Informing Digital Programs for Lupus Self-Management Education: A Systematic Scoping Review.

Diabetes self-management education and support can improve outcomes in people with diabetes. Providing health interventions via digital modes of delivery can extend the reach of programs delivered through traditional means. The web-based version of the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (MyDESMOND) is a digital diabetes education and support program for people with type 2 diabetes. The program was originally developed in the United Kingdom and is evidence-based, grounded in behavioral theory, and designed through a rigorous process of intervention mapping. As such, MyDESMOND was considered an ideal candidate for adaptation to the Australian setting. Program content and the digital platform were modified to suit the local context to increase the likelihood that the revised version of MyDESMOND will deliver similar outcomes to the original program. The aim of this paper is to describe the systematic processes undertaken to adapt the digital MyDESMOND diabetes education and support program for people with type 2 diabetes to the Australian setting. The adaptation involved a multidisciplinary group with a diverse range of skills and expertise—a governance structure was established, a skilled project team was appointed, and stakeholder engagement was strategically planned. The adaptation of the program content included modifications to the clinical recommendations, the inclusion of local resources, practical changes, and revisions to optimize readability. A 2-stage independent review of the modified content was enacted. Digital adaptations were informed by relevant standards, local legislative requirements, and considerations of data sovereignty. The digital platform was extensively tested before deployment to the production setting. MyDESMOND is the first evidence-based digital diabetes education and support program for Australians with type 2 diabetes. This paper provides a road map for the adaptation of digital health interventions to new contexts.

Recent controlled trials have demonstrated that type 2 diabetes (T2D) remission is possible with significant weight loss in people with newly diagnosed T2D. However, current programs focus on face-to-face education and behavior change, which limit scalability and inclusivity. We examined the effect of a digital education and behavior change program targeting a very low-calorie diet on metabolic control, insulin sensitivity as well as liver fat and fibrosis. Patients with diet/metformin controlled T2D (n=8, 50% male, 52±12 years, BMI 33±4 kg/m2) were remotely supported to undertake a very low-calorie (800 kcal/day) diet using digital education, behavior change and tracking with one-to-one tele-coaching for 12 weeks. Insulin sensitivity index was calculated using a mixed-meal tolerance test, liver fat content by 1H-magnetic resonance spectroscopy and liver fibrosis by elastography. After 12 weeks, participants had reduced their body weight by 9.0±3.6 kg and HbA1c (6.6±1.2% vs. 6.0±0.6%, p=0.05) and improved insulin sensitivity (319±61 vs. 355±49 ml.min-1.m-2, p<0.05). Liver fat content declined (9.8±8.2% to 3.3±3.1%, p<0.01) alongside with measures of liver fibrosis (7.0±3.1 to 4.4±1.3 kPa, p=0.05). Changes of liver fat were directly correlated with changes in body weight (r=0.80, p<0.05) as well as changes in fasting plasma glucose (r=0.85, p<0.01) and HbA1c (r=0.91, p<0.01). Within 12 weeks. 38% of participants achieved remission of T2D (HbA1c <6.5%) and 50% normalized liver fat (intrahepatic fat content <5.6%). In conclusion, this feasibility study demonstrates that digital education, behavior change and tracking can reduce body weight which conveys significant improvements in metabolism and liver health. These preliminary data suggest that care teams should explore how digital education and behavior change can enhance existing care for people with newly diagnosed T2D with a view to achieving remission. Disclosure D. Pesta: None. O.P. Zaharia: None. Y. Kupriyanova: None. J. Hwang: None. D.F. Markgraf: Research Support; Self; Sanofi. M. Trenell: Other Relationship; Self; Changing Health Ltd. J. Szendroedi: None. M. Roden: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Poxel SA, Servier. Board Member; Self; Eli Lilly and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. Speaker's Bureau; Self; Novo Nordisk Inc. Funding EIT Health; German Ministry of Culture and Science of the State of North Rhine-Westphalia; German Federal Ministry of Health; German Federal Ministry of Education and Research

