European League Against Rheumatism

Background: Patients with inflammatory rheumatic diseases (IRD) are susceptible to influenza infections and their complications. However, they may avoid vaccination for fear of exacerbating their IRD. This study evaluates the 2023/24 influenza vaccine in IRD patients, aiming to provide recommendations for this group in the upcoming season. Methods: In this prospective, longitudinal study, we assessed the self-reported impact of influenza vaccination on patients with IRD. Participants were recruited nationwide between October and December 2023 and completed an online questionnaire after vaccination as well as at three and six months of follow-up. Results: Among 633 patients, 87.5% were female, with a median age of 50.4 (18-84) years. Post-vaccination, 50% experienced injection site pain; 41% reported no side effects. IRD flares occurred in 5%, with 1% requiring changes to immunomodulation. Among 428 patients with follow-up, influenza infections were reported in 38 patients (8.9%), including 10 (2.3%) with reinfections. No severe cases requiring hospitalization were reported. Spondyloarthritis patients had higher susceptibility to influenza (p = 0.002), accounting for 55.3% of infections. IRD flare-ups in the 12 months before vaccination predicted infections (p = 0.002). Conclusions: The 2023/24 vaccine was well tolerated by IRD patients, with no impact on the course of the disease in 95% of cases. Only 9% of patients reported influenza infections, none of which were severe. In light of these findings, physicians are advised to recommend vaccination to eligible IRD patients prior to or in the respective season.

The glass industry is striving to achieve climate neutrality by 2045 and, like many other industries, is facing profound transformation processes. Different challenges arise along the value chain of glass and façade products: while environmental aspects can be integrated more easily in some areas, others require far‐reaching changes. As part of the CircuClarity initiative, stakeholders from industry and academia are working together on innovations for climate neutrality and circularity. This evaluation study provides an overview of current trends and uses the initiative's structure to assess the state of development using a six‐stage model. The results indicate a varied range: while only limited progress has been made to date in terms of energy sources for glass production and there is still a need for further innovation, the multiple uses of glass are undergoing dynamic development, with further differentiation in terms of products and practical, resource‐saving solutions that have the potential for widespread application.

The field of rheumatoid arthritis (RA) is moving towards identification of and intervention in people at risk of RA, but a validated risk stratification method is lacking. This work was undertaken to develop a risk stratification method for persons presenting with arthralgia considered to be at risk of RA. A joint European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) expert committee was established. Risk factor and outcome data from 10 arthralgia cohorts (including clinically suspect arthralgia and autoantibody-positive arthralgia) were studied. The work focused on differentiating the risk of progression to clinically apparent inflammatory arthritis (IA) within 1 year, using clinical and serologic variables, without and with subclinical joint inflammation detected by ultrasound (US) or magnetic resonance imaging (MRI). Developing RA according to the 2010 EULAR/ACR criteria within 1 year was a secondary outcome. A set of validated risk stratification criteria was developed. Using data from 2293 symptomatic at-risk individuals, a stratification method was derived consisting of 6 clinical and serologic variables (morning stiffness, patient-reported joint swelling, difficulty making a fist, C-reactive protein, rheumatoid factor, and anti-citrullinated peptide antibody) yielding an area under the curve (AUC) of 0.80 (95% CI, 0.77-0.83) for IA development. The inclusion of US variables did not increase the discriminative ability. When MRI-detected subclinical inflammation variables were included, the AUC was 0.87 (95% CI, 0.82-0.90). In the presence of clinical, serologic, and MRI variables, a sensitivity and specificity of >75% was achieved. For RA development, the AUC of the criteria with MRI was 0.93 (95% CI, 0.90-0.97). EULAR/ACR risk stratification criteria have been developed for people with arthralgia in secondary care who are considered at risk for RA. They can be applied in the absence or presence of imaging data and have been developed to define homogeneous risk groups for future prevention trials.

