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Background The association between the weather and chronic pain is complex and largely undetermined. More than 80% of patients believe in an association between weather and pain. However, beliefs vary about which weather variable (e.g. temperature, atmospheric pressure) influences pain, with possible differences across pain disorders. Objectives To describe participants9 beliefs about an association between weather and pain at the time of enrolment to a national smartphone study entitled “Cloudy with a Chance of Pain”, stratified by self-reported diagnosis. Methods Participants in the UK aged 17 years or older, with access to a smartphone and who had arthritis or other chronic pain for at least 3 months were recruited to “Cloudy with a Chance of Pain”. Participants completed an 8 point enrolment questionnaire which included two questions about their beliefs: 1) Belief strength: On a scale of 0–10, how likely do you think weather is associated with pain? 2) Belief type: If you think there is a possible association, which weather condition(s) affect your pain the most? Both questions offered categorical response options. In question 2, participants were permitted to select multiple categories and a “free text” option was also offered. We present a descriptive analysis of the categorical data and sub-analyses of differential beliefs by age (above/below 50yrs), gender and self-reported diagnosis. Results are reported as median (IQR) or number (%). Mann-Whitney U-Test and Fisher9s exact test were used for statistical analysis. Within Table 1, significant associations (p Results 5,282 enrolment questionnaires were included in analysis. Median belief strength was 7 (5–9). 8% reported a belief strength of 4 or less. Participants most commonly believed that “damp/rain” affected their symptoms (72%). When compared to the total study population, those with fibromyalgia, chronic headache and neuropathic pain more frequently believed that changes in temperature and pressure correlated with pain. Indeed, participants with fibromyalgia and neuropathic pain more commonly reported belief in an association between all aspects of weather and pain when compared to the total study population. Table 1 summarises belief strength and belief type by gender, age and underlying diagnosis. Conclusions Most participants strongly believed in an association between weather and pain. Participants most commonly believed that damp/rain affected their pain. Specific beliefs vary between participants and between diagnostic groups, perhaps reflecting different causal pathways in these conditions. Acknowledgement Arthritis Research UK and uMotif Ltd. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with the presence of psoriasis. Lifestyle factors such as body mass index (BMI), smoking and alcohol consumption have been reported to contribute to the risk of both diseases. These risk factors also contribute to cardiovascular disease (CVD) which is a major cause of morbidity and mortality in patients with psoriasis and PsA. Objectives To compare lifestyle factors between individuals with PsA, psoriasis and a control group and to assess the association between these inflammatory diseases and CVD outcomes utilising the UK Biobank resource. Methods UK Biobank recruited 502,664 people aged 40–70 years in the UK between 2006 and 2010. Data on lifestyle, sociodemographics, health and medical history were collected at the assessment visit by questionnaire and interview by research nurse. Participants were asked if they have ever been diagnosed by a physician with a disease. Lifestyle factors including alcohol (current or past drinker) and smoking status (ever or never) were recorded and height and weight measured to calculate BMI. In this cross-sectional study, the frequency of these factors was compared between PsA, psoriasis and healthy controls using logistic or linear regression analyses depending on the outcome, adjusting for age and gender. Comparison between disease groups was performed by linear combinations of coefficients post estimation. Three CVD outcomes: heart attack, angina and hypertension, were tested for association with disease group using logistic regression including BMI, smoking, alcohol, age and sex as covariates. Odds ratios (OR) and β coefficients are reported with 95% confidence intervals (CI). Results 862 people with PsA, 4,761 with psoriasis and 465,371 control participants were included in the study (Table). Compared to the control group; both the PsA and psoriasis groups had higher BMI (β 1.43 (95% CI 1.11:1.75) and 0.72 (0.58:0.85) respectively), the psoriasis group smoked more (OR 1.63 (1.54:1.72)) and patients with PsA were less likely to be current drinkers (OR 0.68 (0.55:0.85)). Compared to patients with psoriasis, patients with PsA had higher BMI (β 0.69 (0.32:1.06)) and were less likely to be ever smokers and current drinkers (OR 0.70 (0.61:0.81) and 0.65 (0.51:0.83), respectively). Finally, hypertension was more prevalent in PsA compared to the control and psoriasis cohorts (OR 1.71 (1.48:1.97) and 1.55 (1.33:1.82), respectively). Conclusions Using a large population based cohort we show that self-reported CVD outcomes, in particular hypertension, are significantly higher in PsA compared to psoriasis independently of known CVD risk factors. The results contribute to our understanding of the lower quality of life reported by patients with PsA. Disclosure of Interest None declared

