the transparency of the evidence base leading to judgements for the endorsement of instruments in core outcome sets. [ABSTRACT FROM AUTHOR]

Objectives: To investigate opinion and routine practice of specialists from different disciplines on imaging techniques for interventional procedures related to rheumatic and musculoskeletal diseases (RMDs).Methods: An English-language questionnaire was developed by an international working group and distributed to health care providers of various disciplines involved in the care of people with RMDs via an online survey tool (SoSci Survey®) from December 2019 to May 2020.Results: A total of 1,105 respondents from 56 countries completed the survey, over 60% of participants were rheumatologists. The majority of respondents (88%) performed interventional procedures in RMDs patients and 90% of them used imaging guidance. Ultrasonography was the most frequently used technique, particularly among rheumatologists. X-ray and computed tomography were mainly used by radiologists. A discrepancy emerged between the importance assigned to certain items such as the availability of a second operator and their actual implementation in clinical practice. Local barriers, lack of resources and facilities were mentioned as the most relevant obstacles in this regard. Lack of training on imaging and/or imaging guided procedures did not emerge as a barrier to perform such interventions; in fact, 19% of respondents performing the procedures indicated not to have received adequate training in this field.Conclusions: This is the first multinational multidisciplinary survey exploring in detail the opinions and practice on imaging guidance for interventional procedures in RMDs. A harmonization of protocols based on international guidelines, along with adequate training programmes and interventions on barriers at national/local levels are the main unmet needs requiring attention.

Objectives During the COVID-19 pandemic, much communication occurred online, through social media. This study aimed to provide patient perspective data on how the COVID-19 pandemic impacted people with rheumatic and musculoskeletal diseases (RMDs), using Twitter-based patient-generated health data (PGHD). Methods A convenience sample of Twitter messages in English posted by people with RMDs was extracted between 1 March and 12 July 2020 and examined using thematic analysis. Included were Twitter messages that mentioned keywords and hashtags related to both COVID-19 (or SARS-CoV-2) and select RMDs. The RMDs monitored included inflammatory-driven (joint) conditions (ankylosing spondylitis, RA, PsA, lupus/SLE and gout). Results The analysis included 569 tweets by 375 Twitter users with RMDs across several countries. Eight themes emerged regarding the impact of the COVID-19 pandemic on people with RMDs: (i) lack of understanding of SARS-CoV-2/COVID-19; (ii) critical changes in health behaviour; (iii) challenges in healthcare practice and communication with healthcare professionals; (iv) difficulties with access to medical care; (v) negative impact on physical and mental health, coping strategies; (vi) issues around work participation; (vii) negative effects of the media; and (viii) awareness-raising. Conclusion The findings show that Twitter serves as a real-time data source to understand the impact of the COVID-19 pandemic on people with RMDs. The platform provided 'early signals' of potentially critical health behaviour changes. Future epidemics might benefit from the real-time use of Twitter-based PGHD to identify emerging health needs, facilitate communication and inform clinical practice decisions. [ABSTRACT FROM AUTHOR]

• Clear definition of the domain we want to measure is a necessary prerequisite to the selection of a good instrument. • Measurement instruments, whatever the domain they strive to measure, are always the result of the interaction between the instrument (technique+ application + scoring system) and a domain of interest, and it is always the score that is used to represent the domain. • Imaging outcome measurement instruments for research are not the imaging techniques themselves (i.e. ultrasound or X-ray), but the result of a formalized interpretation (through a scale or score) • Clear identification of the sources of variability that can directly influence the instrument and therefore the measurement of the domain of interest should be clearly identified before endorsing any outcome measurement instrument Imaging is one of the most rapidly evolving fields in medicine. Unfortunately, many imaging technologies have been applied as measurement instruments without rigorous evaluation of the evidence supporting their truth, discriminatory capability and feasibility for that context of use. The Outcome Measures in Rheumatology (OMERACT) Filter 2.1 Instrument Selection Algorithm (OFISA) is used to evaluate such evidence for use of an instrument in a research setting. The objectives of this work are to: [1] define and describe the key conceptual aspects that are essential for the evaluation of imaging as an outcome measurement instrument and [2] describe how these aspects can be assessed through OFISA. Experts in imaging and/or methodology met to formalize concepts and define key steps. These concepts were discussed with a team of patient research partners with interest in imaging to refine technical and methodological aspects into comprehensible information. A workshop was held at OMERACT2020 and feedback was incorporated into existing OMERACT process for domain and instrument selection. Three key lessons were identified: (1) a clear definition of the domain we want to measure is a necessary prerequisite to the selection of a good instrument, (2) the sources of variability that can directly influence the instrument should be clearly identified, (3) incorporating these first two lessons into OFISA improves the quality of every instrument selection process. The incorporation of these lessons in the updated OMERACT Filter (now 2.2) will improve the quality of the selection process for all types of outcome measurement instruments. [ABSTRACT FROM AUTHOR]

