Baseline pain, fatigue, and sleep quality predict 12-week pain improvement in inflammatory arthritis: retrospective real-world analysis of a digital health application cohort

FRI0031 Change in functional disability in acpa-positive arthralgia patients prior to progression to inflammatory arthritis

Background/Aims Pain is often persistent in patients with inflammatory arthritis (IA). Deciphering whether this pain is primarily inflammatory or non-inflammatory (via predominantly peripheral or central nervous system mediated mechanisms) offers opportunities for mechanism-based care. This study prospectively investigated the relative contribution of peripherally versus centrally mediated mechanisms of pain from newly diagnosed IA over two years. Methods Patients with newly diagnosed IA and baseline pain scores ≥3 were followed across 4 timepoints over two years. Assessments included: disease activity (Disease Activity Score-28, musculoskeletal ultrasound); quality of life (Musculoskeletal Health questionnaire (MSK-HQ); mental health status (Patient Health Questionnaire Anxiety, Depression Scale), and pain characteristics (fibromyalgia criteria, painDETECT, Static and Dynamic Quantitative Sensory Testing, QST). Mixed-effects regression models examined longitudinal associations. Results Among 66 participants (all baseline pain NRS ≥3), pain decreased significantly during the first six months, with smaller, non-significant reductions thereafter; at 24 months, 49% still reported pain (NRS ≥3). Centrally mediated pain markers improved (fibromyalgia severity -2.7; PainDETECT -2.7; PHQ-15 -1.9; GAD-7 -2.3; PHQ-9 -1.7), as did inflammation (CRP -4.9; SJC -1.7; EGA -12.6) and MSK-HQ (+10.3). Joint PPT increased, but trapezius PPT, TSP and CPM did not significantly change. In mixed-effects models over two years, controlling for prior pain, inflammation was not associated with subsequent pain (AME -0.05, 95% CI -0.67 to 0.56), whereas higher centrally mediated pain markers predicted less pain reduction (AME 1.41, 95% CI 0.83-1.99, p < 0.001). Participants with persistent pain had higher baseline and longitudinal scores for centrally mediated pain (fibromyalgia severity, painDETECT, mental health, fatigue), despite similar baseline inflammation and comparable reductions over time. Baseline centrally mediated pain, but not inflammation, predicted persistent pain (AME 1.32, 95% CI 0.83-1.82, p < 0.001); baseline fatigue, painDETECT, fibromyalgia severity, PHQ-15, PHQ-9, and GAD-7 were the strongest predictors (Table 1). Conclusion In our IA cohort followed from diagnosis, while inflammation reduced comparably across patients, centrally mediated mechanisms primarily contributed to pain persistence. Early identification and treatment of such mechanisms may be key to optimising long-term pain outcomes. Disclosure Z. Rutter-Locher: Grants/research support; NIHR301674. S. Norton: None. B. Menon: None. L. Taams: None. K. Bannister: None. B. Kirkham: None.

Digital health applications (DHAs) can support self-management in inflammatory arthritis (IA), but sustained adherence remains challenging in real-world use. To determine demographic and clinical predictors of 12-week adherence to a rheumatology-specific mobile health application in patients with IA. We retrospectively analyzed 2,036 adult users of the CE-certified Mida Rheuma App (2022–2024). Adherence was defined as self-reported body weight entry at week 12. Candidate predictors included age, gender, time since diagnosis, baseline body weight, and two patient-reported outcomes (PROs): Patient’s Global Assessment of Disease Activity (PGADA) and Patient’s Global Assessment of Pain Intensity (PPAIN). A Random Forest classifier (six predictors) was evaluated with repeated stratified 5 × 2 cross-validation; performance was summarized by receiver-operating characteristic area under the curve (ROC AUC). Of 2,036 patients, 526 (25.8%) met the adherence criterion. Adherence increased with age (peak ≈ 47.4% at 63–69 years) and showed a threshold with disease duration (peak ≈ 45.2% at 3,001–3,500 days, > 3,000-day inflection). PROs exhibited non-linear (“inverted-U”) patterns, with higher adherence at moderate-to-high symptoms (e.g., PGADA 35–40 ≈ 39.3%; PPAIN 10–15 ≈ 39.3%) and lower adherence at minimal or extreme values. Baseline body weight contributed modest predictive information, while the gender effect was minimal. The model achieved an ROC AUC of 0.627 (95% CI, 0.600–0.654), indicating modest but informative discrimination. In this large real-world IA cohort, 12-week adherence was highest among older patients, those with longer disease durations (> 3,000 days), and those reporting moderate-to-high symptom burdens. These results support the use of stratified onboarding and tailored support, particularly for younger or newly diagnosed patients and those at symptom extremes, and motivate the development of multidimensional adherence metrics in prospective studies.

