Patient prioritisation of impact items to develop the patient-reported impact of dermatological diseases (PRIDD) measure: European Delphi data

BACKGROUND

The Global Research on the Impact of Dermatological Diseases (GRIDD) project is developing a patient-reported measure of the impact of dermatological disease on the patient's life called Patient Reported Impact of Dermatological Diseases (PRIDD). We developed a list of 263 potential impact items through a global qualitative interview study with 68 patients. We next conducted a Delphi study to seek consensus on which of these items to prioritize for inclusion in PRIDD. This study aims to explore patterns in demographic (e.g. country) and clinical variables (e.g. disease group) across the impacts ranked as most important to European dermatology patients.

METHODS

We conducted a modified, two rounds Delphi study, testing the outcomes from the previous qualitative interview study. Adults (≥18 years) living with a dermatological disease were recruited through the International Alliance of Dermatology Patient Organizations' (GlobalSkin) membership network. The survey consisted of a demographic questionnaire and 263 impact items and was available in six languages. Quantitative data were collected using ranking scales and analysed against a priori consensus criteria. Qualitative data were collected using free-text responses and a Framework Analysis was conducted. European data were obtained, and descriptive statistics, including multiple subgroup analyses, were performed.

RESULTS

Out of 1154 participants, 441 Europeans representing 46 dermatological disease from 25 countries participated. The results produced a list of the top 20 impacts reported by European patients, with psychological impacts accounting for the greatest proportion.

CONCLUSION

This study identified what patients consider to be the most important issues impacting their lives as a result of their dermatological disease. The data support previous evidence that patients experience profound psychological impacts and require psychological support. The findings can inform research, clinical practice and policy by indicating research questions and initiatives that are of most benefit to patients.

AB0809 Assessment of the Impact of Axial Spondyloarthritis on Patient’s Social Life. Results from the European Map of Axial Spondyloarthritis (EMAS)

Background

As spinal mobility becomes progressively impaired and pain levels escalate, difficulty in performing simple physical routines places a huge burden on axial spondyloarthritis (axSpA).

Objectives

The aim is to evaluate the impact of axSpA on patients’ social life and to identify the factors associated with this.

Methods

Data from 2,846 unselected patients participating in EMAS, an online survey (2017-2018) across 13 European countries, were analysed. Impact of axSpA on social life was assessed by: “Score your relationships since you have been affected by Spondylitis / Spondyloarthritis” [Much worse to much better relationships with spouse, family, friend, and neighbours], and “Please indicate the frequency with which you do the following activities since you became affected by Spondylitis/ Spondyloarthritis?” [Much less frequent to much more frequent engagement in restaurants, cultural outings, travel, and sports]. Patients who rated at least one relationship as “worse/much worse” and at least one of social activity as “less/much less frequent” were considered to have a negatively impacted social life. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health via the General Health Questionnaire GHQ-12 (0-12) were assessed. Univariable and multivariable binary logistic regression were used to identify variables possibly explaining negative impact on social life (n= 2,120).

Results

Mean age was 43.8±12.3 years, 61.5% female, 49.2% had a university degree, and 68.2% married. 44.9% (n= 1,205) patients had their social life negatively impacted since the onset of axSpA.

Those experiencing a negative impact on their social life were more frequently females (49.5% vs. 37.5% males, p<0.001), divorced/separated (59.5% vs. 34.4% widowed, p<0.001), and on sick leave (temporary and permanent) or unemployed (63.9%, 60.9% and 57.0% vs. 36.8% employed, p<0.001). Furthermore, those whose social life was negatively impacted reported greater BASDAI (6.2 vs. 5.0), functional limitation (24.4 vs. 17.4), spinal stiffness (8.4 vs. 7.3), longer diagnostic delay (9.7 vs. 7.4), poorer mental health (6.7 vs. 3.6), anxiety (62.6% vs. 37.1% no anxiety), depression (61.9% vs. 38.5% no depression), or sleep disorders (55.7% vs. 37.5% no sleep disorders), all p<0.001.

The variables associated with negative impact on social life in the multivariable logistic regression were higher disease activity (OR=1.15), poor mental health (OR=1.14), being on a sick leave/unemployed (OR=1.49), divorced/separated (OR=1.46), anxiety (OR= 1.41) and female gender (OR= 1.30; Table 1).

Table 1.

Factors associated with a worsening social life (n= 2,120)

Univariable logistic analysisMultivariable logistic analysisORCI 95%ORCI 95%Age0.990.98, 0.991.000.99, 1.01Gender. Female11.631.39, 1.911.301.06, 1.60Marital status. Divorced/separated21.931.48, 2.501.461.05, 2.04Employment status. Sick Leave/Unemployed32.662.24, 3.171.491.20, 1.85BASDAI (0-10)1.411.35, 1.481.151.08, 1.22Functional Limitation (0-54)1.031.02, 1.031.021.09, 1.02Spinal Stiffness (3-12)1.201.16, 1.241.061.01, 1.11Diagnostic delay1.021.01, 1.031.010.99, 1.02GHQ-12 (0-12)1.221.19, 1.241.141.11, 1.17Anxiety2.842.39, 3.371.411.08, 1.83Depression2.592.17, 3.101.140.87, 1.49Sleep disorders2.101.79, 2.461.020.81, 1.27

1Female vs. male; 2Divorced/separated vs. single/married/widow; 3Sick leave/unemployed vs. other employment status.

Conclusion

Almost half of the axSpA patients reported to have negatively impacted their social life. Being female, divorced/separated, on sick leave/unemployed, with higher disease activity, poor mental health, and anxiety increase the likelihood of worsening social life. As relationships with others and engagement in social or community activities influence quality of life, greater attention to enabling individuals to participate socially through controlling disease activity and addressing mental health comorbidity in the management of axSpA.

Acknowledgements

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests

Marco Garrido-Cumbrera Grant/research support from: has a research collaboration with and provides services to Novartis Pharma AG, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Raj Mahapatra: None declared, Souzi Makri Grant/research support from: Novartis, GSK and Bayer, José Correa-Fernández: None declared, Laura Christen Employee of: Novartis Pharma AG, Carlos Jesús Delgado-Domínguez: None declared, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis and Pfizer

POS1052 DEVELOPING EVIDENCE-BASED PATIENT FOCUSED LEARNING MATERIALS TO SUPPORT HEALTH BEHAVIOUR CHANGE FOR PEOPLE LIVING WITH PSORIATIC ARTHRITIS

Background

Psoriatic arthritis (PsA) is a complex condition that requires high levels of self-management from those living with the condition. It is associated with many comorbidities, including depression, metabolic syndrome, and increased cardiovascular disease risk and can adversely affect quality of life. There is growing evidence that people living with psoriatic arthritis (PsA) are more likely to be overweight, consume alcohol above recommended levels, smoke, be affected by poor sleep, fatigue, anxiety, and take insufficient exercise for healthy living. These modifiable health behaviours further increase the already known risk of cardiovascular morbidity and mortality. These issues are not systematically addressed in routine clinical care due to low confidence in effective delivery and time constraints.

Objectives

To co-develop evidence-based patient-focused learning materials to support healthy lifestyle changes for people living with PsA.

Methods

The development of the materials was overseen by a steering group of people living with PsA, psychologists, rheumatologists, and researchers. The COM-B model was used in the development of the materials, and they are designed around motivational interviewing principles. Firstly, a systematic literature review was performed to establish the evidence for the current burden and potential interventions aimed at these issues in PsA. These included diet, weight, alcohol, smoking, exercise, anxiety, depression, and stress. An initial focus group of people living with PsA was used to identify priority behaviours and ideas for content.

The steering group developed draft materials, and we partnered with a design agency to create engaging materials. They developed a website and downloadable postcards. A second focus made up of people living with PsA was held for people to give their views on the draft content for the materials and initial design ideas. A third focus group was held with people living with PsA and a fourth with clinicians to refine the design materials and ensure they were accessible, interesting, and helpful to initiate and maintain change. A final evaluation survey was performed to review the draft website before launching the final materials. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) approved the final materials.

Results

Following the steering and focus groups’ input, 15 candidate topics were prioritised (Table 1). A website and downloadable postcards summarising each of the topics were developed by the design team and refined following feedback from the patient focus groups. An example of the postcard for ‘keeping active’ can be found in Figure 1. The resources are free to use and can be accessed at https://www.informatree.org.

Table 1.Topics1Pain2Fatigue3Healthcare appointments4Tobacco5Different treatments6Alcohol7Work8Social support9Food and weight10Sleep11Keeping active12Mood13Intimacy14Travel15Using treatmentsFigure 1.

During the development of the website and downloadable postcards, particular attention was paid to making the material as accessible and as friendly as possible for patients.

Conclusion

This project created patient-focused information to support behaviour change in clinical practice. It addresses common concerns of people living with PsA about how they may optimise their health by providing practical and brief interventions to challenge and support them to make personal changes. Future research is needed to test the impact of the resource.

Acknowledgements

This research project was funded by a Medical Education Grant from Pfizer. SK was funded by Cancer Research UK (grant C49297/A27294).

Disclosure of Interests

Louise Hailey: None declared, Christine Bundy Consultant of: Over the last 3 years, I have received funds for consultancy from the following pharmaceutical companies: Abbvie, Almirall, Amgen (was Celgene), Beiersdorf, Janssen, Novartis, Pfizer, UCB., Grant/research support from: Over the last 3 years, I have received funds for research and honoraria from the following pharmaceutical companies: Abbvie, Almirall, Amgen (was Celgene), Beiersdorf, Janssen, Novartis, Pfizer, UCB., Laura Howells: None declared, Shona Kirtley: None declared, Sam Martin: None declared, Denis O’Sullivan: None declared, Ingrid Steinkoenig: None declared, Melissa Stepney: None declared, Laura Coates Speakers bureau: LCC has been paid as a speaker for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer and UCB.

, Consultant of: LCC has worked as a paid consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB., Grant/research support from: LCC has received grants/research support from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB.

The role of native language use in motivational interviewing

Introduction

A native language is a language that a person has been subjected to from birth or within a period in childhood where a language is acquired. Motivational Interviewing (MI) is a collaborative, goal-oriented style of communication with an emphasis on change. It has been developed to encourage a person’s motivation through compassion and acceptance. ‘The spirit’ of MI is captured through its key concepts include collaboration, evocation, and autonomy. Emotion and the therapeutic relationship are also important features of this connection within the MI process (1). Research on bilingualism and emotions has found that bilingual speakers show stronger emotional responses in their first language compared to their second language (2).