Background: Western dietary patterns, characterized by high intake of ultra-processed foods (UPFs), added sugars, and saturated fats, have been increasingly implicated in promoting systemic inflammation and disrupting gut microbiota composition. These mechanisms may influence the onset, progression, and comorbidities of chronic inflammatory arthritides. This systematic scoping review aimed to summarize current evidence on the association between Western diet (WD) or UPF consumption and the risk, activity, and related outcomes in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and psoriatic arthritis (PsA). Methods: We conducted a systematic review including randomized controlled trials, observational studies (cohort, case-control, cross-sectional), and preclinical models assessing the relationship between WD or UPF intake and disease-related outcomes in RA, axSpA, or PsA. Exclusion criteria comprised narrative reviews, editorials, case reports, and studies not specifically addressing both the dietary exposure and relevant disease outcomes. A comprehensive literature search was conducted in PubMed, Embase, Scopus, Web of Science, and the Cochrane Library, with the final search on May 18, 2025 and no time limit applied. Reference lists were manually screened, and forward citation tracking was performed using Google Scholar. Risk of bias was not formally assessed, consistent with the exploratory nature of this scoping review. Data were synthesized narratively and tabulated by dietary exposure, outcomes, and key findings. Results: During screening, we assessed 165 papers. Only 10 studies involving over 244,000 individuals were included. Eight studies addressed RA, comprising 7 clinical and 1 preclinical investigation. Across these, greater UPF consumption or adherence to WD was consistently associated with adverse outcomes. Cohort studies reported an increased RA incidence with adjusted hazard ratios between 1.04 and 1.17; case-control analyses found odds ratios up to 1.84. Inflammatory markers were elevated, including CRP (+0.01 to +0.097 mg/L), ESR (+2 to +3.985 mm/h), and HbA1c (+0.02% to +0.04%). Effects on disease activity were variable (DAS28: +0.01 to +0.49; SJC: up to +0.6 joints). Cardiometabolic risk indicators, such as Framingham score, glucose, insulin, and visceral fat, also worsened with higher UPF intake. Alterations in gut microbiota were documented in both clinical and murine RA models. For axSpA, 1 prospective study (n=140) found no significant association between UPF intake and disease activity. No eligible clinical studies were found for PsA, though one preclinical model demonstrated that WD exposure exacerbated joint and skin inflammation and induced dysbiosis. Discussion: Current evidence supports a detrimental association between WD or UPF intake and inflammatory and metabolic outcomes in RA. Data on axSpA are scarce and inconclusive, and clinical evidence in PsA is lacking. These findings underscore the need for targeted dietary research in spondyloarthritis and support the incorporation of nutritional assessment into comprehensive rheumatologic care.

To evaluate the effect of a novel, co-designed, digital AF educational program, 'INFORM-AF', to reduce re-hospitalisation of people with AF. The secondary aims are to examine the effect of the intervention on: (a) reducing cardiovascular-related hospitalisation, (b) increasing medication adherence, AF-related knowledge, and Atrial fibrillation (AF)-related quality of life and (c) determining the cost-effectiveness of the intervention. AF is an increasingly prevalent cardiac arrythmia that involves complex clinical management. Comprehensive education is essential for successful self-management of AF and is associated with positive health-related outcomes. There has been an increase in technology-based education for AF. However, its effects on hospitalisation, medication adherence and patient-reported outcomes are unclear. A prospective, randomised (1:1), open-label, blinded-endpoint, multicentre clinical trial. Eligible participants are aged 18 years or above, diagnosed with AF, and own a smartphone. The study will be conducted at two metropolitan hospitals. In the intervention group, participants will receive the AF educational program delivered via Qstream®. In the control group, participants will receive the Stroke Foundation 'Living with AF' booklet. The primary outcome is re-hospitalisation within 12 months from an indexed presentation or hospital admission. This clinical trial is part of a developing program of work that will examine mHealth educational-behavioural interventions on cardiovascular outcomes. Findings from this pilot study will inform the development of a digital educational framework for patients living with AF. There remain many gaps in providing high-quality patient education for patients with AF. This trial will test a new theory-driven, smartphone-based education program on important clinical outcomes, including rehospitalisation. This study evaluates a novel, co-designed, digital AF educational program, 'INFORM-AF', to reduce the re-hospitalisation of people with AF. Study results are expected to be reported in 2025. Findings are expected to inform practice recommendations for AF patient education that may be included in future clinical practice guideline recommendations. SPIRIT Checklist. JL is a consumer co-researcher on the project and provided critical input into intervention design, and feedback and input across the study duration.

