Management and treatment of children, young people and adults with systemic lupus erythematosus: British Society for Rheumatology guideline scope

The objective of this guideline is to provide up-to-date, evidence-based recommendations for the management of SLE that builds upon the existing treatment guideline for adults living with SLE published in 2017. This will incorporate advances in the assessment, diagnosis, monitoring, non-pharmacological and pharmacological management of SLE. General approaches to management as well as organ-specific treatment, including lupus nephritis and cutaneous lupus, will be covered. This will be the first guideline in SLE using a whole life course approach from childhood through adolescence and adulthood. The guideline will be developed with people with SLE as an important target audience in addition to healthcare professionals. It will include guidance related to emerging approved therapies and account for National Institute for Health and Care Excellence Technology Appraisals, National Health Service England clinical commissioning policies and national guidance relevant to SLE. The guideline will be developed using the methods and rigorous processes outlined in 'Creating Clinical Guidelines: Our Protocol' by the British Society for Rheumatology.

OP0203-HPR EVALUATION OF A 10-WEEK PROGRESSIVE RESISTANCE TRAINING PROGRAMME FOR PEOPLE WITH INFLAMMATORY ARTHRITIS

Background:

Inflammatory Arthritis [IA] adversely affects well-being, function, fatigue and strength1. Guidelines recommend people with IA should exercise to improve strength and cardiovascular fitness2. In 2015, our team introduced an evidence-based Progressive Resistance Training Programme [PRTP] for IA3.

Objectives:

To evaluate the effectiveness of a PRTP within a United Kingdom National Health Service setting.

Methods:

A pre- to post-treatment evaluation was conducted. People with IA attending Rheumatology Physiotherapy were offered a supervised PRTP (1 hour x 10 weeks): 7 exercises at 70-80% 1-repetition maximum (3 x 8-12 repetitions). Treatment outcomes included Health Assessment Questionnaire [HAQ], EQ5D-5L, 30s sit-to-stand [STS], Self-Efficacy (SARAH Trial) [SE], Grip Strength and FACIT-Fatigue [FACIT-F]. Changes in outcomes were analysed using Paired Samples t-tests and standardised mean difference (SMD).

Results:

201 patients commenced the programme between May 2015 and April 2019, with 121 participants providing complete pre-post HAQ data. Diagnoses included Rheumatoid Arthritis (n=149), Psoriatic Arthritis (n=42), Juvenile Idiopathic Arthritis (n=5), Enteropathic IA (n=2), Oligoarthritis (n=1), Reactive Arthritis (n=1) and Undifferentiated IA (n=1). Age (mean ± SD) = 56.8 ± 14.8 years; number of sessions attended = 7.7 ± 3.4.

There were no differences between those recorded as not completing the PTRP (n=54; 72% women; age 55.0 ± 14.6 years; HAQ 0.99 ± 0.70) versus the others (n=147; 78% women; age 57.5 ± 14.8; HAQ 0.86 ± 0.65). A pragmatic decision was made to analyse all available data for each outcome.

Table 1.

Analysis of PRTP outcomes * Indicates clinical improvement.

Outcome measurePre-treatmentPost-treatmentMean difference(95% CI)p-valueStandardised mean difference(95% CI)HAQmax score 3 (n=121)0.83 ± 0.650.70 ± 0.67-0.13(-0.07, -0.19)p<0.001-0.20*(-0.46, 0.07)EQ5D VASmax score 100 (n=119)70.0 ± 16.376.7 ± 15.26.7(9.4, 3.9)p<0.0010.42*(0.17, 0.68)STSnumber in 30s (n=118)13.2 ± 4.916.2 ± 5.33.0(3.6, 2.5)p<0.0010.59*(0.33, 0.85)SEmax score 70 (n=117)52.3 ± 10.458.6 ± 8.06.3(8.3, 4.4)p<0.0010.68*(0.41, 0.94)Grip Strength kg force(n=62)20.3 ± 9.423.6 ± 10.63.3(4.8, 1.7)p<0.0010.33*(-0.03, 0.68)FACIT-Fmax score 52(n=58)30.9 ± 11.535.5 ± 12.04.6(7.2, 2.1)p=0.0010.39*(0.02, 0.76)

Conclusion:

All outcome measures demonstrated statistically significant improvements. Notably, minimal clinically important differences were achieved in STS and FACIT-F. STS correlates to lower limb power, balance and endurance, and is a predictor of falls4. Fatigue significantly impacts function in people with IA5, often limiting confidence and willingness to participate in exercise activities6.