Aim

To explore the role of native language use between health care practitioners and their clients during Motivational Interviewing and other consultations related to behaviour change.

Methods

After obtaining ethics consent, participants were recruited using a snowball sampling technique. Semi-structured interviews were conducted with 19 health care practitioners (HCP’s) from various disciplines including pharmacists, psychologists, nurses, a psychiatrist, a G.P and dieticians. The interview schedule included questions about the HCP’s native language, language choices, their professional and MI experience. The interviews were conducted via video calls; eleven in Welsh and eight in English. The transcribed interviews were recorded and analysed using a Thematic Analysis approach and a synthesis of the themes were created.

Results

Four main themes were identified, with several sub-themes, which included: 1.) Language and Motivational Interviewing (internal dialogue, unique role of the individual’s words, use of translators); 2.) Therapeutic Relationship (respect and empathy, being heard, connection, non-verbal communication, trust, and autonomy) 3.) Emotion (a comfortable environment, depth, emotion, and the process of change) 4.) Culture and Identity (native language, acknowledge individual differences).

“I think emotion is crucial to the change process…..so being able to touch people emotionally is really important…..it definitely works much easier in their own native language”(Psychiatrist).

Conclusion

Many of the HCP’s recognised that communicating with a client in their native language had a positive effect on the therapeutic relationship especially while using MI. This experience was not unique to HCP’s who spoke Welsh as their first language. It was suggested that there is something subtle and powerful occurring on several levels in the process of communicating and maintaining relationships linguistically, particularly when communicating in a native language, and emotion plays a key role in this process.

Recommendations

Creating a network and a database of Welsh-speaking MI practitioners, offering better training through the medium of Welsh, and recognising that an individual does not have to be fluent in Welsh and should encouraged to speak whatever the standard of their Welsh were key recommendations.

The advantage of this research is that it has been possible to gather and analyse individualistic perspectives of the HCPs on a deeper level. The smaller sample size of this research can also be a disadvantage, as a small sample is not always representative of a larger population demographic.

References

(1) Miller W R, Rollnick S (2002). Motivational interviewing: Preparing people for change. New York: Guilford Press.

(2) Caldwell-Harris, C. (2014). Emotionality differences between a native and foreign language: Theoretical implications. Frontiers in Psychology, 5. doi: 10.3389/fpsyg.2014.01055

POS0244 PATIENT JOURNEY WITH AXIAL SPONDYLOARTHRITIS: CRITICAL ISSUES FROM THE PATIENT PERSPECTIVE. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

The journey of axial spondyloarthritis (axSpA) for most patients is slow and arduous.

Objectives:

The goal of this analysis is to describe the journey to diagnosis and further management in axSpA patients.

Methods:

2,846 unselected patients participated in EMAS, a cross-sectional study (2017-2018) across 13 European countries. Descriptive analysis of sociodemographic factors, insurance scheme, diagnostic journey and post diagnosis healthcare utilization was performed. Mann-Whitey test was used to analyse possible differences between BASDAI (>4 v ≤4) and the number of visits to healthcare professionals and follow-up tests undertaken.

Results:

Mean age was 43.9 years, 61.3% were female, 48.1% university educated, 67.9% married, 53.9% employed and 81.7% had public health insurance. Mean age at symptoms onset was 26.6 (11.1), while mean age at diagnosis was 33.7 (11.5) and mean diagnostic delay was 7.4 years. Over 50% had a diagnostic delay of ≥4 years. Prior to receiving a diagnosis, patients visited on average 2.6 specialists. The most commonly performed diagnostic tests were x-rays (72.3%), HLA B27 tests (65.4%) and MRIs (64.3%). 78.4% were diagnosed by a rheumatologist while 14.9% received their diagnosis by a GP. Patients who experienced a diagnostic delay of more than a year (n= 2,208) undertook a considerable number of visits to specialists and medical tests in the year prior to participating in EMAS, which increased with disease activity. Patients with active disease (BASDAI >4) reported a higher number of visits to rheumatologists (3.7±3.5 vs 2.9±2.6), general practitioners (6.6±10.0 vs 3.5±4.1), physiotherapists (19.3±25.0 vs 11.7±17.0), and psychologists/psychiatrists (3.4±10.7 vs 1.9±7.7). Patients with active disease also undertook more x-rays (1.8±2.8 vs. 1.3±1.9), MRI scans (0.9±1.2 vs. 0.6±1.1), and blood tests (4.7±4.4 vs 3.6±3.2). However, one in five patients visited the rheumatologist only once in the year prior to EMAS (21.1%).

Conclusion:

Diagnostic delay continues to be a key challenge in the axSpA patient journey, with patients waiting an average of 7.4 years and visiting multiple doctors prior to diagnosis. Once diagnosed, disease management presents a further challenge, as patients with higher disease activity reported more healthcare professional visits as well as medical tests. Safeguarding health and controlling healthcare utilization requires effective disease management, greater education for non-specialists, rapid referral routes for diagnosis and collaborative care between specialists and non-specialists.

Figure 1.

axSpA Patient journey according to EMAS

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all participants who participated in this study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis and Pfizer, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, Sergio Sanz-Gómez: None declared, Pedro Plazuelo-Ramos: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

POS0960 PRESENCE AND ASSOCIATED FACTORS OF FATIGUE IN PATIENTS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Fatigue/tiredness is an essential aspect of disease for patients with axial spondyloarthritis (axSpA). However, little is known about its prevalence and associated factors.

Objectives:

The aim is to assess the prevalence of fatigue and associated factors in a large sample of patients with axSpA patients from 13 European countries.

Methods:

Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries were analyzed.

The presence of fatigue/tiredness was evaluated using the Visual Analogue Scale from the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): “How would you describe the overall level of fatigue/tiredness you have experienced? (0-10)”. Risk of poor mental health was assessed using the 12-Item General Health Questionnaire (GHQ-12; 0-12).

Possible associated factors included: Socio-demographic and disease characteristics, disease activity and function and mental health disorders.

The Mann-Whitney test was used to compare the means of variables of two categories vs. the numerical variables, the χ2 test was used to compare the distribution between the categorical variables. Binary logistic regression and multiple linear regression were used to identify possible predictors.

Results:

A total of 2,846 axSpA patients participated in the EMAS survey: mean age was 43.9 years, 61.3% female, 48.1% had a university degree, 67.9% were married and 71.3% were HLA-B27 positive. Fatigue/tiredness was associated with younger age (6.4±2.3 vs 5.5±2.4), being female (6.6±2.2 vs 5.7±2.4), lower educational level (6.9±2.4 vs 6.0±2.0) and separated or divorced persons (6.8±2.2 vs 6.2±2.3; all p<0.001). Those reporting work impact (6.8±2.1 vs 5.8±2.4), physically inactive (6.9±2.2 vs 6.1±2.3) or those with sleep disorders (7.0±2.0 vs 5.8±2.4), anxiety (7.0 ± 2.0 vs 5.9±2.4) or depression (7.2±1.9 vs 5.9±2.4; all p<0.001) also presented greater fatigue, as did those with higher morning stiffness (r=0.499) and functional limitation (r=0.257), and poorer mental health GHQ-12 (r=0.419). Finally, the variables independently associated with fatigue were female gender (B=0.427), being physical inactive (B=-0.395) and those with greater morning stiffness severity (B=0.349; see Table 1). In addition, those on temporary and permanent sick leave, along with the unemployed, presented greater fatigue (7.1, 6.8 and 7.1 respectively).

Table 1.

Linear regression analysis to predict presence of fatigue/tiredness (N = 2052)

SimpleMultivariateB95% CIp-valueB95% CIp-valueAge-0.018-0.025, -0.011<0.001*-0.015-0.022, -0.008<0.001Gender (female)0.8380.659, 1.017<0.001*0.4270.264, 0.590<0.001Marital status (married)0.1900.042, 0.3390.012*0.1620.021, 0.3020.024*Educational level (university)-0.274-0.402, -0.146<0.001*-0.128-0.245, -0.0120.031*BMI (Overweight/Obesity)0.151-0.026, 0.3280.094NANANAMorning stiffness severity (0-10) *0.4730.442, 0.505<0.001*0.3490.314, 0.385<0.001*Functional limitation (0-54)0.0380.032, 0.044<0.001*0.0140.008, 0.019<0.001*Reported Work impact (yes)0.9360.753, 1.119<0.001*0.2280.068, 0.3890.005*Physical activity (yes)-0.726-0.968, -0.485<0.001*-0.395-0.611, -0.178<0.001*Sleep disorder (yes)1.1911.013, 1.368<0.001*0.2760.095, 0.4580.003*Anxiety (yes)1.1390.950, 1.327<0.001*0.002-0.215, 0.2200.982Depression (yes)1.2741.079, 1.469<0.001*0.2230.001, 0.4460.049*GHQ-12 (0-12) **0.2340.215, 0.254<0.0010.1100.088, 0.132<0.001*

*As measured by the respective item of the BASDAI scale

**12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental health

Conclusion:

Fatigue/tiredness was highly prevalent among axSpA European patients with female gender, engage in physical activity and those with greater morning stiffness severity most strongly associated, and the unemployed presenting greatest fatigue.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Sergio Sanz-Gómez: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

POS0990 FACTORS ASSOCIATED WITH ENGAGING IN PHYSICAL ACTIVITY IN AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Physical activity is an essential component in axial spondyloarthritis (axSpA) care, improving physical and mental well-being.

Objectives:

This analysis aims to identify factors associated with engaging in physical activity among axSpA patients.

Methods:

Data from 2,424 unselected patients participating in EMAS (N=2,846), a cross-sectional study (2017-2018) across 13 European countries, were analysed. Engaging in physical activity was assessed by the following item: “Do you do any physical or sporting activity?” for which participants could report at least 1 physical activity or that they did not do any physical activity. BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and mental health using General Health Questionnaire GHQ-12 (0-12) were assessed. Mann-Whitney and Pearson’s χ2 tests were used to analyse relationships between engaging in physical activity and sociodemographic factors, patient-reported outcomes, employment, lifestyle and comorbidities. Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining engagement in physical activity.