Background Traditionally, participant recruitment for observational studies occurs by clinical teams identifying and approaching eligible patients. The current digital age, with increasing access to the web via PCs, tablets and smartphones provides an exciting alternative recruitment strategy. However, it is not clear whether studies can successfully recruit large numbers of participants in this way. “Cloudy with a Chance of Pain” is a national prospective population study which utilises participant9s own smartphones to connect daily symptoms and hourly local weather using global positioning system (GPS) and is recruiting participants without the involvement of their clinical teams. Objectives To describe website activity and subsequent participant enrolment in the first week of recruitment following two national television broadcasts featuring the study. Methods Cloudy with a Chance of Pain was featured on BBC Two9s “Trust Me I9m a Doctor” (20th January 2016) and BBC One9s “Breakfast” (26th January 2016). Potential participants were directed to the study website www.cloudywithachangeofpain.com. The landing page described the project in text and video, after which interested visitors were directed to click through each item of an eligibility questionnaire (age ≥17 years, have arthritis or other chronic pain, resident in the UK, own a smartphone). If eligible in all 4, they were instructed to download the study app. Following download, participants were required to consent and then complete a baseline questionnaire. Google Analytics was used to evaluate the pattern and frequency of website traffic since launch. Enrolment data was provided by the data custodians and app developers, uMotif. Results are reported as mean (SD) or number (%). Results Within one week of launch, there were 84,494 visits from 22,732 visitors to the landing page of the website. There were 22,046 views of the “Take Part” page. The “take part” eligibility questionnaire was completed on 18,631 occasions. Of those, 15,836 (85%) were determined eligible. 5,683 participants successfully enrolled after following instructions to download the app and provide consent. 4,433 (78%) participants were female. The mean age was 49 (13). Figure 1 demonstrates cumulative enrolment within the first 7 days of launch. 48% of all enrolees registered within 3 hours of either the first or second TV broadcast. Conclusions Early recruitment to this study has been highly successful without any involvement of clinical teams. Although high website activity has been enabled by national media coverage, we have noted an excellent conversion rate (>33%) from website activity to app downloads without offering personal support or incentives. This confirms that direct participant recruitment using website information and smartphones is a novel and potentially successful approach to patient recruitment to observational studies. Acknowledgement Arthritis Research UK and uMotif Ltd. Disclosure of Interest None declared

Background Anti-citrullinated protein antibody (ACPA) immune response occurs several years prior to the diagnosis of rheumatoid arthritis (RA). However, limited data are available on ACPA status in the general population compared to those who develop RA or inflammatory polyarthritis (IP) in the future. Objectives The aim of this study was to examine ACPA status in the general population and in patients developing IP/RA. Methods ACPA was measured by ELISA (Euro-Diagnostica) in stored serum samples collected at baseline in people participating in the European Prospective Investigation of Cancer in Norfolk, (EPIC-Norfolk), a prospective population-based study in the UK. In addition, data on ACPA status (positive >25 U/ml) age, gender, socio-economic status (i.e. manual/unskilled worker, manager/skilled non-manual worker, professional), smoking status (i.e. never, former, current) were also collected at inclusion. Individuals who subsequently developed IP/RA were identified by linkage with the Norfolk Arthritis Register (NOAR), a primary-care based cohort with an overlapping catchment area in the UK. Logistic regression analyses were used to assess the association between demographic characteristics and ACPA positivity in the general population. Cox regression analyses were performed to assess the association between ACPA and the development of IP, adjusting for age and gender. Patients with a symptom onset prior to inclusion in EPIC-Norfolk were excluded from the Cox regression analysis (N=104). In addition, the interaction between ACPA and smoking was tested. People were followed until development of IP/RA or censored at date of death or May 2014, whichever came first. Results ACPA was measured in 18,628 EPIC participants aged 40-79 years. ACPA was positive in 429 subjects (2.30%) of the whole EPIC population including 104 patients with prevalent IP/RA (35.6% ACPA positive, median titre 6.95 [IQR 3.75 – 121.2] U/ml) and 173 (16.8% ACPA positive, median titre 5.14 [IQR 3.37 – 9.41] U/ml) subjects who developed IP during 311,051 person years of follow-up. Cross-sectionally, current and former smokers (OR 1.60, 95%CI 1.95 to 2.13 and OR 1.29 95%CI 1.02 to 1.55, respectively) and older age (OR 1.01 95%CI 1.00 to 1.03) were associated with ACPA positivity. Gender and socio-economic status were not associated with ACPA. Of 173 patients who developed IP and were notified to NOAR, 85 (49.4%) fulfilled the 2010 ACR/EULAR criteria for RA at entry to the NOAR cohort. ACPA status was predictive for the development of IP/RA (adjHR 10,3 95%CI 6.90 to 15.34). The interaction between ACPA and smoking was not significant. Conclusions ACPA was positive in 2.1% of a general population sample aged 40-79 years old. People who were ACPA positive were 10 times more likely to develop IP/RA in the next 3-10 years than those ACPA negative subjects. ACPA may be a useful adjunct to other screening approaches to identify people at higher risk of developing IP/RA. Disclosure of Interest None declared

