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Objectives To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the second wave of the COVID-19 pandemic in England, and describe the impact of corticosteroids on outcomes. Methods Hospital Episode Statistics data were used to identify people alive on 1 August 2020 with ICD-10 codes for RAIRD from the whole population of England. Linked national health records were used to calculate rates and rate ratios of COVID-19 infection and death up to 30 April 2021. Primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. NHS Digital and Office for National Statistics general population data were used for comparison. The association between 30-day corticosteroid usage and COVID-19-related death, COVID-19-related hospital admissions and all-cause deaths was also described. Results Of 168 330 people with RAIRD, 9961 (5.92%) had a positive COVID-19 PCR test. The age-standardized infection rate ratio between RAIRD and the general population was 0.99 (95% CI: 0.97, 1.00). 1342 (0.80%) people with RAIRD died with COVID-19 on their death certificate and the age–sex-standardized mortality rate for COVID-19-related death was 2.76 (95% CI: 2.63, 2.89) times higher than in the general population. There was a dose-dependent relationship between 30-day corticosteroid usage and COVID-19-related death. There was no increase in deaths due to other causes. Conclusions During the second wave of COVID-19 in England, people with RAIRD had the same risk of COVID-19 infection but a 2.76-fold increased risk of COVID-19-related death compared with the general population, with corticosteroids associated with increased risk. [ABSTRACT FROM AUTHOR]

Background: Patients with inflammatory rheumatic diseases (IRDs) face challenges including pain, fatigue and disease flares. Evidence suggests their levels of anxiety and depression are higher compared to the general population. Rheumatology teams report psychologically distressed patients have additional support needs and require more clinical time. Little is currently known about models of support and their integration into care pathways. Aim: To understand rheumatology health professionals' perspectives on patients' psychological distress and ways to meet support needs. Methods: The study used a qualitative design, with data collected in telephone semi‐structured interviews. Inductive thematic analysis was used to analyse the data. Results: Fifteen interviews were conducted. Two main themes with sub‐themes represent the data: Theme 1: 'No one shoe fits all'—the many manifestations of distress in patients (sub‐themes: recognising distress, dealing with distress, dealing with life events alongside an IRD) and Theme 2: 'If rheumatology could be interwoven with psychological principles'—the need to attend to the psychological impact of IRDs, alongside the physical impact (sub‐themes: priority given to physical health, working together to help patients in distress, how should patient distress be measured?, the need for extra time and resources). Conclusion: Distress can be obvious or hidden, cause issues for patients and health professionals and lead to poor engagement with care provision. Health professionals described the powerful link between physical and mental distress. This study suggests psychological support provision should be embedded within the rheumatology team and that patients' emotional wellbeing should be given equal priority to their physical wellbeing. [ABSTRACT FROM AUTHOR]

Objectives To calculate the rates of COVID-19 infection and COVID-19-related death among people with rare autoimmune rheumatic diseases (RAIRD) during the first wave of the COVID-19 pandemic in England compared with the general population. Methods We used Hospital Episode Statistics to identify all people alive on 1 March 2020 with ICD-10 codes for RAIRD from the whole population of England. We used linked national health records (demographic, death certificate, admissions and PCR testing data) to calculate rates of COVID-19 infection and death up to 31 July 2020. Our primary definition of COVID-19-related death was mention of COVID-19 on the death certificate. General population data from Public Health England and the Office for National Statistics were used for comparison. We also describe COVID-19-related hospital admissions and all-cause deaths. Results We identified a cohort of 168 680 people with RAIRD, of whom 1874 (1.11%) had a positive COVID-19 PCR test. The age-standardized infection rate was 1.54 (95% CI: 1.50, 1.59) times higher than in the general population. A total of 713 (0.42%) people with RAIRD died with COVID-19 on their death certificate and the age-sex-standardized mortality rate for COVID-19-related death was 2.41 (2.30–2.53) times higher than in the general population. There was no evidence of an increase in deaths from other causes in the RAIRD population. Conclusions During the first wave of COVID-19 in England, people with RAIRD had a 54% increased risk of COVID-19 infection and more than twice the risk of COVID-19-related death compared with the general population. These increases were seen despite shielding policies. [ABSTRACT FROM AUTHOR]