Results:

Mean age was 43.9±12.3 years, 61.3% were female, 48.1% had a university degree and 67.9% were married. 81.8% (n= 2,329) engaged in at least one kind of physical activity. Those physically active were typically male (85.3% vs 79.7% female, p<0.001), university educated (86.0% vs 78.0%, p<0.001), married (83.1% vs 79.2% unmarried, p=0.046), and members of a patient organisation (86.4% vs 78.9% non-member, p<0.001). 25.1% of obese patients (n=533) did not engage in physical exercise (v. 16.6% not obese, p<0.001). Those not engaging in physical activity reported greater disease activity (6.0 vs 5.4 BASDAI, p<0.001), functional limitation (21.6 vs 20.2, p=0.010), spinal stiffness (8.3 vs 7.6, p<0.001), and poorer mental health (5.9 vs 4.8 GHQ-12, p<0.001). Furthermore, 83.9% of those employed (n=1,457) were physically active, versus 73.7% unemployed (n=205; p<0.001). In the multivariable binary logistic regression, the qualitative variables associated with engaging in physical activity were belonging to a patient organisation (OR= 1.91), not being obese (OR= 1.58), being university educated (OR= 1.54), and being male (OR= 1.39). The quantitative variables associated with engaging in physical activity were lower spinal stiffness (OR=0.90), better mental health (OR=0.96), and one-year age increase (OR=1.02). (Table 1).

Table 1.

Regression analysis for variables explaining engagement in physical activity (n=2,424)

Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI7OR95% CI7Gender. Male11.481.21, 1.811.391.06, 1.82Educational level. University21.731.42, 2.111.541.18, 2.00Marital Status. Married31.731.06, 1.581.180.91, 1.54Patient organization. Member41.71)1.39, 2.101.911.43, 2.55Body Mass Index. Not Obese51.691.35, 2.121.581.17, 2.13Employment status. Employed61.281.06, 1.561.000.76, 1.32Quantitative variablesOR95% CI7OR95% CI7Age1.011.00, 1.021.021.01, 1.03BASDAI (0-10)0.860.82, 0.910.960.89, 1.04GHQ-12 (0-12)0.940.92, 0.960.960.93, 0.99Functional Limitation (0-54)0.990.99, 1.001.000.99, 1.01Spinal Stiffness (3-12)0.900.86, 0.940.900.84, 0.95Proportion of life with axSpA (0-1)2.831.50, 5.352.000.91, 4.39

1Male vs Female; 2University vs no university; 3Married vs unmarried; 4Member vs not; 5Not obese (underweight, normal and overweight) vs obese; 6Employed vs not (unemployed, sick leave, retirement, housework and student).795% CI for test H0: OR=1

Conclusion:

These results show that increasing age, being male, university educated, member of a patient organisation, not obese, having lower spinal stiffness, and better mental health increase the probability of engaging in physical activity. Physical activity is an important part of axSpA care and patient organizations play a critical role in enhancing access to and participation in physical activity.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: Abbvie, MSD, Novartis, and Pfizer, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

POS0989 FACTORS ASSOCIATED WITH INABILITY TO WORK AND DISABILITY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Axial spondyloarthritis (axSpA) is associated with a high burden of disease, which may lead to inability to work and disability.

Objectives:

This analysis aims to identify factors associated with inability to work and disability among European axSpA patients.

Methods:

Data from 2,846 unselected patients participating in EMAS, a cross-sectional study (2017-2018) across 13 European countries were analysed. The sample was divided into those on permanent sick leave or with a recognised disability (Group 1) and those with neither permanent sick leave nor a recognized disability (Group 2). Mann-Whitney and Pearson’s χ2 tests were used to analyse possible differences between groups regarding sociodemographic characteristics, patient-reported outcomes [BASDAI (0-10), GHQ-12 (0-12), functional limitation (0-54) and spinal stiffness (3-12)], lifestyle habits, working life, and comorbidities). Univariable and multivariable binary logistic regression were used to analyse variables possibly explaining being on permanent sick leave and disability, for which 1,657 patients were included.

Results:

Mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 67.9% were married. Patients in Group 1 (34.4%; n=978) were more likely to be women (54.3%), married (71.1%), with higher disease activity (BASDAI 5.9 vs. 5.3), functional limitation (25.1 vs. 18.0), spinal stiffness (8.6 vs. 7.3; all p<0.001), and longer diagnostic delay (8.1 vs 7.1 years; p = 0.01) than those in Group 2 (65.6%; n=1,868). In addition, 88.0% of Group 1 (n=728) had difficulties in finding a job due to axSpA throughout life; and more than 30.0% reported a diagnosis of anxiety, depression, or sleep disorders. Moreover, being in Group 1 was associated with higher functional limitation in all daily activities. In the multivariable binary logistic regression, the qualitative variables associated with permanent sick leave or disability were: difficulties finding work (OR= 2.52), belonging to a patient organisation (OR= 1.54) and work choice determined by axSpA (OR= 1.38). The quantitative variables associated with permanent sick leave or disability were: higher spinal stiffness (OR= 1.09), older age (OR= 1.03), longer disease duration (OR= 1.03), shorter diagnostic delay (OR= 0.98), and higher functional limitation (OR= 1.01) (Table 1).

Table 1.

Regression analysis for variables explaining being on permanent sick leave or disability (n=1,657)

Univariable logistic analysisMultivariable logistic analysisQualitative variablesOR95% CI3OR95% CI3Gender11.571.34, 1.831.240.97, 1.57Educational level21.711.46, 2.001.080.86, 1.35Member of a patient organisation. Yes1.961.67, 2.291.541.23, 1.94Smoking. Yes1.281.08, 1.511.220.96, 1.55Difficulty finding job due to axSpA. Yes3.712.89, 4.772.521.83, 3.47Work choice determined by axSpA. Yes1.691.43, 1.991.381.09, 1.75Anxiety diagnosis. Yes1.271.07, 1.510.980.72, 1.34Depression diagnosis. Yes1.581.33, 1.891.250.92, 1.69Sleep disorder diagnosis. Yes1.331.13, 1.560.950.73, 1.23Quantitative variablesOR95% CI3OR95% CI3Age. Years1.041.03, 1.041.031.01, 1.04BASDAI (0-10)1.181.13, 1.241.060.98, 1.13Functional limitation (0-54)1.031.02, 1.031.011.00, 1.02Spinal stiffness (3-12)1.251.20, 1.291.091.03, 1.15Diagnostic delay1.011.01, 1.020.980.96, 0.99Disease duration1.041.03, 1.051.031.01, 1.04

1Male vs Female; 2No university studies vs university studies. 395% CI for test H0: OR=1

Conclusion:

One third of patients reported being on permanent sick leave or having a recognised disability. They were more likely to have higher spinal stiffness scores, were older in age, experiencing difficulty finding a job, and belonged to a patient organisation. Increased efforts in relation to early access to effective treatments and the creation of flexible working environments are essential for axSpA patients to continue working and remain active, which benefits their quality of life.

Acknowledgements:

This study was supported by Novartis Pharma AG.The authors would like to thank all patients who participated in this study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, David Gálvez-Ruiz: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

POS0065-PARE HEALTH IMPACT OF OVERWEIGHT AND OBESITY IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Growing evidence on the negative role of overweight and obesity on the health outcomes of patients with axial spondyloarthritis (axSpA) exists.

Objectives:

The aim of the study is to evaluate the association between Body Mass Index (BMI) categories and sociodemographic, disease-characteristics and patient-reported outcomes (PROs) in a large sample of axSpA patients.

Methods:

Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries were analyzed. Using self-reported height and weight patients were classified into under and normal weight (<24.9 Kg/m2), overweight (25.0-29.9Kg/m2) or obese (>30.0Kg/m2) following WHO guidelines. The Kruskal-Wallis test was used to compare the means of numerical variables between polytomous variables, the χ2 test was used to compare the distribution between the categorical variables. Simple and multivariate logistic regression were used to identify possible associated factors.

Results:

A total 2,846 axSpA patients participated in the EMAS survey: mean age was 43.9 years, 61.3% female, 48.1% had a university degree and 67.9% were married and 71.3% were HLA-B27 positive. The percentage of patients with obesity was 18.7%, overweight 33.5%, normal weight 44.0% and underweight 3.8% with an accumulate prevalence of overweight/obesity of 52.2% (compared to 51.6 % of the EU’s population1). Those with obesity engage less frequently in sport (50.1% vs 33.3%; p<0.001) and in intimate relationships since disease onset (36.5% vs 20.4%; p<0.001), have higher functional limitations when tying shoe laces (46.8% vs 33.6%; p<0.001) and higher functional limitations regarding housework (52.2% vs 48.2%; p=0.024). Furthermore, they present greater disease activity (6.1±1.8 vs 5.4±2.0; p<0.001) and spinal stiffness (8.6±2.3 vs 7.4±2.5; p<0.001) compared to under and normal weight. For obese patients, the percentage of depression is higher (34.5% vs 23.7%; p<0.001), presenting a poorer mental health (5.7 ± 4.3 vs 5.0 ±4.2; p<0.001). The factors most strongly associated with obesity were higher functional limitation when tying shoe laces (OR=1.467; p<0.001), the female gender (OR=1.433; p<0.001) and lesser frequency of intimate relation (OR=1.239; p<0.001; see Table 1).

Table 1.

Logistic regression analysis to predict presence of obesity (N = 1,194)

SimpleMultivariateOR95% CIp-valueOR95% CIp-valueAge1.0261.018, 1.034<0.0011.0261.012, 1.040<0.001Gender (female)1.3361.095, 1.6290.0041.4331.031, 1.9900.032Marital status (married)1.3841.184, 1.617<0.0010.9820.746, 1.2920.897Educational level (university)0.7760.681, 0.884<0.0011.0460.849,1.2890.674Employment status (employed)1.0350.987, 1.0850.154NANANAEngage in sports (much less than before)1.3131.202, 1.433<0.0011.1430.978, 1.3360.093Travel/ excursions (much less than before)1.3161.186, 1.461<0.0010.9810.800, 1.2020.852Intimate relations (much less than before)1.5711.393, 1.772<0.0011.2391.003, 1.5300.047Tying shoe laces (high)1.4331.232, 1.666<0.0011.4671.176, 1.8300.001Housework / cleaning (high)1.2261.048, 1.4340.0110.7600.596, 0.9700.028BASDAI (0-10) N:2,5841.2201.156, 1.288<0.0011.1271.021, 1.2440.018Spinal Stiffness (3-12) N:2,6601.1841.136, 1.234<0.0011.0570.987, 1.1330.115Sleep disorders diagnosis1.5581.284, 1.892<0.0011.0450.753, 1.4490.793Depression diagnosis1.6481.340, 2.027<0.0011.2670.892, 1.7990.186Psychological distress GHQ-12 (0-12)1.0531.029, 1.078<0.0010.9950.954, 1.0380.813

Conclusion:

Results from the largest European axSpA survey reveal a similar prevalence of overweight and obesity to the general population. However, compared to normal weight, obese patients present greater disease activity, spinal stiffness and poorer mental health. Additionally, women with axSpA appear to be more vulnerable than men to obesity.