Objectives: To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic. Method: A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1–3, 4–6 and 7–9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a 'low' level of agreement. Results: A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting. Conclusions: The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges. Key Points • AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic. • COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to the African rheumatologists. • Hydroxychloroquine shortage has become rampart across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of treatment plan for some patients with RMDs. • Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk. [ABSTRACT FROM AUTHOR]

Objectives The aim was to compare the impact of the first wave of the coronavirus disease 2019 (COVID-19) pandemic and lockdown measures on patients with rheumatic and musculoskeletal diseases (RMDs) in the UK and other European countries (OEC). Methods REUMAVID was an online cross-sectional survey of seven European countries. The data collected included the following: demographics, lifestyle, employment, access to health-care services, disease-specific characteristics, the World Health Organization five well-being index (WHO-5), hospital anxiety and depression scale (HADS), visual analogue scale (VAS) disease activity, and the perceived acceptable symptom scale. Results One thousand eight hundred responses were received between April and July 2020 [UK, n = 558 (31.0%); OEC, n = 1242 (69.0%)]. UK patients were more likely to be older [mean (S.d.): UK 58.5 (13.4) years; OEC 50.0 (12.2) years], university educated [UK n = 302 (54.1%); OEC n = 572 (46.1%), quit smoking [UK n = 92 (59.4%); OEC n = 65 (16.2%)] and continue exercise [UK, n = 216 (49.2%); OEC, n = 228 (33.1%)], although, conversely, alcohol consumption increased [UK n = 99 (36.3%); OEC n = 98 (12.1%)]. UK patients felt informed about COVID-19 (UK 72.7%, OEC 57.4%) and kept their planned rheumatology [UK n = 87 (51.2%); OEC n = 213 (38.6%)] and/or general practice appointments [UK n = 87 (76.3%); OEC n = 310 (53.9%)]. Almost half the patients with RMDs reported a decline in health and well-being, although this was less common in UK patients [UK n = 214 (38.4%), OEC n = 618 (50.2%)], who reported better perceived acceptable symptom scale, VAS pain and HADS scores, but worse WHO-5 scores. Conclusions UK RMD patients performed better in the physical and mental health domains tested, possibly owing to a less restrictive lockdown and better health-care access. These findings have implications for health-care services globally in planning patient care after the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

To investigate identifying the knowledge levels, behavior attitude and belief levels about rheumatic and musculoskeletal diseases (RMDs) and spa treatments (ST) among health workers in communication with patients and determining target groups for health training. Cross-sectional, descriptive study. Bolu Izzet Baysal Physical Medicine and Rehabilitation Education and Research Hospital and Izzet Baysal Education and Research Hospital 01.04.2019-15.04.2019. 600 participants completed 6 descriptive questions with yes-no answers about demographic characteristics and completed a survey determining knowledge levels about RMDs and ST as correct or incorrect. Though there was statistically significant difference in favor of women about RMDs knowledge level, there was no statistically significant difference between 2 groups for ST knowledge levels. When RMDs and ST knowledge levels are compared, doctors and physiotherapists had statistically similar knowledge levels, with statistically significant level of difference compared to the other groups. Among groups reporting similar opinions about the efficacy of ST, there was no statistically significant difference identified between RMDs knowledge levels, with a statistically significant level of difference identified for ST knowledge levels. Apart from doctors and physiotherapists, 307 other health workers did not have RMDs themselves or in their family, while only 167 had RMDs themselves and 126 stated both they and their family had RMDs. There was a statistically significant difference identified for RMDs knowledge levels. We found that even among the health workers who communicate with patients in hospitals, the level of knowledge with RMDs and ST is very variable. Taking this into account, we believe that all personnel should be provided with supportive scientific information and training in order to ensure that the health workers who are intertwined with the health problems of the individuals reach the correct information. [Med-Science 2019; 8(4.000): 901-7]