BackgroundFall prevention programmes are essential interventions in societies with aging populations. This study assessed the fall rate and other health outcomes, as well as the cost-effectiveness of a home-based fall prevention programme for community-dwelling older people. In a single home visit, trained physical or occupational therapists performed fall risk assessments, eliminated environmental risk factors, and provided tailored exercises.MethodsA prospective, longitudinal observational study was performed with participants of a fall prevention programme who agreed to be followed-up over one year. Baseline data included self-reported falls one month and one year before the intervention. Participants were monitored through bi-monthly telephone calls, assessing their number of falls, fear of falling (using the Falls Efficacy Scale-International (FES-I), quality of life (using the EuroQuol-5 Dimensions-5 Levels, EQ-5D-5L), and physical activity (in minutes per week). Statistical analysis of the data used a Generalized Estimating Equations (GEE) Poisson-Modell for number of falls and a Linear Mixed Model (LMM) for fear of falling, quality of life and physical activity. In addition, health insurance claims data were used to compare the number of medically treated falls in the year before and after the intervention, as well as the related healthcare spending. Cost-effectiveness of the programme versus usual care was estimated as cost per prevented medically treated fall.ResultsOverall, 639 person-years of observation time were analyzed. Participants had a mean age of 81.8 years (+/- 5.2) and 59% were female. On average, the fall rate decreased from 1.35 to 1.02 per person-year, or -23.9% (95%CI from -35.92 to -9.67), fear of falling decreased by -1.27 points (95%CI from −1.50 to -1.05), quality of life improved by -0.88 points (95%CI from −1.09 to -0.68), and physical activity increased by 9.87 min per day (95%CI from 5.65 to 14.09). Analysis of claims data showed a 48.0% reduction (95%CI from 30.5% to 61.0%) in medically treated falls. The average cost per prevented medically treated fall was estimated at approximately 1,353 USD, with a 50% probability of the intervention being cost saving.ConclusionsThis fall prevention programme with a single home visit was found to be effective and cost effective. Health policies should establish such a model as a reimbursed standard care to assist in combatting the increasing burden of falls on individuals and societies.

Background:Complex multinational projects aiming at developing solutions in healthcare, like the SQUEEZE project, need to build fruitful relationships with stakeholders to make the research more efficient, relevant and implementable. Many institutions and networks have developed frameworks for stakeholder engagement. Still, the practicalities are unclear, and many are focused solely on patient and public involvement, not on the involvement of researchers, clinicians, or other stakeholders.Objectives:To develop a stakeholder strategy efficient enough to provide clear guidance on where, when, and how to involve stakeholders in the context of the SQUEEZE project. To implement it and test it in the first year after its development.Methods:The overall SQUEEZE stakeholder strategy was built systematically and iteratively adapting Barkhordarian et al.’s framework [1] consisting of seven steps: 1) Defining, 2) Long-listing, 3) Mapping, 4) Visualizing, 5) Verifying, 6) Mobilizing, and 6) Evaluating. After the development and endorsement, the evaluation included the evaluation of KPIs: stakeholder satisfaction, engagement, influence, and impact. For their measurement, we developed surveys and interviews.Results:The SQUEEZE stakeholder strategy included objectives, values, and actionable points. Several rounds of eliciting dynamics, including patient journeys, favoured an exhaustive long listing that was further reduced. All the identified stakeholders were categorised into significant domains for the project. The work-package (WP) leaders were then surveyed to identify which of the listed stakeholders were relevant for their studies and outputs and why and whether they could identify additional critical stakeholders. The level of preferred engagement was finally decided for each stakeholder on their relevance for implementing SQUEEZE products, the level of influence, and the likelihood of engagement. The stakeholders were then mapped into the research cycle phases to identify the timing for involvement. Finally, actionable strategies were established by tailoring the different groups to the tasks in the SQUEEZE WPs and adding potential outcomes to guide the evaluation, e.g., improved retention rates and recruitment for the involvement of PRPs, etc. The strategies include specific training, recruitment for focus groups, webinars, checklists, etc.After 6 months of issuing the strategy, the WP leaders identified some areas for improvement (Table 1). The survey to stakeholders showed high levels of engagement and satisfaction with the project. The discussions with the strategy team disclosed potential drawbacks of the strategy that had not been well implemented.Table 1. Overview of the stakeholder strategy evaluation by the WP leaders (randomly represented in columns).Conclusion:The SQUEEZE stakeholder strategy provides a comprehensive approach for stakeholder involvement in all work packages of this complex international multinational project. Evaluation, an often-missing part of stakeholder involvement strategies, is an inherent part of the strategy. The developed strategy can be a blueprint for other projects.REFERENCES:[1] Barkhordarian A, et al. J Transl Med. 2015;13:15.Acknowledgements:This project has received funding from the European Union’s Horizon Europe research and innovation programme under grant agreement No 101095052 and from the Swiss State Secretariat for Education, Research and Innovation (SERI).Disclosure of Interests:None declared.