References:

[1]EU Eurostat. Overweight and obesity - BMI statistics.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, José Correa-Fernández: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.

POS0961 PREVALENCE AND ASSOCIATED FACTORS OF SLEEP DISORDERS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Sleep is an essential health aspect that is often impacted in patients with axial spondyloarthritis (axSpA).

Objectives:

This analysis aims to assess the prevalence and associated factors of sleep disorders in a large sample of European axSpA patients.

Methods:

Data were analyzed from 2,846 unselected patients with self-reported clinician-given diagnosis of axSpA of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 European countries. Socio-demographic data; BASDAI [0-10] scores; engagement in physical activity; axSpA influence on work choice (assessed with yes/no question “Was your current or past work choice in any way determined by axSpA?”); risk of psychological distress (12-item General Health Questionnaire [GHQ-12; 0-12]); functional limitation [0-54] and self-reported anxiety and depression were evaluated. Presence of sleep disorders was assessed by the question: “Please indicate whether you have been diagnosed with any of the following: sleep disorders”. A Mann-Whitney test was used to compare the means of numerical variables between dichotomous variables, the Chi-Square test was used to compare the distribution between the categorical variables. Simple and multivariable logistic regression models were used to identify associations between sleep disorders and disease characteristics, mental health and work-related variables.

Results:

Age of respondents was 43.9 years; 61.3% were female; 48.1% had a university degree; 67.9% were married and 71.3% were HLA-B27 positive. The prevalence of sleep disorders was 39.0%. In the bivariate analysis, presence of sleep disorders was associated with female gender (68.3% vs. 31.7%; p<0.001); overweight/obese (56.5% vs. 49.8%; p<0.001); increased BASDAI scores (6.1±1.8 vs. 5.0±2.1; p<0.001); fatigue (7.0±2.0 vs. 5.8±2.4; p<0.001); morning stiffness (5.8±2.4 vs. 4.8±2.4; p<0.001), work impact (56.5% vs. 38.2%; p< 0.001); anxiety (56.8% vs. 12.5%; p<0.001); depression (51.8% vs. 10.1%; p<0.001) and higher GHQ-12 scores (6.4±4.0 vs. 3.9±3.9; p<0.001). However, factors that remained independently associated with sleep disorders in the multivariable analysis were anxiety (OR=3.8 p<0.001) and depression (OR=3.1 p<0.001) and female gender (OR=1.4; p=0.002) [Table 1].

Table 1.

Regression analysis to predict presence of sleep disorders (N=2191)

Simple logistic regressionMultivariable logistic regressionOR95% CIp-valueOR95% CIp-valueGender (female)1.591.36-1.87<0.0011.401.13-1.730.002Marital status (married)1.130.99-1.280.074NANANAOverweight/Obesity1.311.12-1.530.0011.391.14-1.710.001BASDAI (0-10)1.331.27-1.39<0.0011.070.95-1.210.246Fatigue/Tiredness (0-10)*1.281.23-1.33<0.0011.040.97-1.120.271Morning Stiffness intensity (0-10)*1.191.15-1.23<0.0011.050.98-1.130.188Reported Work impact (yes)2.101.78-2.48<0.0011.291.05-1.580.015Anxiety (yes)9.187.58-11.11<0.0013.842.99-4.94<0.001Depression (yes)9.537.78-11.66<0.0013.092.37-4.02<0.001GHQ-12 (0-12)**1.161.14-1.19<0.0011.031.00-1.060.029

*As measured by the respective item of the BASDAI scale.

**12-item General Health Questionnaire. A value of 3 or above indicates a risk of poor mental health.

Conclusion:

Sleep disorders were highly prevalent among axSpA European patients and strongly associated with female gender and reporting worse mental health, and spinal stiffness. Patients on permanent and temporary sick leave were more likely to report sleep disorders. The strong association between sleep disorders with both anxiety and depression should encourage rheumatologists to screen their patients with sleep disturbance in case they require additional specialist support.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB., Laura Christen Employee of: Novartis Pharma AG, Christine Bundy Speakers bureau: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Denis Poddubnyy Speakers bureau: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

POS0988 FACTORS ASSOCIATED WITH PAIN INTENSITY IN AXIAL SPONDYLOARTHRITIS. RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Pain is a hallmark of axial spondyloarthritis (axSpA) and can significantly deteriorate patients’ health status.

Objectives:

This analysis aims to investigate factors associated with pain intensity in a large sample of European axSpA patients.

Methods:

2,846 unselected patients participated in EMAS, a cross-sectional study (2017-2018) across 13 European countries. Data from 2,636 participants who reported pain were analysed. Pain was measured by the mean of two BASDAI questions (range 0 “no pain” to 10 “most severe pain”): “How would you describe the overall level of AS neck, back or hip pain you have had?” and “How would you describe the overall level of pain/swelling in joints other than neck, back, hips you have had?”. Linear regression analysis was applied to identify associations between pain intensity and sociodemographic factors, patient-reported outcomes [BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), mental health using the 12-item General Health Questionnaire GHQ-12 (0-12)], work life, physical activity and comorbidities, for which 850 patients were included.

Results:

The mean age of the sample was 44 years, 61.4% were female, 49.4% had a university degree and 67.7% were married. The average reported pain intensity was 5.3 (±2.2); 76.2% reported pain intensity ≥4, with the greatest intensity reported by women (5.5 vs 4.9, p<0.001), those not university educated (5.6 vs 5.0, p<0.001), separated or divorced compared to singles (5.8 vs 5.2, p=0.004), and not physically active (5.7 vs 5.2, p<0.001). In addition, employed patients who experienced work-related issues reported greater pain (5.2 vs 3.9) as did those who experienced/ believed they would face difficulties finding work due to axSpA (5.9 vs 4.3), and those whose employment choice was determined by axSpA (5.7 vs 4.9; all p<0.001). Moreover, associations with anxiety (5.9 vs 5.0), depression (6.1 vs 5.0) and sleep disorders (5.9 vs 4.9; all p<0.001) were also found. The multiple linear regression model showed that those with higher pain intensity reported at least one work-related issue (B=0.65), difficulties finding work due to axSpA (B=0.48), not having attended university (B=0.38), greater spinal stiffness (B= 0.29), being female (B=0.26) and poorer mental health (GHQ-12) (B=0.10) (Table 1).

Table 1.

Regression analysis of the variables associated with pain intensity (0-10 NRS), n=850

UnivariableMultivariableB95% CIB95% CIGender. Female10.6040.432, 0.7750.2600.003, 0.517Educational level. No University20.6710.504, 0.8380.3760.118,0.634Marital Status. Divorced/Separated30.4950.209, 0.780-0.044-0.468, 0.380Body Mass Index. Obese40.362-0.097, 0.821NANAGHQ-12 (0-12)0.1820.163, 0.2010.1000.064, 0.137Functional Limitation (0-54)0.0360.030, 0.0410.009-0.001, 0.018Spinal Stiffness (3-12)0.3570.326, 0.3880.2880.234, 0.342Diagnostic Delay, years0.0200.010, 0.030-0.015-0.032, 0.002Work-Related Issues. Yes1.3381.095, 1.5820.6540.338, 0.970Difficulty finding job due to axSpA. Yes1.5681.362, 1.7740.4760.176, 0.776Work choice determinate by axSpA. Yes0.8080.633, 0.9830.199-0.069, 0.467Physical activity. No0.4940.263, 0.725-0.128-0.497, 0.242Anxiety diagnosis. Yes0.9350.753, 1.117-0.047-0.416, 0.321Depression diagnosis. Yes1.1070.919, 1.2950.115-0.270, 0.500Sleep disorder diagnosis. Yes1.0420.871, 1.213-0.091-0.392, 0.211

1Female vs Male; 2No university studies (no schooling, primary and high school) vs University studies; 3Divorced/separated vs single, married and widow; 4Obese vs not obese (underweight, normal and overweight).

Conclusion:

Pain was most strongly associated with working life impairment, as well as with spinal stiffness. Pain was also associated with suffering from depression, anxiety and sleep disorders. Understanding how pain affects individuals and shared-decision making between rheumatologists and patients are essential for long-term disease management and preserving quality of life of axSpA patients.

Acknowledgements:

This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the EMAS study.

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Christine Bundy Consultant of: Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer, Laura Christen Employee of: Novartis Pharma AG, Raj Mahapatra: None declared, Souzi Makri: None declared, Carlos Jesús Delgado-Domínguez: None declared, José Correa-Fernández: None declared, Pedro Plazuelo-Ramos: None declared, Denis Poddubnyy Consultant of: Abbvie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Abbvie, MSD, Novartis, and Pfizer.

Thematic synthesis of the experiences of people with hidradenitis suppurativa: a systematic review

BACKGROUND

Although hidradenitis suppurativa (HS) is known to affect quality of life, little summative knowledge exists on how HS impacts people living with the condition.

OBJECTIVES

To synthesize experiences of people with HS within published qualitative research.

METHODS

Searches on databases MEDLINE, PsycINFO, Embase and CINAHL were conducted on 17 April 2020. Two independent reviewers screened 5512 publications. Study quality was assessed using the National Institute for Health and Care Excellence quality appraisal checklist for qualitative studies. Thematic synthesis generated descriptive and analytic themes.