Introduction: An important aspect of self‐management is patient activation (the skills, abilities and confidence someone uses to actively manage their health). The dominant method of capturing patient activation is the Patient Activation Measure (PAM) which has been integrated into many aspects of clinical practice in musculoskeletal care. However, limited research has investigated how rheumatology patients understand and perform patient activation, and how closely their perceptions align with the PAM. Methods: Seventeen patients from two rheumatology departments in South West England participated in semi‐structured interviews at two timepoints. They discussed how they actively managed their health and their views on the PAM. Data on activation were analysed using framework analysis and data on the PAM were analysed using content analysis. Results: Participants self‐managed with determination, finding ways to make small, sustainable behaviour changes and effectively navigate the healthcare system. They reported the value of knowing what self‐management techniques suited them individually and reported benefitting from positive perceptions of their own health and good social support. Participants noted that the PAM did not always capture the fluctuating nature of their inflammatory arthritis and the collaborative nature of healthcare. Conclusions: Patients' perceptions and experiences of patient activation covered a wide range of skills, behaviours and beliefs. However, these are not always captured by the PAM. Therefore, its use as a clinical tool is best accompanied by dialogue with patients to understand their self‐management. [ABSTRACT FROM AUTHOR]

Objective: COVID-19 has had a substantial impact on rheumatology. There were many studies about rheumatology and COVID-19. But there is no study about bibliometric analysis of these studies. This study provides a general overview of studies on rheumatology and COVID-19. Methods: Data were taken from the Web of Science (WoS) website. Analysis and network visualization mapping processes were carried out using VOSviewer. We used the following keywords: "COVID-19" and "Rheumatology"; "Coronavirus" and "Rheumatology"; "2019-nCoV" and "Rheumatology"; "SARS-CoV-2" and "Rheumatology"; "COVID-19" and "Rheumatic Disease"; "Coronavirus" and "Rheumatic Disease"; "2019-nCoV" and "Rheumatic Disease"; "SARS-CoV-2" and "Rheumatic Disease"; "COVID-19" and "Rheumatism"; "Coronavirus" and "Rheumatism"; "2019-nCoV" and "Rheumatism"; and "SARS-CoV-2" and "Rheumatism." A total of 234 publications were analyzed, and the correlations between citation numbers and reference counts, usage counts, and page numbers were analyzed with Spearman correlation coefficients. Results: The average number of citations per item was 6.03. The studies were cited 1411 times in total, and 1121 times without self-citations. The countries with the highest number of publications on rheumatology and COVID-19 were the USA and England; the countries with the highest number of citations were Italy and the USA, and Jinoos Yazdany was the most cited author. The Annals of the Rheumatic Diseases was the most cited journal, whereas the highest number of articles on rheumatology and COVID-19 were published in Arthritis and Rheumatology. Conclusions: Bibliometric analysis of rheumatology and COVID-19 can be useful to future studies because it provides a general perspective on the studies. This study provides an insight into the development of publications on rheumatology during the COVID-19 pandemic. Key Points • Covid-19 has substantial impact on rheumatology. • There many studies about rheumatology and COVID-19. But there is no study about bibliometric analysis of these studies. • This study provides a general perspective of the studies about rheumatology and COVID-19. • This study aims to inform the efforts to improve the studies about rheumatology studies during the pandemic process and to analyze the publications about both rheumatology and COVID-19 with bibliometric methods. • Bibliometric analysis about rheumatology and COVID-19 can be useful and helpful tool for future studies. [ABSTRACT FROM AUTHOR]

Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England from 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results We included 168 691 people with a recorded diagnosis of RAIRD alive on 1 March 2020. Their median age was 61.7 (IQR 41.5–75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. A total of 1815 (1.1%) participants died during March and April 2020. The age-standardized mortality rate (ASMR) among people with RAIRD (3669.3; 95% CI: 3500.4, 3838.1 per 100 000 person-years) was 1.44 (95% CI: 1.42, 1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to health-care services. [ABSTRACT FROM AUTHOR]

Rheumatology teams care for patients with diverse, systemic autoimmune diseases who are often immunosuppressed and at high risk of infections. The current COVID-19 pandemic has presented particular challenges in caring for and managing this patient group. The office of the chief medical officer (CMO) for England contacted the rheumatology community to provide expert advice on the identification of extremely vulnerable patients at very high risk during the COVID-19 pandemic who should be 'shielded'. This involves the patients being asked to strictly self-isolate for at least 12 weeks with additional funded support provided for them to remain at home. A group of rheumatologists (the authors) have devised a pragmatic guide to identifying the very highest risk group using a rapidly developed scoring system which went live simultaneous with the Government announcement on shielding and was cascaded to all rheumatologists working in England. [ABSTRACT FROM AUTHOR]

The author discusses the study "Covid-19 Infection, Administration and Death Among People With Rare Autoimmune Rheumatic Disease in England: Results from The RECORDER Project" by Megan Rutter et al, published within the issue. Topics discussed include giant cell arteritis (GCA) as the disease in the cohort to have less risk of death, a late complication of GCA, and patients with a higher risk of COVID-19 infection.