BackgroundRheumatic and musculoskeletal diseases (RMDs) are a burden for individuals and a challenge to healthcare systems.Comparing the current and the future number of rheumatologists and the frequency of RMDs, studies state a huge gap. Another key issue is the uneven distribution of rheumatologists in most countries. These deficits are glaring in low and middle income countries in particular. In sub-Saharan Africa e.g. just in the past 20 years more attention has been drawn to non-communicable diseases. Great challenges exist in Latin America.Patient organisations (POs) offer information and assistance, are competence networks, represent and advocate for patients’ interests and needs and play a pivotal role in healthcare systems.ObjectivesOverarching: With its activities IPARE aims at contributing to a world, where RMDs are recognized, prevented and cured, and patient-centredness is an integral part of health care delivery.The specific aims are.To connect and exchange with national patient organisations and continental networks/organisations of patient organisations from other continents than Europe.To develop, step by step, a network of globally active national POs, national umbrella POs and continental POs.To initiate collaborative projects in the field of education, research, quality of care, congress and advocacy.To share best practices aiming at developing and supporting POs and pan-continental POs.To promote the access to and the exchange at conferences and congresses for RMDs.MethodsIPARE is a PARE project group embedded in the PARE Sub-Committee „Community Relations“, meaning all EULAR regulations will apply.A small project group consisting of representatives from South and Central America, North America, Africa and Europe has been established. We are aiming at enlarging the group (e.g. by having a representative from Asia), but the total number should not exceed 10 in order to work efficiently.After an introductory in-person meeting at the PARE Conference in October the members decided to meet virtually every 6-8 weeks. Webinars are offered every 2-3 months.Aspects of membership, objectives, mode of working were defined.ResultsThe project group members identified - in spite of different health care systems, economic statuses and the extent of the deficits - certain commonalities like lack of rheumatologists (in particular lack of paediatric rheumatologists), shortage of health professionals (e.g. nurses, physiotherapists trained for the treatment of RMDs), delayed diagnosis, access to medical treatment according to internationally accepted treatment recommendations, insufficient non-pharmacological treatment, needs to educate the public and create awareness for RMDs and the situation of people with an RMD, research and patient involvement in research.The group developed a first list of items how these deficits could be tackled, how we can collaborate being aware of the fact that national peculiarities and features and language items have to be taken into account if any material will be produced. To avoid duplication and to check what already exists, an inventory list of informative and educational material is being established.A first webinar open to all representatives of international patient organisations is determined for February.ConclusionThe project group members work with great enthusiasm, are eager to share knowledge and want to learn what can be implemented in their organisations and countries. In addition the group members focus on supranational issues.The project group members share, learn and convey to support implementation.Reference[1]Objectives have to be approved by the PARE Council.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Background: Sacroiliac Joint pain is among the most prevalent causes of low back pain that must be distinguished from other types of LBP. Treatment of sacroiliac pain could be obtained by many methods involving intraarticular steroid injection or pulsed radiofrequency. Objectives: This study purposed to determine Ultrasound-Guided Radiofrequency ablation technique influence and to compare its efficacy with local steroid injection for Sacroiliac pain. Study Design: A clinical comparative study. Methods: Number of 20 patients were randomly allocated in two groups. Group I was subjected to pulsed intraarticular PRFA and group II was subjected to intraarticular steroid injection ultrasounded-guided. The Oswestry Disability Index (ODI) II and Visual Analogue Scale (VAS) were measured before intervention and on follow up immediately post intervention, 1, 3 and 6 weeks later. Results: Patients who received pulsed intraarticular RFA showed decreased pain after therapy with an average of mean ± SD of 3.5 ± 0.53 immediately post and from 4 -6 with a mean ± SD of 4.9 ± 0.88 six weeks after. Following therapy, patients who received SIJ intraarticular steroid injection reported, on average, less discomfort of 3.5 ± 0.53 immediately post and from 5 -7 with a mean ± SD of 5.8 ± 0.63 six weeks after. Conclusions: SIJ intraarticular steroid injections and SIJ pulsed RFA ,both provided considerable pain reduction in SIJafflicted individuals. SIJ pulsed RFA offered longer-lasting pain alleviation and a substantial decrease in the ODI.

Find more EULAR recommendations at [EULAR%7CRecommendations and initiatives][1]. This new section aims to share the latest guidelines and news from scientific societies about important topics related to rheumatology, such as new guidelines from British Society for Rheumatology for treating