RESULTS

Fourteen studies were included: four studies fulfilled most quality criteria, eight fulfilled some quality criteria, and two fulfilled few quality criteria. There were three final themes. (i) Putting the brakes on life. The physical, psychological and social consequences of HS resulted in people missing out on multiple life events. This could have a cumulative effect that influences the trajectory of someone's life. (ii) A stigmatized identity: concealed and revealed. People try to conceal their HS, visually and verbally, but this results in anticipation and fear of exposure. Social support and psychological acceptance helped people cope. Connecting to others with HS may have a specific role in preserving a positive self-identity. (iii) Falling through the cracks. Delayed diagnosis, misdiagnosis and lack of access to care were reported. People felt unheard and misunderstood by healthcare professionals, and healthcare interactions could enhance feelings of shame.

CONCLUSIONS

There need to be improvements to clinical care to allow people with HS to live their life more fully.

Exploring beliefs and distress in patients with facial palsies

Evidence suggests that people with facial palsy may experience higher levels of distress, but the reasons for this are yet to be explored. This study aimed to explore people's illness beliefs, emotions, and behaviours in relation to their facial palsy and understand how distress is experienced by this group. Semi-structured individual interviews were conducted in the UK with adults with facial palsy. Interview questions were theoretically informed by the Common-Sense Self-Regulatory Model (CS-SRM). Thematic Analysis was conducted following a combined inductive and deductive approach. Twenty people with facial palsy participated (70% female; aged 29-84). Patient distress was accounted for by illness beliefs (symptoms, cause, control and treatment, timeline and consequences), and four additional themes (coping behaviours, social support, identity and health service provision). Experiences of anxiety, depression, and anger were widespread, and some participants experienced suicidal ideation. The burden of managing a long-term condition, altered self-perception, and social anxiety and isolation were key drivers of distress. There is a need for more integrated psychological support for patients with facial palsy. Within clinical consultations, patient's beliefs about facial palsy should be identified and systematically addressed. Service development should include appropriate referral to specialist psychological support via an established care pathway.

SAT0374 ONSET OF AXIAL SPONDYLOARTHRITIS REPERCUSSIONS ON PATIENTS’ SOCIAL AND FAMILY LIFE: RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Axial Spondyloarthritis (axSpA) is associated with a high degree of functional limitation in daily life activities. However, few studies have evaluated the social and family burden from the patient’s perspective.

Objectives:

To describe the impact of axSpA on social and family life since disease onset, and the associated PROs.

Methods:

Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017-2018) across 13 European countries were analysed. The impact of axSpA on social and family life were assessed through four PROs: i) Impact on relationships with the spouse, family, friends, neighbours, and work colleagues since disease onset (5 point Likert scale; 1 “much better” – 5 “much worse”; ii) Frequency of social activities including outings to bars/restaurants, cinema/theatre/museums, practising sports, travel/excursions, and intimate relations since disease onset (5 point Likert scale; 1 “much more” – 5 “much less”); iii) Adaptations made to cope with axSpA since disease onset (yes/no question); iv) The degree of functional limitation in 18 daily activities (3 point Likert scale). Self-reported BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54), and psychological distress (GHQ-12) were analysed using Pearson’s correlation comparing the impact on relationships and frequency of social activities since disease onset.

Results:

Among 2,846 participants, mean age was 43.9 years, 61.3% were female, 48.1% had a university degree. The greatest impact on relationships (sum of ‘worse’ and ‘much worse’) since disease onset were those with work-colleagues (44.5%), friends (35.6%), and spouse (30.4%). Sport was the activity they reduced the most since disease onset (64.2%), followed by travel/excursions (57.3%) and intimate relationships (56.4%) (Fig. 1). 55.5% had purchased comfortable shoes (N = 2748) and 43.9% had made adaptations to their workplace (N = 2651). For those who reported their level of functional limitation in daily activities, the greatest limitations were in physical exercise (85.5%), cleaning the house (84.4%) and using stairs (79.2%) (Fig. 2). In the correlation analysis, BASDAI, spinal stiffness, functional limitation, GHQ-12 were associated with a worsening in all of relationships and social activities (p < 0.001) (Table 1).

Table 1.

Pearson’s correlation between social and family life changes and PROs

Relationships: 1 much better – 5 much worseBASDAISpinal StiffnessFunctional LimitationGHQ-12Spouse0.157*0.130*0.167*0.258*Family0.162*0.133*0.138*0.206*Friends0.211*0.173*0.180*0.282*Neighbours0.210*0.165*0.112*0.229*Work colleagues0.229*0.153*0.213*0.334*Frequency activities: 1 much more – 5 much lessBars / restaurants0.261*0.246*0.314*0.316*Cinemas / theatres / museums0.291*0.243*0.299*0.338*Do sports0.271*0.213*0.240*0.242*Travel / excursions0.308*0.218*0.307*0.362*Intimate relations0.284*0.254*0.288*0.321*

*p <0.001

Figure 1.

Reported social and family live changes since disease outset

Figure 2.

Reported level of functional limitation in daily live activities

Conclusion:

For most participants the onset of axSpA marked the worsening of personal relationships in different areas, as well as the reduction of social, leisure, and entertainment activities.

Acknowledgments:

Funded by Novartis Pharma AG

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Raj Mahapatra: None declared, Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB

FRI0315 GENDER DIFFERENCES IN PATIENT JOURNEY TO DIAGNOSIS AND PATIENT-REPORTED OUTCOMES: RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Growing evidence of similarities in male-female prevalence of axial spondyloarthritis (axSpA) has stimulated the need to evaluate gender differences in patient experiences.

Objectives:

To evaluate gender differences in diagnostic journey, disease-characteristics and patient-reported outcomes (PROs) in axSpA patients.

Methods:

Data from 2846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 countries were analysed. Socio-demographic characteristics, diagnosis, disease-characteristics, and PROs [BASDAI (0-10), spinal stiffness (3-12), functional limitation (0-54) and psychological distress (0-12, GHQ-12)] were compared between genders. Χ2(for categorical variables) and student-t (for continuous variables) were employed.

Results:

1,746 (61.3%) females participated in the EMAS, with homogeneous gender distribution across most countries (Fig 1). Compared to males, females reported longer diagnostic delay (6.1±7.4 vs 8.2±8.9; p<0.001), more visits to physiotherapists (34.5% vs 49.5%; p<0.001) and osteopaths (13.3% vs 24.4%; p<0.001) before being diagnosed (Table 1), higher disease activity in all BASDAI items and greater functional limitation, psychological distress and self-reported anxiety and depression (Table 2).

Table 1.

Disease characteristics by gender (N: 2846, unless specified)

Men (n: 1100)(mean ± SD or %)Women (n: 1746)(mean ± SD or %)p valueAge at onset of first symptoms, n: 272127.0 ± 11.826.4 ± 10.70.342Age at diagnosis, n: 272232.6 ± 12.234.4 ± 10.9<0.001Diagnostic delay, n: 26526.1 ± 7.48.2 ± 8.9<0.001Disease Duration, n: 271618.9 ± 13.316.1 ± 11.7<0.001HCP seen before diagnosis - General practitioner822 (74.7)1434 (82.1)<0.001 - Orthopaedic specialist377 (34.3)557 (31.9)0.190 - Physiotherapist380 (34.5)865 (49.5)<0.001 - Osteopath, n: 2166103 (13.3)339 (24.4)<0.001 - Other, n: 2220135 (14.0)233 (18.5)0.005Family history of axSpA (yes), n: 2244291 (33.5)584 (42.5)<0.001HLA-B27 (positive), n: 1799497 (80.2)786 (66.7)<0.001Uveitis (yes), n: 2096199 (25.2)270 (20.7)0.023IBD (yes), n: 2096113 (14.3)181 (13.9)0.688Table 2.

PROs by gender (N: 2846, unless specified)

Men (n: 1100)(mean ± SD or %)Women (n: 1746)(mean ± SD or %)p valueBASDAI, (0-10) n: 25845.1 ± 2.05.7 ± 1.9<0.001 - Fatigue, n: 26365.7 ± 2.46.6 ± 2.2<0.001 - Neck, back or hip pain, n: 26365.6 ± 2.46.2 ± 2.2<0.001 - Pain other than neck, back or hip, n: 26364.3 ± 2.74.9 ± 2.6<0.001 - Discomfort to touch or pressure, n: 26364.5 ± 2.75.6 ± 2.6<0.001 - Morning stiffness level, n: 26365.3 ± 2.65.9 ± 2.6<0.001 - Morning stiffness duration, n: 25844.5 ± 2.84.7 ± 2.80.070Stiffness, (3-12) n: 27077.7 ± 2.67.8 ± 2.40.107Functional Limitation, (0-54) n: 277119.1 ± 16.721.2 ± 16.0<0.001GHQ-12 ≥3, n: 2640564 (55.4)1060 (65.4)<0.001Anxiety243 (30.6)566 (43.3)<0.001Depression238 (30.1)472 (36.1)<0.001Figure 1.

Countries’ sample distribution stratified by gender (N: 2846)

Conclusion:

Important gender differences are observed in axSpA such as a longer patient journey to diagnosis, poorer PROs, and greater psychological burden in females. These results point to unmet needs in females with axSpA, requiring particular attention.

Acknowledgments:

Funded by Novartis Pharma AG

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Raj Mahapatra: None declared, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Souzi Makri: None declared, Sergio Sanz-Gómez: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

OP0278 IDENTIFICATION OF PARAMETERS ASSOCIATED WITH A DIAGNOSTIC DELAY IN AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Early diagnosis of Axial Spondyloarthritis (axSpA) is crucial for timely access to specialist care and effective treatment.

Objectives:

To assess the current diagnostic delay in axSpA and identify the parameters associated with increased diagnostic delay in a European sample.

Methods:

Data from unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017- 2018) across 13 countries were analysed. Mean differences in diagnostic delay were analysed using Mann-Whitney and Kruskal-Wallis tests, among sociodemographic and disease-related factors. A multivariate linear regression analysis was carried out to identify the relative weight of the associated parameters in determining diagnostic delay.

Results:

2,846 patients participated in EMAS. Mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 53.9% were employed. Of the 2846 participants, 2652 provided information for calculating diagnostic delay. Mean age at symptom onset was 26.6 ± 11.1, mean age at diagnosis was 33.7 ± 11.5, and mean diagnostic delay was 7.4 ± 8.4 (Fig. 1). The following variables were associated with longer diagnostic delay in the bivariate analysis: older age, female gender, being diagnosed by a rheumatologist (Table 1). In the multivariate regression analysis younger age at symptom onset, number of HCPs seen before were associated with diagnostic delay (Table 2).