Background In the UK, methotrexate (MTX) monotherapy is only recommended in the initial management of patients presenting with RA where there are contraindications to combination therapy, or multiple comorbidities. However it is not clear how frequently and why different treatment strategies are used in routine practice. Objectives To identify, in a national cohort, the frequency of methotrexate monotherapy and examine factors associated with its prescription. Methods The Rheumatoid Arthritis Medications Study (RAMS) recruited patients with RA starting MTX for the first time since 2008 across the UK, with symptom duration Results Of 731 patients included 493 (67%) were prescribed MTX monotherapy (table 1). 193 (80%) patients on combination therapy were treated with another DMARD and 48 (20%) with steroids. Older age was associated with increased odds of monotherapy and RF positivity with combination therapy (table 1). Conclusions Despite current UK recommendations, in our study MTX was more commonly prescribed as monotherapy than in combination with other DMARDs. Older patients were more frequently treated with monotherapy; however no association was seen with the presence of multiple comorbidities. Others factors such as patient preference may be contributing to these prescribing practices. Disclosure of Interest None declared

Background Linkage of the European Prospective Investigation of Cancer, Norfolk (EPIC-Norfolk) population and the Norfolk Arthritis Register (NOAR), the EPIC-2-NOAR study, has enabled investigation of potential lifestyle predictors of incident inflammatory polyarthritis (IP) [1]. However, potential metabolic predictors of IP have not been as well investigated in this population and have not been considered alongside lifestyle factors. Objectives To assess the addition of metabolic factors to an established multivariate lifestyle factor model for incident IP [1], with updated record linkage in EPIC-2-NOAR. Methods Data on lifestyle factors (pack-years of smoking (adjusted for never being a smoker), smoking status, alcohol consumption (adjusted for being a teetotaller), body mass index, socio-economic status, self-reported diabetes mellitus (DM), parity and duration of breast feeding) was collected by questionnaire at entry to EPIC-Norfolk. Metabolic factors (serum uric acid, HDL-C, Apo-A1, Apo-B and HbA1c) were measured using a non-fasting blood sample taken at the same time. EPIC-Norfolk participants who subsequently developed IP were identified via linkage with NOAR, a primary care based inception cohort study of early IP. Associations between the metabolic predictors and incident IP were assessed using Cox regression: univariately, adjusting for age and gender, and by adding individual predictors to the existing multivariate Cox models [1], one for all participants (with an interaction term for gender and pack years of smoking) and one for females only. Subjects were followed until development of IP, death, loss to follow-up or May 2014, whichever came first. Results Data was available on 25 636 subjects (55% female), including 231 incident cases of IP (66% female). Median (IQR) age at entry to EPIC-Norfolk was 59 (51-67) years, median follow-up was 214 (198-230) months and median time to onset of IP was 79 (34-136) months. No significant association was observed between incident IP and serum uric acid, HDL-C, Apo-A or Apo-B. Baseline HbA1c was positively associated with incident IP in univariate analysis (HR 1.22, 95% CI (1.03, 1.44)), when adjusted for sex and age (HR 1.27 (1.08, 1.49)) and when added to the existing multivariate lifestyle factor models for all (HR 1.26 (1.07, 1.47)) and for females only (HR 1.23 (1.00, 1.52)). Inclusion of HbA1c in the multivariate models led to self-reported DM no longer being significantly associated with IP. Conclusions Baseline HbA1c was significantly associated with incident IP, at the expense of self-reported DM in an established multivariate lifestyle factor model. While DM is an established risk factor for IP, HbA1c levels may capture additional information on those in a prediabetic state and could prove a more sensitive marker of future IP. References Lahiri et al. Ann Rheum Dis 2014; 73: 219 Disclosure of Interest None declared