Psychosocial Predictors of Acute and Chronic Pain in Adolescents Undergoing Major Musculoskeletal Surgery

TEN-OM (Toxic Epidermal Necrolysis-Optimal Management) is a retrospective dual-centre cohort analysis of adult patients with toxic epidermal necrolysis (TEN) admitted from 2010 to 2023. It is a multidisciplinary project including dermatology, plastic surgery, pharmacy, ophthalmology and gynaecology. The objective of this study is to describe a range of culpable drug classes in the aetiology of TEN, demographic differences, clinical phenotypes and outcomes in patients hospitalized for TEN. Thirty-five cases were identified from clinical records and met the criteria for inclusion in a semiquantitative analysis. The majority of patients were White (n = 18) and female (n = 24). The median age was 53 years [interquartile range (IQR) 30.5–62.5]. The median length of admission was 21 days (IQR 14–32). The median SCORTEN was 2 (n = 23). Antibiotics constituted the largest category of culpable drugs (n = 10), including co-trimoxazole in three cases. All four cases in the antiepileptic category were attributed to lamotrigine. The median time to re-epithelization was 7 days (IQR 7–9.5). The mortality rate was 26% (n = 9). Deceased patients had involved body surface area (BSA) of ≥ 60% and a SCORTEN of 3–5. Most patients received intravenous immunoglobulin (n = 27, 77%), and 33% (n = 9) of those patients followed the Chelsea Protocol (2 g kg−1 on day 1; then 1 g kg−1 on days 2 and 3). Other systemic treatments included ciclosporin (n = 13, 37%), filgrastim (granulocyte colony-stimulating factor; n = 12, 34%), etanercept (n = 4, 11%) and systemic steroids (n = 11, 32%). Most patients had more than one treatment simultaneously. More than half of the female patients had vulval involvement (n = 16, 67%), but only two patients required dilators. The median time for gynaecological opinion was 6 days from admission. Male urethral examination was documented in only one case. Eye involvement tended to lag up to 7 days behind initial skin signs. This was observed in 74% patients (n = 26), and nearly one in four patients (23%, n = 8) required amniotic membrane transplant. Patients requiring amniotic membrane transplant had ≥ 60% BSA involved, but admission SCORTEN ranged between 0 and 4. This suggests that SCORTEN or BSA alone are not reliable predictors of eye involvement, which might be related to drug pharmacokinetics such as half-life. To date, this is the largest retrospective cohort analysis of patients with TEN in the UK. It highlights the need for a multidisciplinary and collaborative approach in management of TEN, with a particular focus on ocular sequalae. Quantitative analysis was not performed due to data paucity, but there was a possible correlation between nadir serum albumin and length of stay. Considering emerging evidence for the role of etanercept in management of TEN, there is an acute need for a prospective, multicentre register to determine treatment efficacy.

