Living with foot and ankle disorders in rheumatic and musculoskeletal diseases: A systematic review of qualitative studies to inform the work of the OMERACT foot and ankle working group

ObjectivesThis study aimed to determine outcome domains of importance to patients living with foot and ankle disorders in rheumatic and musculoskeletal diseases (RMDs), by exploring the symptoms and impact of these disorders reported in existing qualitative studies.MethodsSix databases were searched from inception to March 2022. Studies were included if they used qualitative interview or focus group methods, were published in English, and involved participants living with RMDs (inflammatory arthritis, osteoarthritis, crystal arthropathies, connective tissue diseases, and musculoskeletal conditions in the absence of systemic disease) who had experienced foot and ankle problems. Quality was assessed using the Critical Appraisal Skills Programme qualitative tool and confidence in the findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. All data from the results section of included studies were extracted, coded and synthesised to develop themes.ResultsOf 1,443 records screened, 34 studies were included, with a total of 503 participants. Studies included participants with rheumatoid arthritis (n = 18), osteoarthritis (n = 5), gout (n = 3), psoriatic arthritis (n = 1), lupus (n = 1), posterior tibial tendon dysfunction (n = 1), plantar heel pain (n = 1), Achilles tendonitis (n = 1), and a mixed population (n = 3), who live with foot and ankle disorders. Seven descriptive themes were generated from the thematic synthesis: pain, change in appearance, activity limitations, social isolation, work disruption, financial burden and emotional impact. Descriptive themes were inductively analysed further to construct analytical themes relating to potential outcome domains of importance to patients. Foot or ankle pain was the predominant symptom experienced by patients across all RMDs explored in this review. Based on grading of the evidence, we had moderate confidence that most of the review findings represented the experiences of patients with foot and ankle disorders in RMDs.ConclusionsFindings indicate that foot and ankle disorders impact on multiple areas of patients’ lives, and patients’ experiences are similar regardless of the RMD. This study will inform the development of a core domain set for future foot and ankle research and are also useful for clinicians, helping to focus clinical appointments and measurement of outcomes within clinical practice

Pathophysiology of acute respiratory syndrome coronavirus 2 infection: a systematic literature review to inform EULAR points to consider

Background The SARS-CoV-2 pandemic is a global health problem. Beside the specific pathogenic effect of SARS-CoV-2, incompletely understood deleterious and aberrant host immune responses play critical roles in severe disease. Our objective was to summarise the available information on the pathophysiology of COVID-19.Methods Two reviewers independently identified eligible studies according to the following PICO framework: P (population): patients with SARS-CoV-2 infection; I (intervention): any intervention/no intervention; C (comparator): any comparator; O (outcome) any clinical or serological outcome including but not limited to immune cell phenotype and function and serum cytokine concentration.Results Of the 55 496 records yielded, 84 articles were eligible for inclusion according to question-specific research criteria. Proinflammatory cytokine expression, including interleukin-6 (IL-6), was increased, especially in severe COVID-19, although not as high as other states with severe systemic inflammation. The myeloid and lymphoid compartments were differentially affected by SARS-CoV-2 infection depending on disease phenotype. Failure to maintain high interferon (IFN) levels was characteristic of severe forms of COVID-19 and could be related to loss-of-function mutations in the IFN pathway and/or the presence of anti-IFN antibodies. Antibody response to SARS-CoV-2 infection showed a high variability across individuals and disease spectrum. Multiparametric algorithms showed variable diagnostic performances in predicting survival, hospitalisation, disease progression or severity, and mortality.Conclusions SARS-CoV-2 infection affects both humoral and cellular immunity depending on both disease severity and individual parameters. This systematic literature review informed the EULAR ‘points to consider’ on COVID-19 pathophysiology and immunomodulatory therapies

Characterisation of prodromal and very early psoriatic arthritis: a systematic literature review informing a EULAR taskforce