Table 1.

Associations between sociodemographic and disease-related variables and diagnostic delay (N: 2,652)

VariableDiagnostic Delay (years)Mean ± SDP-valueAge categories18-344.4 ± 5.5<0.00135-517.9 ± 8.252-689.5 ± 10.2>687.3 ± 9.7GenderMale6.1 ± 7.4<0.001Female8.2 ± 8.9Education levelNo school completed8.0 ± 10.70.397Primary school7.6 ± 8.9High school7.6 ± 8.4University7.3 ± 8.3OccupationManual worker6.7 ± 8.30.163Non-manual worker7.3 ± 8.4Diagnosed by rheumatologistYes7.9 ± 8.7<0.001No5.7 ± 7.3HLA-B27Positive8.3 ± 8.30.775Negative8.7 ± 9.0Uveitis (ever)Yes8.0 ± 8.30.098No7.6 ± 8.4IBD (ever)Yes7.7 ± 8.70.944No7.5 ± 8.5Table 2.

Regression analysis between sociodemographic and clinical variables in relation to diagnostic delay

VariableUnivariable linear regressionMultivariable stepwise linear regressionB95% CIB95% CIAge at symptoms onset-0.289-0.316, -0.262-0.321-0.390, -0.253Female gender2.0991.442, 2.755NANAEmployed, Manual worker-0.604-1.953, 0.746NANAEducational status, University-0.343-0.986, 0.299NANADiagnosed by rheumatologist, Yes2.1171.321, 2.913NANANumber of HCPs seen before diagnosis1.7231.486, 1.9601.2580.739, 1.776HLA-B27, Positive-0.471-1.347, 0.404NANAUveitis (ever), Yes0.463-0.392, 1.319NANAIBD (ever), Yes0.123-0.971, 1.217NANAFigure 1.

Average years of diagnostic delay across EMAS countries (N: 2,652)

Conclusion:

In this large sample of axSpA patients from 13 different European countries, the average diagnostic delay was more than seven years. The fact that one of the most strongly associated parameters to diagnostic delay was number of HCPs seen before diagnosis suggests the need for urgent action to reduce incorrect referrals to shorten the patient journey to diagnosis across Europe.

Acknowledgments:

Funded by Novartis Pharma AG

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Raj Mahapatra: None declared, Souzi Makri: None declared, José Correa-Fernández: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB

OP0081 THE IMPACT OF AXIAL SPONDYLOARTHRITIS ON PATIENTS’ SEXUAL LIFE: RESULTS FROM THE EUROPEAN MAP OF AXIAL SPONDYLOARTHRITIS (EMAS)

Background:

Axial Spondyloarthritis (axSpA) involves a great degree of functional limitation in daily activities and psychological health, which can impact patients’ sexual life.

Objectives:

To study the determinants of reduced frequency of sexual activity and intimacy since disease onset in axSpA patients.

Methods:

Data from 2,846 unselected patients of the European Map of Axial Spondyloarthritis (EMAS) through an online survey (2017-2018) across 13 countries were analysed. The impact of axSpA on patients’ sexual life was evaluated by a question assessing changes in the frequency of intimate relations since the onset of axSpA on a 5 point Likert scale. Impact of axSpA on the spousal relationship since disease onset was also assessed using 5 point Likert scale. Other lifestyle variables included smoking and physical activity and burden of disease [BASDAI (0-10), spinal stiffness (3-12), functional limitation in intimate relations (0-2), and psychological distress (GHQ-12)]. Regression analysis were carried out to determine the relative weight of the assessed variables.

Results:

EMAS total sample mean age was 43.9 years, 61.3% were female, 48.1% had a university degree, and 67.9% were married. Out of the 2,515 participants that reported on the frequency of intimate relations since disease onset, 56.4% declared that it was less or much less than before; 74.1% declared high or medium limitation in intimate relations; and 30.4% reported worsening relations with their spouse. A lower frequency of intimate relations was related to: older age, female gender, higher BASDAI, spinal stiffness, higher functional limitation in intimate relations, higher psychological distress, self-reported diagnosis of depression, worsening relationship with spouse since disease onset, higher BMI, smoking, lack of physical activity, and lack of biologics use. In the multivariate regression analysis, the most strongly associated variables with lower frequency of intimate relations were: functional limitation in intimate relations (β = 0.218; 95% CI 0.185 – 0.251), worse relationship with spouse (β = 0.207; 95% CI = 0.165 - 0.250), female gender (β = 0.150; 95% CI 0.071 – 0.229), and no engaging in physical activity (β = -0.135; 95% CI -0.234 – -0.036) (Table 2).

Conclusion:

EMAS results reveal a great impact of axSpA on patients’ sexual life, with multiple sociodemographic, lifestyle and PROs being associated with a lower frequency of intimate relations.

Table 1.

Regression analysis to predict frequency of intimate relations

Simple linear regressionMultivariable stepwise linear regressionB95% CIpB95% CIpAge (Years)0.0070.004,0.010<0.0010.0100.007,0.013<0.001Gender (Female)0.2150.146,0.284<0.0010.1500.071,0.229<0.001BASDAI0.1240.107,0.141<0.0010.0290.007,0.0500.010Spinal Stiffness0.0890.075,0.102<0.001NANA0.214Functional Limitation – Intimate relations0.2970.271,0.323<0.0010.2180.185,0.251<0.001GHQ-120.0670.059,0.075<0.0010.0350.024,0.045<0.001Depression (Yes)0.3750.298,0.452<0.001NANA0.064Relationship with spouse0.3430.306,0.380<0.0010.2070.165,0.250<0.001BMI0.0170.011,0.024<0.0010.0080.001,0.0150.031Smoking (Yes)0.0750.002,0.1480.044NANA0.907Physical activity (Yes)-0.212-0.306,-0.119<0.001-0.135-0.234,-0.0360.007Biologics (Yes)0.1880.110, 0.267<0.001NANA0.185

Acknowledgments:

Funded by Novartis Pharma AG

Disclosure of Interests:

Marco Garrido-Cumbrera: None declared, Christine Bundy Grant/research support from: Has received unrelated honoraria from Abbvie, Celgene, Janssen, Lilly, Novartis, and Pfizer., Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Souzi Makri: None declared, Raj Mahapatra: None declared, Sergio Sanz-Gómez: None declared, Laura Christen: None declared, Carlos Jesús Delgado-Domínguez: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB

Psychological distress and coping following eye removal surgery

Purpose: Psychological distress is reasonably well documented in people with facial disfigurement; however, in patients following eye removal surgery this has not been studied adequately. We hypothesised that lower distress levels would be associated with age and more adaptive coping strategies and that women would be more likely to report higher levels of distress and, therefore, use maladaptive coping strategies.Methods: This exploratory, cross-sectional study measured distress and coping in a sample of 56 post enucleation or evisceration patients. The Hospital Anxiety and Depression Scale and the Brief COPE measured distress and coping strategies.Results: In all, 25.5% and 10.9% of the sample had high levels of anxiety and depression, respectively. Significant associations were found between levels of distress, coping strategies and demographic variables (p < .05). There were significant differences in coping strategies between those with higher and lower levels of distress (p < .05). Females reported higher levels of anxiety (U = 202.5, p < .01) and depression (U = 229, p < .05) than males. Those who experienced enucleation or evisceration aged between 20 and 39 years reported significantly higher levels of depression compared with other age groups (U = 68.5, p < .01).Conclusions: There was a relatively low level of distress across the whole sample, but we found high levels of distress in a considerable proportion (18.18%) of participants. Participants' coping strategies and levels of distress were correlated. Females and participants aged between 20 and 39 years at time of eye removal were particularly vulnerable to distress.

Understanding the experience of sleep disturbance in psoriasis: a qualitative exploration using the Common-Sense Model of Self-Regulation

BACKGROUND

Psoriasis is associated with significant morbidity, which negatively impacts upon quality of life. Sleep disturbance is reported to be common in patients with psoriasis and is associated with physical and psychological variables, although there is little published work in this area. Understanding sleep and the factors involved in its disturbance in psoriasis is a potentially important clinical area given the role of sleep in health and disease processes.

OBJECTIVES

To explore the experience of sleep and sleep disturbance in psoriasis using the Common-Sense Model of Self-Regulation (CS-SRM).

METHODS

Semistructured interviews were conducted with adults diagnosed with psoriasis. Interview questions were informed by the CS-SRM and previous research. Framework analysis was applied, including coding data into the CS-SRM dimensions and allowing additional inductive themes to emerge.

RESULTS

Seventeen people with psoriasis (nine women, eight men; aged 19-86 years) were interviewed about sleep and sleep disturbance. Seven themes emerged, with six accounted for by the CS-SRM: characteristics of sleep disturbance, change in sleep patterns, thoughts about and symptoms of disease disturbing sleep, impact of poor sleep on daily life, attempts to improve sleep, a daily battle for control and a seventh relating to metacognitive processes. A reciprocal relationship between sleep and psoriasis was evident across themes with interactions between key sleep-related thoughts, emotions and behaviours.

CONCLUSIONS

This study showed that sleep disturbance is a persistent concern for people with psoriasis; it has a 24-h impact, and interacts with the psychological and physical aspects of psoriasis. The distress and frustration felt when managing sleep disturbance perpetuated problematic sleep. Addressing this with currently available sleep treatments may therefore confer sleep and psoriasis-related benefits for people living with this condition.