Inguinal hernias are a common surgical condition that, if untreated, can lead to severe complications. Bilateral inguinal hernias add challenges due to increased recurrence and postoperative risks. Although Lichtenstein repair, a mesh-based approach, is the gold standard for its low recurrence, Darn repair - a mesh-free technique - offers a cost-effective alternative in low-resource settings. This study assesses the applicability and effectiveness of both techniques for bilateral inguinal hernias in a resource-limited environment. With Institutional Review Board (IRB) approval from Al-Waleedeen Specialized Hospital (IRB number WAD.12.01.2021), a retrospective cohort analysis was conducted on 75 adult males who underwent bilateral inguinal hernia repair from January 2021 to October 2023 in Sudan. Patients were divided into Group A (Lichtenstein, n =30) and Group B (Darn, n =45). Data on operative time, complications, hospital stay, return to normal activities, patient satisfaction, and economic impact were collected, with a three-month follow-up. Darn repair showed fewer postoperative complications, particularly lower surgical site infections (SSI) (8% vs. 20%, P =0.014). It also had shorter operative times (mean 30minutes less), reduced hospital stays (1.5 vs. 2.8days, P < 0.0001), and lower costs. Recurrence rates were comparable across both groups. While both methods yielded similar recurrence rates, Darn repair showed advantages in resource-limited settings, with fewer complications, shorter hospital stays, and lower costs, making it a practical option when mesh is not readily available. Limitations include retrospective design, convenience sampling, and possible recall bias from phone follow-ups. The three-month follow-up may not capture long-term outcomes like chronic pain or late recurrences. Future studies should extend follow-ups and conduct prospective trials to optimize Darn repair across diverse settings.

BackgroundHemodialysis equipment alarms significantly impact clinical workflow and patient safety. This study aimed to characterize alarm patterns, identify risk factors, and evaluate management effectiveness in hemodialysis facilities.MethodsA retrospective cohort analysis was conducted at 1 hemodialysis center from January 2020 to December 2023. Equipment alarm data from hemodialysis stations (Nikkiso, Gambro, and B.Braun) were systematically collected and analyzed. Multivariate regression and machine learning approaches identified risk factors and developed predictive model.ResultsAmong 4231 recorded alarm events over 32 months, the monthly alarm rate averaged 132.2 ± 54.4 events. The COVID-19 pandemic period (2020–2021) accounted for 82.2% of alarms, with a significant 78.3% reduction post-pandemic (P = 0.022). B.Braun equipment generated 68.7% of alarms, significantly higher than Gambro (21.2%) and Nikkiso (10.1%) devices (P < 0.001). Engineering analysis revealed B.Braun’s lower pressure thresholds (150 vs. 180 mmHg), higher sensor sensitivity (1 vs. 2–5 mmHg resolution), and conservative air detection algorithms (0.3 vs. 0.5 mL) contributed to increased alarm frequency. Pressure-related alarms predominated (37.4%), while 94.5% occurred during active treatment phases. Vascular access complications contributed to 19.8% of events, with permanent catheters being the primary source (47.3%). Patient-related factors accounted for 83.6% of human factor contributions. Patients with BMI > 30 kg/m2 experienced 28% more alarms (OR 1.28, 95% CI 1.12–1.47, P < 0.001), highlighting the need for individualized alarm strategies. The alarm management protocol achieved a 99.3% immediate resolution rate. Predictive modeling (sensitivity 72.3%, specificity 75.8%, PPV 68.9%, NPV 78.6%) enabled targeted interventions, resulting in a 43% alarm reduction, a 56% false alarm decrease, and 51% fewer treatment interruptions (all P < 0.001).ConclusionsEquipment-specific alarm patterns and human factors significantly influence hemodialysis alarm burden. Implementation of predictive analytics and targeted interventions substantially improves alarm management effectiveness and clinical outcomes.

Although mandible trauma has been studied extensively, there is no standard for use of pre- and postoperative antibiotics in other facial trauma. We sought to determine whether antibiotic strategies have an effect on infection rates. Retrospective chart review and cohort analysis. Patients seen by the otolaryngology service for traumatic facial injuries between January 1, 2003 and January 1, 2009, were included in a retrospective cohort analysis (N = 223). All patients received perioperative antibiotic coverage. Isolated mandible fractures were excluded. Patient demographics were 73% male and 27% female, with an average age of 35 years (range, 8-81 years). The most common causes of trauma were assault (39%), motor vehicle accidents (28%), and falls (11%). The overall infection rate was 9%. There was no significant difference (P = .248) between infection rates for patients in each antibiotic group (preoperative, postoperative, pre- and postoperative, only perioperative). Infection rate was independently correlated with both number of fractures (P < .0001) and open fracture wounds (P = .034). There was no significant difference in infection rate between patients who received only perioperative antibiotics and those who received additional antibiotics (P = .997). However, the cohort with the most antibiotic use (pre-, peri-, and postoperative) had more severe facial injuries than the cohort that received only perioperative antibiotics. The use of additional antibiotics outside the perioperative timeframe does not reduce the rate of postoperative infections; however, such antibiotic use may be warranted in cases of severe facial trauma with multiple open fracture wounds. Laryngoscope, 2010.