AB1262 Relative contribution of tenosynovitis and joint synovitis in rheumatoid and psoriatic arthritis revealed by contrast-enhanced, dynamic MRI: Das 28 correlates with the extension of synovitis but not with its...

German S3-Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm - Part 2: Treatment monitoring and specific clinical or comorbid situations.

AB1045 Efficacy of Etanercept on Radiographic Progression in Adult Patients with Rheumatoid Arthritis or Psoriatic Arthritis: Results from The Second Interim Analysis of A German Non-Interventional, Prospective, Multi-Center Study

BackgroundThe study of the relationship between the presence of fibromyalgia (FM) with rheumatoid (RA) and psoriatic arthritis (PsA) patients can affect the main disease outcome and the treatment decision. The research aims to assess the associated fibromyalgia and vitamin D level in rheumatoid and psoriatic arthritis patients.ResultsA cross-sectional study included 60 RA, 30 PsA, and 40 healthy controls, all of them were evaluated for the diagnosis of FM and serum vitamin D level, disease activity score 28 (DAS28), and health quality of life. The mean age of RA was 47.75 ± 11.11 SD, for PsA 44.17 ± 10.8 SD, and for the controls 44.35 ± 13.64 with no significant differences. FM was diagnosed in 21.7% of RA, 13.3% of PsA, and 2.5% of healthy controls with a significant difference among the three groups (P value = 0.025). RA and PsA patients with concomitant FM showed statistically significant higher disease activity scores, significantly worse quality of life than those without FM, and significantly lower serum vitamin D than those without FM.ConclusionVitamin D deficiency and the presence of FM can be related to higher disease activity and less response to treatment, early recognition and treatment of FM and vitamin D deficiency in RA and PsA patients could be important to obtain a good response to therapy and achieve remission.

Objectives. Improvement of early diagnosis of psoriatic arthritis based on clinical data, immunological and mathematical research methods. Material and methods. The study was carried out between 2019 and 2022 at the Rheumatology and Nephrology Discipline, in the arthrology and rheumatology departments of the Timofei Moşneaga Republican Clinical Hospital. To accomplish the tasks set out in the study, 110 patients were examined, including 55 patients with psoriatic arthritis (group I) and 55 patients with rheumatoid arthritis (group II). Results. The range with the highest probability of psoriatic arthritis for the instrumental index is between 0.54 and 1.86. Of the 55 patients with psoriatic arthritis in 95% of patients clinical, laboratory, immunological and instrumental indices were within the range of the highest probability of the disease, which indicates a fairly high reliability of the mathematical model. Conclusions. Immune disorders in the early stages of rheumatoid arthritis and psoriatic arthritis are nonspecific and are characterized by an increase in CD16+ (26.2±1.5) and CD29+ (24.8±2.1) in rheumatoid arthritis, which is significantly higher than in psoriatic arthritis CD16+ (22.0±1.3) and CD29+ (17.4±3.2) (p <0.05). A mathematical model of rheumatoid arthritis and psoriatic arthritis has been developed, which serves as an additional way of diagnosing rheumatoid arthritis and early psoriatic arthritis. Keywords: rheumatoid, psoriatic arthritis, mathematical, immune diagnosis.

THU0606 Incidence and Prevalence of Cardiovascular Risk Factors among Patients with Rheumatoid Arthritis, Psoriasis, or Psoriatic Arthritis

AB0840 INFLUENCE OF PSORIATIC ARTHRITIS (PsA) ON BONE LOSS AND ANALYSIS BETWEEN AXIAL AND PERIPHERAL PsA IN JAPANESE PATIENTS