Background Methotrexate (MTX) is the disease modifying drug of first choice for most patients with rheumatoid arthritis (RA). However, response to MTX varies and attempts to identify predictors of response have proved inconsistent. Objectives To evaluate potential lifestyle, clinical and novel psychosocial predictors of response to MTX in the Rheumatoid Arthritis Medication Study (RAMS), a cohort of RA patients commencing MTX therapy for the first time. Methods RAMS is a multi-centre observational study recruiting RA patients from across the UK who are ≥18 years old and starting MTX for the first time. Predictors of response to MTX are acquired via questionnaires and from case notes at baseline 3, 6 and 12 months after MTX commencement. Response to treatment was defined at 6 months using the EULAR definition of good response: disease activity score-28 (DAS28) ≤3.2 and reduction in DAS28 from baseline >1.2. Associations between good response at six months and baseline measures of body mass index (BMI), smoking status (current/former/never), alcohol intake, symptom duration, DAS28, functional disability (Health Assessment Questionnaire, HAQ), C-reactive protein (CRP), creatinine, rheumatoid factor (RF), socioeconomic status (Index of Multiple Deprivation, IMD), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), beliefs about medicines (Beliefs about Medicines Questionnaire, BMQ) and illness representation (Brief Illness Perceptions Questionnaire (BIPQ)) were assessed using chi-square or Mann-Whitney tests and adjusted for age and sex using multiple logistic regression. Results Complete data on baseline predictors and response at six months was available on 460 participants: 338 female (73%), median age 60 (IQR 48-68) years, median symptom duration 9 (IQR 5-30) months. 130 participants (28%) were good responders. Baseline measures for good responders and non-good responders, together with group comparisons and adjusted odds ratios are shown in Table 1. Good response was negatively associated with BMI, current smoking and anxiety and depression, and positively associated with baseline DAS28, elevated CRP, RF positivity and positive illness representation. Conclusions Lifestyle, clincial, and novel psychosocial factors were found to be predictors of response to MTX at six months. Notably those with higher values of baseline disease activity and serological and inflammatory markers were more likely to be good responders, perhaps reflecting a greater potential to improve. Prediction models of individual MTX response in RA may need to consider the potential role of such factors in personalising treatment decisions. Disclosure of Interest None declared

Background The idiopathic inflammatory myopathies (IIM) are a group of autoimmune mediated disorders characterised by skeletal muscle inflammation. Identification of factors associated with mortality may allow future interventional measures to reduce mortality. Objectives To compare mortality rates in a large UK IIM population with those in the general population and to identify clinical, serological and demographic factors associated with mortality. Methods IIM patients were identified through the UKMYONET study from 84 UK centres. Patients with adult-onset probable or definite polymyositis (PM) or dermatomyositis (DM), or defined inclusion body myositis (IBM) as per accepted criteria (Bohan/Peter, Griggs, MRC) were recruited. Data included demographics, smoking status, cancer diagnosis, clinical features and presence of myositis-specific/associated antibodies (MSA/MAA). Date and cause of death was collated from the UK Health and Social Care Information Service. Age-standardised mortality rates (ASR) per 100,000 persons were calculated for each gender and IIM subtype. Mortality was compared between IIM subtypes (PM as a reference), clinical features and MSA/MAA subsets using calculated hazard ratios (HRs), adjusted for age, sex and smoking. Results 724 IIM patients were recruited (62.2% female, 34% smoked, mean age of disease onset 52.4 years [SD 14.9]). Mean symptom onset to diagnosis time was 1.3 years (SD 2.5). 72 (10%) had died at time of analysis. Median time from diagnosis to death for the whole cohort was 12 years (1st quartile 4 years, 3rd quartile 17 years), 8 years for the cancer-associated myositis (CAM) cohort and 16 years for the non-CAM cohort. Mortality risk did not vary between men and women: 10.2% vs 9.8%, p=0.9. 31 deaths were due to pneumonia, 2 interstitial lung disease (ILD), 1 pulmonary embolism, 16 cardiac causes (myocardial infarction, cardiac failure), 11 malignancy, 8 sepsis, 2 IIM and 1 spontaneous haemothorax. Increasing age at onset and smoking history were associated with mortality: HR 1.1 (95% CI 1.1, 1.2) and 2.3 (1.4, 3.8) respectively. Cardiovascular pathology was associated with higher mortality: HR 3.5 (1.2, 10.4). Periorbital oedema was associated with higher mortality in the DM group: HR 6.7 (1.5, 31.5). Table 1 shows that ASRs per 100,000 persons were more than seven times higher than those in the general UK population: ASR 7559 vs 987/100,000 persons respectively. IBM ASR was significantly lower than DM and PM for females only. CAM was significantly associated with mortality in men only: HR 5.7 (95% CI 2.5, 13.1). No other IIM subtype, clinical feature (including ILD) or MSA/MAA subsets (including Jo-1) were associated with mortality. Conclusions This is the first study to investigate factors associated with increased mortality in a large UK IIM population with a verified IIM diagnosis. Mortality rates in IIM are higher than those of the general UK population mainly due to cardiovascular pathology and cancer, with pneumonia being the leading cause of death. Disclosure of Interest None declared