BackgroundEvidence regarding the relationships among high plasma triglycerides (TG), all‐cause mortality, and atherosclerotic cardiovascular disease (ASCVD) events in low‐to‐moderate risk individuals is limited. The aim of this study was to determine whether the presence of high TG levels influences the risk of all‐cause mortality and ASCVD events in a population cohort followed in the real‐world clinical setting.Methods and ResultsA retrospective longitudinal cohort analysis using administrative databases of 3 Italian Local Health Units was performed. All individuals with at least one TG measurement between January 1, 2010 and December 31, 2015 were followed through December 2016. Outcome measures included incident ASCVD events and all‐cause mortality. Individuals with normal TG levels (<150 mg/dL) were compared with those with high (150–500 mg/dL) and very high TG (>500 mg/dL). 158 042 individuals (142 289 with normal, 15 558 with high, and 195 with very high TG) were considered. In the whole cohort, the overall incidence rates of ASCVD and all‐cause mortality were 7.2 and 17.1 per 1000 person‐years, respectively. After multivariate adjustment for potential confounders, individuals with high and very high TG showed a significantly increased risk of all‐cause mortality (hazard ratio [HR]=1.49 [95% confidence interval (CI) 1.36–1.63], P<0.001, and HR=3.08 [95% CI 1.46–6.50], P<0.01, respectively) and incident ASCVD events (HR=1.61 [95% CI 1.43–1.82], P<0.001, and HR=2.30 [95% CI 1.02–5.18], P<0.05, respectively) as compared to those with normal TG.ConclusionsModerate‐to‐severe elevation of TG is associated with a significantly increased risk of all‐cause mortality and ASCVD events in a large cohort of low‐to‐moderate cardiovascular risk individuals in a real‐world clinical setting.

ObjectiveThis study aimed to identify predictors for the presence of cervical dysplasia in diagnostic LEEPs (Loop Electrical Excision Procedure) of the cervix.Materials/MethodsThe study was designed as a retrospective single-institution cohort analysis of all patients who underwent LEEP without prior proof of high-grade intraepitheliallesion (diagnostic LEEP) between 2015 and 2020 in the Department of Obstetrics and Gynecology of University Hospital Aachen. In order to identify the most meaningful predictive variables forCIN status (CIN2+ or non-CIN2+), multivariate logistic regression was performed and a machine-learning method was used.ResultsA total of 849 patients with an indication for loop excision of the cervix were assessed for eligibility. Finally, 125 patients without prior proof of CIN2+ were includedinto the study. Based on the final multivariate logistic regression model, multiple high-risk HPV infections (p = 0.001), the presence of a T2 transformation zone (p = 0.003) and majorlesion changes (p = 0.015) as a result of the colposcopy examination were found to be statistically significant for CIN status based on the diagnostic LEEP. Subsequent ROC analysis showed ahigh predictive value for the model of 88.35% (AUC). The machine-learning technique (recursive partitioning) identified similar variables as important for CIN status with an accuracy of75%.ConclusionFor clinical decision-making, the result of the colposcopy examination (T2, major change) as well as the results of HPV testing (multiple high-risk HPV infections) arestronger indicators for clinicians to perform diagnostic excisional procedures of the cervix than the presence of high-grade cytological abnormalities.