Does message framing affect changes in behavioural intentions in people with psoriasis? A randomized exploratory study examining health risk communication

Message framing is important in health communication research to encourage behaviour change. Psoriasis, a long-term inflammatory skin condition, has additional comorbidities including high levels of anxiety and cardiovascular disease (CVD), making message framing particularly important. This experimental study aimed to: (1) identify whether health messages about psoriasis presented as either gain- or loss-framed were more effective for prompting changes in behavioural intentions (BI), (2) examine whether BI were driven by a desire to improve psoriasis or reduce CVD risk; (3) examine emotional reactions to message frame; and (4) examine predictors of BI. A two by two experiment examined the effects on BI of message frame (loss vs. gain) and message focus (psoriasis symptom reduction vs. CVD risk reduction). Participants with psoriasis (n = 217) were randomly allocated to one of four evidence-based health messages related to either smoking, alcohol, diet or physical activity, using an online questionnaire. BI was the primary outcome. Analysis of variance tests and hierarchical multiple regression analyses were conducted. A significant frame by focus interaction was found for BI to reduce alcohol intake (p = .023); loss-framed messages were more effective for CVD risk reduction information, whilst gain-framed messages were more effective for psoriasis symptom reduction information. Message framing effects were not found for BI for increased physical activity and improving diet. High CVD risk was a significant predictor  of increased BI for both alcohol reduction (β = .290, p < .01) and increased physical activity (β = -.231, p < .001). Message framing may be an important factor to consider depending on the health benefit emphasised (disease symptom reduction or CVD risk reduction) and patient-stated priorities. Condition-specific health messages in psoriasis populations may increase the likelihood of message effectiveness for alcohol reduction.

'New to me': changing patient understanding of psoriasis and identifying mechanisms of change. The Pso Well® patient materials mixed-methods feasibility study

Background

Psoriasis is an inflammatory long‐term condition involving comorbidities, unhealthy lifestyle and significant life impact. Patients’ understanding of psoriasis is limited and support lacking. The Common‐Sense Model of Self‐Regulation of Health and Illness emphasizes the role of illness and treatment beliefs on coping and self‐management. New ‘Pso Well^®’ patient materials informed by the model, addressed psoriasis as a long‐term condition, medication management and lifestyle behaviours.

Objectives

To investigate whether Pso Well^® materials (i) broaden understanding of psoriasis without increasing anxiety; (ii) are acceptable; and (iii) comprise features that appear to effect change.

Methods

The Revised Illness Perceptions Questionnaire (IPQ‐R modified) and the Hospital Anxiety and Depression Scale (HADS) were administered in patients before and after intervention. Numerical rating scales assessed perceptions of change in understanding and anxiety resulting from engagement with the materials. Qualitative interviews explored acceptability and perceived ‘active ingredients’.

Results

Fifty‐five patients completed pre‐ and postintervention questionnaires (56% female; median age 59 years). Postintervention, a large effect size was indicated in two IPQ‐R domains – illness coherence [t(55) = −3·48, P = 0·001 (two‐tailed), η² = 0·19] and personal control [t(55) = −2·98, P = 0·004 (two‐tailed), η² = 0·14] – and a medium effect in one, treatment control [t(55) = −2·08, P = 0·042 (two‐tailed), η² = 0·08]. HADS scores did not change. For numerical rating scales, 80% of participants reported increased understanding of psoriasis and none reported increased anxiety. Interviews with 19 patients indicated the materials were acceptable and usable. Factors reported to broaden understanding and promote engagement with self‐management included linking of related disease aspects, personally relevant content and high‐quality design.

Conclusions

High‐quality, theory‐based psoriasis materials are acceptable to patients and can improve understanding and sense of control without increasing anxiety.

What's already known about this topic?

Psoriasis is associated with comorbidities, unhealthy lifestyle and significant life impact.

Patients’ understanding of psoriasis is limited, self‐management support is lacking and disengagement from healthcare services is common.

What does this study add?

The new, theory‐informed Pso Well^® patient materials address psoriasis as a long‐term condition; medications management and lifestyle behaviour.

The Pso Well^® patient materials can increase understanding of psoriasis, promote feelings of self‐worth and encourage a desire to engage in self‐management and behaviour change, without increasing anxiety or depression.

What are the clinical implications of this work?

The Pso Well^® patient materials could support clinical consultations by helping patients recognize the remitting–relapsing nature of psoriasis.

This will help to improve understanding of the disease, as well as providing a clearer rationale for treatment adherence and lifestyle behaviour change.

Linked Comment: Prinsen. Br J Dermatol 2017; 177:616–617

A cross-sectional survey of the nature and correlates of sleep disturbance in people with psoriasis

BACKGROUND

Research suggests that sleep disturbance is common in psoriasis. While several sleep investigations have been conducted in psoriasis populations, many have methodological shortcomings, and no study has examined multiple dimensions of sleep-wake functioning. Moreover, research has yet to be performed comprehensively examining the range of physical and psychological factors that may affect sleep in people with psoriasis.

OBJECTIVES

To characterize sleep disturbance using validated measures and to identify physical and psychological predictors of sleep quality in people with psoriasis.

METHODS

An online survey was conducted (186 respondents; mean age 39·2 years) comprising validated measures assessing sleep [Pittsburgh Sleep; Quality Index (PSQI), Berlin Questionnaire, Pre-Sleep Arousal Scale]; chronotype (Morningness-Eveningness Questionnaire); mood (Hospital Anxiety and Depression Scale); itch (5-D Itch Scale); and psoriasis severity (Simplified Psoriasis Index). Group comparisons and regression analyses were used to examine predictors of poor sleep.

RESULTS

The mean PSQI score was 9·2 ± 4·3, with 76·3% scoring above the threshold for poor sleep (≥ 6 on the PSQI) and 32·5% scoring 'positive' for probable obstructive sleep apnoea (OSA). Poor sleep and high likelihood of OSA were associated with more severe psoriasis (P < 0·05; η = 0·07; η² = 0·005). Cognitive arousal (β = 0·26, P = 0·001), itch (β = 0·26, P < 0·001) and depression (β = 0·24, P = 0·001) were the most robust predictors of poor sleep quality, which, together with somatic arousal (β = 0·17, P = 0·022), accounted for 43% of variance in PSQI scores.

CONCLUSIONS

Poor sleep is common in psoriasis and associated with psychological and physical factors. Rates of probable OSA are also high. Given the importance of restorative sleep for health, sleep complaints should receive greater clinical attention in the management of psoriasis.

Nonadherence to psoriasis medication as an outcome of limited coping resources and conflicting goals: findings from a qualitative interview study with people with psoriasis

Background

Medication nonadherence is known to limit the effectiveness of available therapies; however, little is known specifically about medication adherence in people with psoriasis. Medicines self‐management can feel onerous to those with dermatological conditions due to the nature of therapies prescribed and many individuals with psoriasis experience additional challenges such as physical and psychological comorbidities that place significant additional demands on individuals and may undermine adherence. Viewing nonadherence to medication as an outcome of limited personal coping resources and conflicting goals may help to explain medication nonadherence.

Objectives

To explore individuals’ perspectives of their psoriasis, medication and its management.

Methods

Twenty people with psoriasis were recruited from community samples in England and interviewed in‐depth about their perceptions of their psoriasis, medication, and adherence to medication and self‐management advice. Data were analysed using Framework Analysis.

Results

Participants reported that adhering to recommended treatment regimens conflicted with the management of the physical and psychological demands of living with psoriasis. Medication usage was viewed as a source of unresolved emotional distress and, for some, resulted in poor self‐reported adherence, which included medication overuse, underuse and rejection of prescribed therapies. Perceived lack of engagement by clinicians with participants’ self‐management difficulties was viewed as an additional source of stress and distress.

Conclusions

Adhering to medication in psoriasis can be an additional source of considerable emotional distress. We interpreted some episodes of nonadherence to psoriasis medication as rational attempts by individuals to minimize distress and to gain control over their life.

What's already known about this topic?

Although common, little is known about factors contributing to nonadherence to therapies used in psoriasis.

What does this study add?

Illness and medication beliefs and associated mood influence medication nonadherence.

Attempts to adhere can undermine people's ability to manage their emotional distress.

For some patients, following prescribed medication regimens adds to rather than relieves psoriasis‐associated distress.

What are the clinical implications of this work?

Some occurrences of nonadherence to medication in psoriasis should be recognized as a strategic decision by the patient to reduce distress and to gain control.

Assessing patients’ beliefs and mood, and identifying potentially conflicting health goals may help to support medication adherence.

Early- and late-onset psoriasis: a cross-sectional clinical and immunocytochemical investigation

BACKGROUND

There is accumulating evidence that early-onset psoriasis (EOP; presenting at or before 40 years of age) and late-onset psoriasis (LOP; presenting after 40 years of age) are different diseases.

OBJECTIVES

We aimed to identify potential clinical and immunocytochemical differences between EOP and LOP.

METHODS

We assessed immunocytochemistry in involved (PP) skin and uninvolved skin (n = 31) and demographics, psoriasis phenotype and psychological parameters (n = 340) in a cross-sectional study.

RESULTS

Immunocytochemistry revealed (17 EOP, 14 LOP) a greater lymphocytic infiltrate in PP skin of EOP compared with LOP (P = 0·03), with a higher epidermal CD4⁺ : CD8⁺ ratio in LOP (1·3) compared with EOP (0·5) (P = 0·002). In 340 patients with psoriasis (278 EOP, 62 LOP), we found an association with a positive first or second degree family history of psoriasis [62·0% vs. 35·6%, adjusted odds ratio (OR) 8·32, 95% confidence interval (CI) 1·90-36·52] and a higher likelihood of having parents with EOP (adjusted OR 10·34, 95% CI 1·32-81·83) in the EOP group. Patients with EOP were more likely to have received biological therapy (13·3% EOP vs. 3·5% LOP, P = 0·042), while patients with LOP had a higher likelihood of having type 2 diabetes (adjusted OR 3·43, 95% CI 1·004-11·691) and autoimmune thyroiditis (adjusted OR 5·05, 95% CI 1·62-15·7). Patients with LOP also had greater anxiety than patients with EOP (mean Hospital Anxiety and Depression Scale-A score LOP 8 ± 5, EOP 5 ± 5; P = 0·006).

CONCLUSIONS

Our findings provide further evidence for the difference between EOP and LOP.

Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience

Patients with psoriatic arthritis (PsA) may not be optimally treated. The impact of the disease extends beyond skin and joint symptoms, impairing quality of life. This indicates that the adoption of a patient-focused approach to PsA management is necessary. An expert multidisciplinary working group was convened, with the objective of developing an informed perspective on current best practice and needs for the future management of PsA. Topics of discussion included the barriers to current best practice and calls to action for the improvement of three areas in PsA management: early and accurate diagnosis of PsA, management of disease progression and management of the impact of the condition on the patient. The working group agreed that, to make best use of the available of diagnostic tools, clinical care recommendations and effective treatments, there is a clear need for healthcare professionals from different disciplines to collaborate in the management of PsA. By facilitating appropriate and rapid referral, providing high quality information about PsA and its treatment to patients, and actively involving patients when choosing management plans and setting treatment goals, management of PsA can be improved. The perspective of the working group is presented here, with recommendations for the adoption of a multidisciplinary, patient-focused approach to the management of PsA.