Effective evidence-based PRTPs for people with IAs can be delivered by Physiotherapists. Improvements in function, wellbeing, self-efficacy, strength and fatigue are achievable, however, exploration of the clinical relevance of these observed changes is recommended. Further research exploring patients’ perspectives of the PRTP and adherence to long-term exercise is needed.

References:

[1]Cooneyet al. (2011) Benefits of Exercise in Rheumatoid ArthritisJ. Aging Res.Vol 2011

[2]Rausch Ostoffet al. (2018) 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritisAnn Rheum Dis77(9)

[3]Lemmeyet al. (2009) Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trialArthritis Rheum16(12)

[4]Beaudartet al. (2019) Assessment of Muscle Function and Physical Performance in Daily Clinical PracticeCalcif. Tissue Int.105(1)

[5]Dureset al. (2016) Patient preferences for psychological support in inflammatory arthritis: a multicentre surveyAnn Rheum Dis75(1)

[6]Rongen-van Dartelet al. (2015) Effect of Aerobic Exercise Training on Fatigue in Rheumatoid Arthritis: A Meta-AnalysisArth Care Res67(8)

Disclosure of Interests:

None declared

P86 Evaluation of a 10-week progressive resistance training programme for people with inflammatory arthritis

Background

Inflammatory arthritis [IA] has adverse effects on strength, function, fatigue and well-being. Guidelines recommend people with IA should exercise to improve strength and cardiovascular fitness. In 2015, our Rheumatology Physiotherapy Team introduced an evidence-based Progressive Resistance Training Programme [PRTP] for people with IA. This research aimed to evaluate its effectiveness within a United Kingdom National Health Service [NHS] setting.

Methods

A pre- to post-treatment evaluation was conducted. People with IA attending Rheumatology Physiotherapy were offered the supervised PRTP (1-hour x 10 weeks), performing 7 resistance exercises each session (70-80% 1RM, 3 x 8-12 reps). Pre- and post-treatment outcomes included Health Assessment Questionnaire [HAQ], EQ5D-5L, Self-Efficacy (SARAH Trial), 30 second Sit-to-Stand [STS], FACIT-F (fatigue scale) and Grip Strength. Changes in outcomes were analysed using Paired Samples t-tests and standardised mean difference (SMD) were calculated.

Results

201 patients commenced the programme between May 2015 and April 2019, with 121 participants completing it. Diagnoses included Rheumatoid Arthritis (n = 149), Psoriatic Arthritis (n = 42), Juvenile Idiopathic Arthritis (n = 5), Enteropathic IA (n = 2), Oligoarthritis (n = 1), Reactive Arthritis (n = 1) and Undifferentiated IA (n = 1). Age = mean 56.8 ± SD 14.8 years; number of sessions attended = 7.7 ± 3.4. There were no differences between participants not completing (n = 54; 72% women; age 55.0 ± 14.6 years; HAQ 0.99 ± 0.70) versus those completing the PRTP (n = 147; 78% women; age 57.5 ± 14.8 years; HAQ 0.86 ± 0.65). A pragmatic decision was made to analyse all available data for each outcome.

Conclusion

All outcome measures demonstrated statistically significant improvements. Notably, minimal clinically important differences were achieved in STS and FACIT-F. STS correlates to lower limb power, balance and endurance, and is a predictor of falls. Fatigue significantly impacts function in people with IA, often limiting confidence and willingness to participate in exercise activities. Effective evidence based PRTPs for people with IAs can be delivered in an NHS service. Improvements in function, wellbeing, self-efficacy, strength and fatigue are achievable, however, exploration of the clinical relevance of these observed changes is recommended. Further research exploring patients’ perspectives of the PRTP and adherence to long-term exercise is needed.

Disclosures

J. Skeates: None. J. Pearson: None. S. Derham: None. S. Palmer: None.