BackgroundHigh sensitive cardiac troponin T (hsTnT) is a widely used biomarker of myocardial injury. Along with other high sensitive troponins, HsTnT can predict mortality in both cardiac and non-cardiac surgery. The aim of this study was to determine the association between hsTnT serum elevations in the immediate postoperative period until 120 h after cardiac surgery and the occurrence of in‐hospital mortality compared to the Simplified Acute Physiology Score 3 (SAPS3). Additionally, we identified an ideal hsTnT serum threshold to predict in‐hospital mortality.MethodsWe performed a retrospective single-institutional cohort analysis of 2179 patients undergoing cardiac surgery with cardiopulmonary bypass from 2013 to 2021. Logistic regression analysis was used to investigate an association of hsTnT at various time points and in-hospital mortality. The model was adjusted for relevant covariates including SAPS3, lactate and administered norepinephrine dosage. ROC analysis was performed to estimate the accuracy to predict mortality by serum hsTnT concentrations. This prediction was compared to the SAPS3 score. An ideal cutoff of hsTnT concentration was calculated by means of Youden index.ResultsIn total 7576 troponins were measured at the predefined timepoints. 100 (4.59%) patients died during the hospital stay. The fourth hsTnT on d3 (at 96–120 h postoperatively) showed the highest association with in-hospital death (OR 1.56; 95% CI (1.39–1.76); p < 0.001). This finding persisted after multivariable adjustment (aOR 1.34; 95% CI (1.18–1.53); p < 0.001). In contrast, the third hsTnT on d2 (at 48–72 h postoperatively) showed the best discrimination for in-hospital mortality (AUC 82.75%; 95% CI (0.77–0.89). The prediction by the third hsTnT was comparable to the in-hospital mortality prediction by SAPS3 (AUC 79.36%; 95% CI (0.73–0.85); p = 0.056). The optimal cutoff for the third hsTnT was calculated to be 1264 ng/L (Sensitivity 0.62; Specificity 0.88).ConclusionElevated hsTnT after cardiac surgery was associated with an increased risk of in-hospital mortality. HsTnT measured on postoperative day 2 and 3 were most accurate to predict in-hospital mortality. The prediction of in-hospital mortality using hsTNT is comparable to mortality prediction using the SAPS3 score. HsTnT serum levels currently recommended to establish clinically important periprocedural myocardial injury are lower than thresholds identified in this study.

The aim of the study is to determine the revision ratio after implantation of the femoral neck system (FNS) for the treatment of femoral neck fractures. A retrospective single center cohort analysis with a total of 71 patients who underwent the implantation of the FNS between December 2019 and December 2021, was performed. 31 males and 40 females were included. There was no exclusion based on BMI, ASA score, Garden classification or Pauwels classification. Primary outcome was the revision rate after FNS implantation. Secondary outcomes comprise the reason for revision surgery as well as the time toward revision surgery and the 30-day mortality. The revision ratio was 11 out of 71 patients (15.5%) with an average time to revision surgery of 10 months. Most common reason for revision was avascular necrosis (AVN) in 45.5%. Other reasons for revision surgery were implant failure due to a secondary fall on to the hip with the FNS implant in place, cut-out, cut-through and malunion in respectively 27.3%, 9%, 9% and 9% of the revision patients. The one- hole plate was used in 72% of the patients. Mean follow-up was 18.07 months (range 6-30 months). Full weight bearing instruction was given to 85.9% of the patients. Partial weight bearing in 14.1% of the patients. In conclusion, the FNS has similar revision ratio when used for femoral neck fractures compared to cannulated screw fixation in literature. The predominant reason for revision is AVN and implant failure with no difference between the use of the one- or-two-hole plate in this study.