The US Institute of Education Sciences (IES) currently provides a progressive series of education research grants that can support the development of innovative and creative educational programs, starting with exploratory grants, and progressing through developmental grants, efficacy trials, and finally, effectiveness studies. The IES further requires an evaluation component for each of these program developmental stages. In this article, the authors report on their experiences as evaluators of the developmental stage of a digital educational program called Scholar. Their reflections concentrate on what might be uniquely relevant to digital educational programs and to programs at the IES developmental stage. The key issues discussed include: (a) the challenge of assessing implementation fidelity and variability for a developmental project; (b) the challenge of assessing the program's reach to diverse program participants, especially those least well served in a given context; and (c) the challenges of securing sufficient and relevant implementation data, and of addressing pressures for gathering preliminary efficacy data. Interwoven through these discussions are snapshots of selected program participants' voices describing their own program experiences and views. The article concludes with the authors' reflections and commentary on future directions for evaluating comparable digital educational programs at the IES developmental stage.

Chronic inflammation, such as that present in rheumatoid arthritis (RA) and psoriatic arthritis (PsA), leads to aberrations in bone remodeling, which is mediated by several signaling pathways, including the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway. In this light, pro-inflammatory cytokines are now clearly implicated in these processes as they can perturb normal bone remodeling through their action on osteoclasts and osteoblasts at both intra- and extra-articular skeletal sites. As a selective inhibitor of JAK1 and JAK3, tofacitinib has the potential to play a role in the management of rheumatic diseases such as RA and PsA. Preclinical studies have demonstrated that tofacitinib can inhibit disturbed osteoclastogenesis in RA, which suggests that targeting the JAK-STAT pathway may help limit bone erosion. Evidence from clinical trials with tofacitinib in RA and PsA is encouraging, as tofacitinib treatment has been shown to decrease articular bone erosion. In this review, the authors summarize current knowledge on the relationship between the immune system and the skeleton before examining the involvement of JAK-STAT signaling in bone homeostasis as well as the available preclinical and clinical evidence on the benefits of tofacitinib on prevention of bone involvement in RA and PsA.Key Points• Chronic inflammation in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) leads to disturbances in bone remodeling• Bone remodeling is mediated by several signaling pathways, including the JAK-STAT pathway• Tofacitinib, a selective inhibitor of JAK1 and JAK3, is active in RA and PsA and may help limit systemic bone loss through inhibiting disturbed osteoclastogenesis• Clinical trials show that tofacitinib reduces articular bone erosion

Invited Commentary

BackgroundOpioid prescribing has more than doubled in the UK between 1998 and 2016. Potential adverse health implications include dependency, falls and increased health expenditure.AimTo describe the predictors of long‐term opioid prescribing (LTOP) (≥3 opioid prescriptions in a 90‐day period).Design and settingA retrospective cross‐sectional study in 41 general practices in South London.MethodMulti‐level multivariable logistic regression to investigate the determinants of LTOP.ResultsOut of 320 639 registered patients ≥18 years, 2679 (0.8%) were identified as having LTOP. Patients were most likely to have LTOP if they had ≥5 long‐term conditions (LTCs) (adjusted odds ratio [AOR] 36.5, 95% confidence interval [CI] 30.4‐43.8) or 2‐4 LTCs (AOR 13.8, CI 11.9‐16.1) in comparison to no LTCs, were ≥75 years compared to 18‐24 years (AOR 12.31, CI 7.1‐21.5), were smokers compared to nonsmokers (AOR 2.2, CI 2.0‐2.5), were female rather than male (AOR 1.9, CI 1.7‐2.0) and in the most deprived deprivation quintile (AOR 1.6, CI 1.4‐1.8) compared to the least deprived. In a separate model examining individual LTCs, the strongest associations for LTOP were noted for sickle cell disease (SCD) (AOR 18.4, CI 12.8‐26.4), osteoarthritis (AOR 3.0, CI 2.8‐3.3), rheumatoid arthritis (AOR 2.8, CI 2.2‐3.4), depression (AOR 2.6, CI 2.3‐2.8) and multiple sclerosis (OR 2.5, CI 1.4‐4.4).ConclusionLTOP was significantly higher in those aged ≥75 years, with multimorbidity or specific LTCs: SCD, osteoarthritis, rheumatoid arthritis, depression and multiple sclerosis. These characteristics may enable the design of targeted interventions to reduce LTOP.