Objectives To assess acceptability of teleconsultation among the socioeconomically marginalized sections of patients with rheumatic and musculoskeletal diseases (RMDs), to identify the socioeconomic barriers in continuing rheumatology care during the COVID-19 crisis and to identify patients who could benefit by shifting to tele-rheumatology consultations. Methods This was a cross sectional analytical study done at a tertiary care teaching hospital in India including patients with RMDs who were not on biological diseases modifying agents. Assessment of disease status, socioeconomic status and economic impact of COVID-19 was done via tele-consultation. Results Out of the 680 patients satisfying inclusion criteria, 373 completed the study. The format was found easy by 334 (89.6%) of them and 284 (76.1%) considered tele-rheumatology better than in-person consultation. During the pre-COVID months, the median monthly per capita income of the families of our patients and cost of illness was Indian rupees (INR) 2000 (US$ 26) and INR 1685 (US$ 21.91), respectively. Families whose financial needs were met (OR = 0.38, 95% CI: 0.239, 0.598) or those with schooling upto at least secondary school (OR = 0.442, 95% CI: 0.260, 0.752) (P  =0.002) were less likely to stop prescription drugs. In a hypothetical model, 289 (77.4%) could be successfully switched to tele-rheumatology follow-up. Conclusion The acceptability of tele-rheumatology among socioeconomically marginalized patients with RMDs is good. During times of crisis, patients from poorer strata of society and lower educational background are likely to abruptly stop medications. Switching to a telemedicine-based hybrid model is likely to improve drug adherence with substantial savings on loss of pay and out of pocket expenditure. [ABSTRACT FROM AUTHOR]

To describe the delivery of care for patients with rheumatic and musculoskeletal diseases (RMDs) from the perspective of rheumatologists in the Netherlands during the first months of the COVID-19 pandemic. A mixed methods design was used with quantitative and qualitative data from a cross-sectional survey sent to all members of the Dutch Rheumatology Society in May 2020. The survey contained questions on demographics, the current way of care delivery, and also on usage, acceptance, facilitators and barriers of telemedicine. Quantitative data were analyzed descriptively. The answers to the open questions were categorized into themes. Seventy-five respondents completed the survey. During the COVID-19 pandemic, continuity of care was guaranteed through telephone and video consultations by 99% and 9% of the respondents, respectively. More than 80% of the total number of outpatient visits were performed exclusively via telephone with in-person visits only on indication. One-quarter of the respondents used patient reported outcomes to guide telephone consultations. The top three facilitators for telemedicine were less travel time for patients, ease of use of the system and shorter waiting period for patients. The top three barriers were impossibility to perform physical examination, difficulty estimating how the patient is doing and difficulty in reaching patients. During the COVID-19 epidemic, care for patients with RMDs in the Netherlands continued uninterrupted by the aid of telemedicine. On average, respondents were content with current solutions, although some felt insecure mainly because of the inability to perform physical examination and missing nonverbal communication with their patients. [ABSTRACT FROM AUTHOR]

Background: To assess the prevalence and risk factors associated with hydroxychloroquine (HCQ) retinopathy in patients with rheumatic and musculoskeletal diseases (RMD). Methods: Retrospective observational study was conducted on 984 patients using HCQ for RMD to detect prevalence of retinopathy by Humphrey visual field, spectral‑domain optical coherence tomography, fundus autofluorescence test, and multifocal electroretinography (mfERG). Results: The patients’ age ranged between 13 and 79 years and 85.8% were female. The prevalence of retinopathy was 13.5% in cases treated with HCQ. It was significantly more in the higher age group (>60 years) compared to lower age (<30 years), P = 0.033, but not significantly associated with gender, body mass index, hypertension, diabetes mellitus, hypothyroidism, and various RMD. In addition, retinopathy was not significantly associated with HCQ dose/day (P = 0.101), but was significantly associated with duration of HCQ treatment (12.2% prevalence with < 5 years treatment, while 19.8% with 5–10 years HCQ use; P = 0.017). A statistically significant difference was found between median duration of patients with and without retinopathy (36 vs. 30 months; P = 0.046). The mean cumulative HCQ dose in retinopathy patients was significantly high compared to nonretinopathy patients (283.79 g vs. 231.33 g; P = 0.006). Among the individual (possible retinopathy) tests, mfERG had the highest detection rate (11.4%) for retinopathy screening, whereas Humphrey visual field analyzer test (HVF) + mfERG had the highest detection rate among the combination (definite retinopathy) tests (12.8%). Conclusions: The high prevalence of retinal toxicity in patients with 1–5 years of HCQ therapy prompts the need for frequent ophthalmic screening, even before completion of 5 years of treatment. [ABSTRACT FROM AUTHOR]

Since 1996, October 12th is recognized as World Arthritis Day. A global initiative bringing people together to raise awareness of rheumatic and musculoskeletal diseases (RMDs), established by Arthritis and Rheumatism International (ARI) and managed by the European League Against Rheumatism (EULAR).