EULAR highlighted the essential role of digital health in increasing self-management and improving clinical outcomes in patients with arthritis. The objective of this study was to evaluate the efficacy and safety of the digital health application (DHA) in patients with inflammatory arthritis. We assessed demographic parameters, treatment regimen, disease activity, and other patient-reported outcomes at baseline and after 4 weeks of DHA use added to standard care treatment. Of 17 patients, who completed the study, 7 (41.2%) patients were male, ranging from 19 to 63 (40.5 ± 12.2) years. No significant change in antirheumatic treatment was observed during the study. Statistically significant improvements (p < 0.05) were noted for health-related quality of life (increase in Physical Component Summary of Short Form-36 (SF-36) by 23.6%) and disease activity (decrease of Clinical Disease Activity Index and Simple Disease Activity Index by 38.4% and 39.9%, respectively). Clinically significant improvement was demonstrated for SF-36 Total Score (+ 14.4%), disease activity (Rheumatoid Arthritis Disease Activity Index− 5 to 15.9%), and depression (Patient Health Questionnaire− 9 to 13.5%). None of the efficacy parameters showed negative trends. No adverse events were reported throughout the study. The usability level was high i.e., the mean mHealth Application Usability Questionnaire Score of 5.96 (max.: 7.0) demonstrated a high level of application usability. This suggests that using a personalized disease management program based on DHA significantly improves several measures of patient-reported outcomes and disease activity in patients with inflammatory arthritis in a timely manner. These findings highlight the potential of complementary digital therapy in patients with inflammatory arthritis.

Complaints of fatigue and poor sleep quality are common in patients with epilepsy. Fatigue may precipitate seizures, and patients with poor sleep quality have higher frequency of seizures and are more likely to have symptoms of depression. This study aims to determine the association of baseline fatigue and sleep quality with antiseizure medication (ASM) resistance in patients with newly diagnosed epilepsy (PWNDE). We also evaluate whether the association is mediated by depression symptoms. We performed a prospective cohort study of PWNDE at comprehensive epilepsy center in Northeast China between June 2020 and May 2024. Fatigue, sleep quality, and depression symptoms were assessed at baseline. All patients were followed for 24 months for ASM-resistant epilepsy. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) of ASM resistance. Models fitted with restricted cubic spline were performed to test for linear and nonlinear shapes of each association. Mediation analysis was used to estimate the mediating effects of depression severity on association between fatigue, sleep quality, and ASM resistance. A total of 189 patients (59 ASM-resistant cases and 130 ASM-responsive controls) were included in the final analysis. Baseline fatigue (HR, 1.98; 95% confidence interval (CI), 1.094-3.583, p = 0.024) and poor sleep quality (HR, 2.193; 95% CI, 1.29-3.729, p = 0.004) were associated with an increased hazard of ASM resistance in PWNDE after full adjustments. There exists a nonlinear association between Fatigue Severity Scale score and the hazard of ASM resistance (P for nonlinear = 0.012). Depression severity partly mediated the effect of fatigue and sleep quality on ASM resistance, with mediated proportions of 18.5% for the fatigue and 23.7% for the sleep quality. Baseline fatigue and poor sleep quality were associated with an increased risk of ASM resistance. The association between fatigue, sleep quality, and ASM resistance were partly mediated by depression severity. These findings emphasize that patients with ASM-resistant epilepsy are more likely to have fatigue, depression, and poor sleep quality at baseline and this may be unrelated to ASM intake.

To examine whether baseline sleep quality is associated with baseline symptoms of posttraumatic stress disorder (PTSD) and level of functioning and whether baseline sleep quality and improvement of sleep quality are specific predictors of change in PTSD symptoms and level of functioning. Data were derived from a four-armed randomized controlled superiority trial (N = 219 trauma-affected refugees). All four groups received treatment as usual consisting of a 10-12 months bio-psycho-social treatment program with an additional differential treatment component added to each arm. We performed bivariate correlation analyses, multiple linear regression analyses, and mediation analyses to examine associations between baseline sleep quality, change in sleep quality, and treatment response for PTSD symptoms and level of functioning. Baseline sleep quality correlated with symptoms of PTSD (r = 0.33) and level of functioning (r = 0.15). Baseline sleep quality, improvement of sleep quality, and improvement of general well-being were predictors of treatment response for symptoms of PTSD and level of functioning when controlling for age, gender, and baseline symptoms of PTSD and depression. We found that good sleep quality at baseline and improvement of sleep quality were predictors of PTSD treatment response. However, treatment response was more closely associated with improvement in general well-being. The results indicate that the effect of improved sleep quality was partly mediated by a more general mental state improvement. Further research is needed to differentiate if a selected subgroup of patients may profit from sleep-enhancing treatment. NCT02761161.