Patient-reported outcome measures in psoriasis: the good, the bad and the missing!

As a long-term condition, psoriasis demands significant personal and professional input for optimal self-management. Low levels of well-being and high levels of psychological distress in patients with psoriasis are associated with reduced resources for self-care. Patient-reported outcome (PRO) measures can be used to assess physical, social and psychological functioning in order to guide treatment. In this article, we systematically reviewed the development and validation of existing PRO measures. PubMed (Medline), PsycINFO and CINAHL were searched systematically using predefined search terms. The search was limited to articles in the English language relating to human subjects. Articles were selected for full review through explicit inclusion/exclusion criteria. PRO measures were critically reviewed in accordance with the published guidelines and theory on the development and validation of PROs. The search identified 967 abstracts; 71 of these articles met the criteria for full review. In these 71 articles, 45 PRO measures were found: 16 were specific to psoriasis, 21 assessed other dermatological conditions and eight were developed for generic nondermatological health conditions. The review revealed several limitations of the existing measures, including: (i) a composite structure assessing multiple, poorly-defined concepts; (ii) a lack of evidence for face and content validity; (iii) a failure to include both patient and clinician perspectives and requirements and (iv) a lack of evidence regarding the feasibility and acceptability for patients and physicians. No single PRO measure with adequate evidence of validity, reliability and sensitivity to change captures patient well-being in psoriasis. A valid, sensitive, specific and acceptable PRO that assesses the full impact of psoriasis on well-being is needed for the comprehensive clinical management of psoriasis.

The role of beliefs: lessons from a pilot study on illness perception, psychological distress and quality of life in patients with primary cicatricial alopecia

BACKGROUND

While alopecia has been shown to have substantial psychological consequences, previous studies have not explicitly explored the key beliefs of patients with primary cicatricial alopecia (PCA) and the relationship between clinical and psychological measures.

OBJECTIVES

To identify the key psychological factors and quality of life (QoL) of patients with PCA and the relationship between these factors and established clinical measures.

METHODS

In total 105 patients with PCA were recruited from a specialist hair research clinic in Manchester, U.K. Patients completed the revised Illness Perception Questionnaire, Hospital Anxiety and Depression Scale (HADS) and Dermatology Life Quality Index. These psychological measures were correlated with disease activity in patients with lichen planopilaris (LPP) and frontal fibrosing alopecia, using the LPP Activity Index (LPPAI).

RESULTS

Patients perceived PCA as a chronic condition with significant personal consequences and emotional impact, and reported that they had low levels of control over the condition and its treatment. Considerable levels of psychological distress were observed (mean HADS total score 11·3 ± 8·1). Impaired QoL was associated with strong beliefs that the symptoms were attributed to their disease (P < 0·001), and that alopecia had serious consequences (P < 0·001) and was distressing (P < 0·001). Disease activity (LPPAI) showed a significant positive correlation with HADS-Depression (r = 0·343, P = 0·026).

CONCLUSIONS

Patients with PCA experience significant psychological distress and impaired QoL, both of which are associated with key beliefs about illness. Management of PCA should involve assessment of the beliefs and emotions that drive patients' psychological distress, as well as giving access to psychological therapy.

Sunlight exposure and photoprotection behaviour of white Caucasian adolescents in the UK

BACKGROUND

Sun exposure has positive and negative effects on health, yet little is known about the sun exposure behaviour of UK adolescents, including those more prone or less prone to sunburn.

OBJECTIVE

To examine sun exposure behaviour of UK white Caucasian adolescents including time spent outdoors, holiday behaviour, use of sunscreen and clothing, with assessment for differences between sun-reactive skin type groups.

METHODS

White Caucasian adolescents (12-15 years) attending schools in Greater Manchester completed a two-page questionnaire to assess sun exposure and photoprotective behaviour.

RESULTS

A total of 133 adolescents (median age 13.4 years; 39% skin type I/II, 61% skin type III/IV) completed the questionnaire. In summer, adolescents spent significantly longer outdoors at weekends (median 4 h/day, range 0.25-10) than on weekdays (2, 0.25-6; P < 0.0001). When at home in the UK during summer, 44% reported never wearing sunscreen compared to just 1% when on a sunny holiday. Sunscreen use was also greater (frequency/coverage) when on a sunny holiday than at home in the UK summer (P < 0.0001). Adolescents of skin types I/II (easy burning) spent significantly less time outdoors than skin types III/IV (easy tanning) on summer weekends (P < 0.001), summer weekdays (P < 0.05) and on a sunny holiday (P = 0.001). Furthermore, skin types I/II reported greater sunscreen use during summer in the UK and on sunny holiday (both P < 0.01), and wore clothing covering a greater skin area on a sunny holiday (P < 0.01) than skin types III/IV. There was no difference in sun exposure behaviour/protection between males and females.

CONCLUSION

The greater sun-protective measures reported by adolescents of sun-reactive skin type group I/II than III/IV suggest those who burn more easily are aware of the greater need to protect their skin. However, use of sunscreen during the UK summer is low and may need more effective promotion in adolescents.

Providing lifestyle behaviour change support for patients with psoriasis: an assessment of the existing training competencies across medical and nursing health professionals

BACKGROUND

Psoriasis is associated with unhealthy lifestyle behaviours which contribute to psoriasis onset and severity. Health professionals who manage patients with psoriasis are well placed to support lifestyle change but few feel confident to do so. Little is known about the extent to which health promotion and lifestyle behaviour change (LBC) skills are included within post-qualification training curricula.

OBJECTIVES

This study aimed to systematically examine the content of post-qualification U.K. training curricula for health professionals across General Practice and Dermatology for evidence of behaviour change skills relating to the promotion of healthy lifestyles.

METHODS

Core curricula documents from professional organizations were analysed for content to examine the extent to which curricula: (1) mentioned health promotion and LBC as part of the professional role; and/or (2) included health promotion and LBC as explicit training competencies or requirements for qualification.

RESULTS

Of the 11 core curricula documents analysed, we found 67 occurrences of terms related to LBC and health promotion. Most were in the General Practitioner curriculum (n = 42; 62·7%), followed by the Dermatology Specialist Nurse curriculum (n = 14; 20·9%) and Dermatologist curriculum (n = 11; 16·4%). No occurrences were found in the General Practitioner with a Special Interest in Dermatology curriculum. LBC knowledge, skills and attitudes were not clearly specified and only basic level LBC competencies were included.

CONCLUSIONS

Development of post-qualification curricula would ensure health professionals are equipped with the necessary knowledge, skills and attitudes to support LBC for patients with psoriasis. This is of particular relevance, given the evidence linking unhealthy lifestyles with psoriasis outcomes.

A novel, web-based, psychological intervention for people with psoriasis: the electronic Targeted Intervention for Psoriasis (eTIPs) study

BACKGROUND

Psychological morbidity and reduced quality of life are common and linked with nonadherence to medication in psoriasis. Access to psychological therapy is often poor with long waiting times. Cognitive behavioural therapy (CBT) is a well-accepted therapy for psychological disorders and is particularly effective when tailored to address condition-specific concerns.

OBJECTIVES

To determine whether an electronic CBT intervention for Psoriasis (eTIPs) would reduce distress, improve quality of life and clinical severity in patients with psoriasis.

METHODS

This was a wait-list, randomized trial of immediate intervention vs. usual care. Self-assessed psoriasis severity (Self-Administered Psoriasis Area and Severity Index), distress (Hospital Anxiety and Depression Scale) and quality of life (Dermatology Life Quality Index) were measured before and after intervention. Analysis was based on complete cases and all cases using multiple imputation to substitute missing values.

RESULTS

Anxiety scores between groups were significantly reduced (P < 0·05) for complete cases only; the mean (SD) scores were: intervention 7·6 (3·6) at baseline and 6·1 (3·5) at follow-up vs. control 8·3 (3·5) at baseline and after intervention 8·1 (4·4) (P = 0·004). Depression scores did not change; the experimental group scores at baseline were 5·0 (4·2) and after intervention 4·0 (3·7) vs. control group at baseline 5·2 (3·4) and after intervention 4·9 (3·8). Psoriasis severity scores did not change: baseline scores for the experimental group were 7·5 (6·0) and after intervention 6·5 (8·5) vs. the control group before 8·3 (6·3) and after 7·6 (6·1) (not significant). Quality-of-life scores improved in both analyses (P < 0·05); the intervention group scores before were 6·6 (4·2) and after intervention 5·0 (5·1) vs. control before 7·4 (4·4) and after intervention 7·7 (4·5) (P = 0·042).

CONCLUSIONS

This first online CBT intervention for people with skin disease showed improvement in anxiety and quality of life in patients with psoriasis. The results are limited by the large amount of missing data and, at this stage, online delivery cannot substitute for established methods of delivery for CBT.

Adherence to medication in patients with psoriasis: a systematic literature review

Psoriasis is associated with considerable physical and psychological morbidity. Optimal use of psoriasis treatments can limit the physical manifestations of psoriasis and help improve quality of life, but nonadherence is common. Smoking, obesity and excessive alcohol consumption are prevalent in this population. A systematic review of adherence to medication and recommendations for lifestyle change in psoriasis was undertaken, with a critical appraisal of the quality of the selected studies. Electronic searches from inception to March 2012 (PubMed, Web of Science and Embase) were conducted. Twenty-nine studies were included; however, none examined adherence to advice about lifestyle change. Studies using a dichotomous classification of adherence tended to report suboptimal adherence, with 21·6-66·6% of patients classed as adherent. No consistent pattern of results emerged for sociodemographical, disease and lifestyle factors as determinants of adherence. However, some treatment factors were associated with adherence. While mixed findings were reported for quality of life as a determinant of adherence, psychological factors (psychological distress and patient satisfaction with care and therapy) were associated with adherence. Only tentative conclusions can be made for determinants of adherence because the methodological quality of many of the included studies limits conclusions. There is a need for improved quality of research and reporting in this area, and this review provides a platform from which future research within this area should progress, along with suggested research recommendations.