International audienceBackground Identifying subjects at risk of imminent psoriatic arthritis (PsA) would allow these subjects to participate in therapeutic interventions to delay or prevent PsA development. Methods A systematic literature review (SLR) was conducted in 2021 in Medline, Embase, PubMed, Central databases and international congress abstracts (PROSPERO CRD42022255102). All articles reporting the characteristics of patients transitioning from psoriasis (PsO) to PsA and from undifferentiated arthritis (UA) to PsA were included. Clinical and imaging characteristics were collated before PsA onset and at time of PsA diagnosis. Results Eighteen of 23 576 references evaluated for PsO/PsA transition were analysed; 14 were cohort studies, 2 case-control studies. Two SLRs were used to enrich the project but were not analysed per se. Of 7873 references focusing on UA to PsA, 3 studies were included. Meta-analysis was not possible due to excessive data heterogeneity. Patients with PsO who developed PsA often reported joint pain, joint tenderness and functional limitations. Arthralgia (PsO, n=669; incident PsA, n=99) was associated with subsequent PsA development. On imaging, subclinical enthesopathy (PsO=325; Incident PsA=39) appeared linked to later PsA development. At the time of PsA onset (incident PsA, N=214), peripheral arthritis, mainly oligo-arthritis (ie, the mean number of swollen joints ranged from 1.5 to 3.2), was the most frequent pattern of clinical presentation. Conclusions Joint pain, arthralgia and entheseal involvement detected by imaging were frequent in individuals with PsO at risk for imminent PsA. Very early PsA was mainly oligoarticular. This review informed a EULAR taskforce on transition to PsA

P041 Living with foot and ankle disorders in rheumatic and musculoskeletal diseases: a thematic synthesis of qualitative studies to inform the work of the Outcome Measures in Rheumatology (OMERACT) Foot and Ankle Working Group

Background/Aims Foot and ankle involvement is common in rheumatic and musculoskeletal diseases (RMDs), but high-quality evidence is lacking to determine the effectiveness of foot and ankle treatments. Heterogeneity in the outcomes used across clinical trials in this area hinders the ability to compare study findings, and some outcomes are not always meaningful to patients. This study aimed to determine what outcomes are important to patients by exploring and synthesising qualitative data relating to the symptoms and impact of living with foot and ankle disorders in RMDs. Methods Six databases (CINAHL; Ovid Embase; Ovid MEDLINE; Psycinfo; Cochrane Database of Systematic Reviews; CENTRAL) were searched from inception to March 2022. Qualitative interview or focus group studies published in English and involving participants living with foot or ankle disorders in RMDs (inflammatory arthritis, osteoarthritis, crystal arthropathies, connective tissue diseases, and musculoskeletal conditions in the absence of systemic disease) were included. Quality was assessed using the Critical Appraisal Skills Programme qualitative tool. All data from the results section of included studies were extracted, coded and synthesised to develop themes. Patient and public involvement contributors were involved throughout the review, from design of the study to interpretation of the results and discussions about the findings. Results Of 1,440 database records screened, 34 studies were included, with a total of 581 participants. Studies focused on living with foot or ankle disorders in rheumatoid arthritis (n = 18), osteoarthritis (n = 5), gout (n = 3), psoriatic arthritis (n = 1), lupus (n = 1), posterior tibial tendon dysfunction (n = 1), plantar heel pain (n = 1), Achilles tendonitis (n = 1), and mixed population (n = 3) patients. Six themes were generated from the thematic synthesis: pain, change in appearance, activity limitations, social isolation, limited work ability and emotional impact. Foot or ankle pain was the predominant symptom experienced by patients in all included studies and was closely linked to other themes. Both pain and change in appearance of the feet or ankles (deformity), and subsequent limitations in footwear and clothing choices, led to restrictions in physical activities, social participation and work. Emotional distress, including anxiety, anger and embarrassment, was common among patients with foot and ankle disorders across all of the RMDs explored in this review. Conclusion This is the first study to synthesise findings of qualitative research exploring the lived experience of patients with foot and ankle disorders in RMDs. Findings indicate that these disorders impact on multiple areas of patients’ lives, both physically and psychologically. Patients’ experiences of foot and ankle disorders are similar across different RMDs, although there are a limited number of qualitative studies focusing on conditions other than rheumatoid arthritis. These findings will inform a future consensus study prioritising the outcomes that should be measured in future research studies and clinical practice. Disclosure L.S. Chapman: None. C. Flurey: None. A.C. Redmond: None. P. Richards: None. C. Hofstetter: None. B. Tapster: None. J. Emmel: None. P.S. Helliwell: None. H.B. Menz: None. M.T. Hannan: None. B. Shea: None. H.J. Siddle: None