The article discusses the highlights of the 2011 European League Against Rheumatism (EULAR) Annual Congress which was held in London, England from May 25-28, 2011. One of the topics presented at the event was American College of Rheumatology (ACR)/EULAR criteria for rheumatoid arthritis (RA) remission which was recommended for use in clinical trials. Also reported were results of the Computer Assisted Management for Early RA II (CAMERA II) study.

Objectives. The Government Department of Health (England) has set a target that by 2008 patients on pathways that do or may involve medical or surgical consultant-led care should wait no longer than 18 weeks from referral to start of definitive treatment. Department of Health guidance must be interpreted and applied to patients with rheumatological problems. [ABSTRACT FROM PUBLISHER]

Focuses on the prospective study on rheumatic symptoms after cardiac surgery in England. Development of rheumatic symptoms after the first six weeks of operation; Absence of association between rheumatism with increased inflammation; Use of immunological tests in the study.

A survey of rheumatic disablement in the population has enabled the comparative impact of self reported causes of disability to be studied. One in three households in Calderdale, West Yorkshire, United Kingdom was screened in 1986 with a postal questionnaire (87% response rate), followed by in depth interviews with a sample of subjects reporting disability in conjunction with a rheumatic disorder (608 interviews). Severity of disablement was assessed using the physical independence handicap classification. The estimated prevalence of disability in conjunction with reported rheumatic disorders is 82/1000 population aged at least 16 years (95% confidence interval (CI) 77 to 87). Arthritis (mainly osteoarthritis) is the most commonly reported cause (47/1000 population; 95% CI 43 to 51), followed by back or neck disorders (25/1000; 95% CI 23 to 28), soft tissue disorders (18/1000; 95% CI 15 to 20), and rheumatoid arthritis (RA) (4/1000; 95% CI 3 to 5). A total of 30% reported more than one category of rheumatic disorder (mean number 1.3) and 63% reported non-rheumatic comorbidity. Current joint symptoms were reported by 98%, current antirheumatic drugs (including analgesics) by 70%, and severe pain by 62%. Overall 82% of subjects had seen their general practitioner in the past year, and 71% reported having attended an outpatient clinic; 26% reported current outpatient clinic attendance, and 15% a hospital inpatient stay during the previous year. Forty six per cent reported some dependence, with 12% reporting being dependent on a daily basis. Rheumatoid arthritis was the most disabling disorder with 73% dependent. Taking into account prevalence, osteoarthritis and back disorders are the most, and RA the least, common causes of dependence and incapacitating pain in the population. This challenges stereotypes and raises questions about the organisation and priorities for specialist services and for research. [ABSTRACT FROM PUBLISHER]

The article reports on topics which were discussed at the West Midlands Rheumatology Forum Autumn Meeting of 2012. Topics included changes which are seen in the human immune system as a result of aging, anti-rheumatic drugs for elderly patients and patient nonadherence to medication.

Reactivation of latent tuberculosis (TB) is an established risk of anti-tumour necrosis factor α (anti-TNF) therapy. We report five cases of active TB occurring in 703 patients treated with anti-TNF therapy over a 10-year period in a central London hospital and review our screening practices for identifying latent TB prior to anti-TNF treatment. Four patients were receiving adalimumab and one patient etanercept at the time of TB diagnosis. Four of the five patients were born in countries with a high TB prevalence. Two of the five patients were healthcare workers. All patients had normal chest radiographs prior to anti-TNF treatment. Our data emphasise that country of origin is important in the determining risk of latent TB and that a normal chest radiograph does not exclude latent TB. [ABSTRACT FROM AUTHOR]

Background The prevalence of autistic spectrum disorder (ASD) in children in UK is ∼1 in 100. There is emerging evidence that dysregulation of the immune system may be an underlying cause of ASD. The CARRA registry from the USA reported a frequency of 0.3% co-morbidity of autism in children with JIA. There is a paucity of data from the UK reporting this association. Methods The department's database of all patients that attended the local paediatric rheumatology clinic was reviewed over a 12-month period from April 2018 to April 2019. Diagnoses were grouped broadly into inflammatory (JIA, systemic disease, non-JIA uveitis) and non-inflammatory (mechanical, bone and collagen disorder and other). Those with a co-morbidity of autism were also identified within inflammatory and non-inflammatory groups. Results There were 196 individual patients within the cohort of paediatric rheumatology patients seen in Bradford in April 2018 to April 2019. These were subcategorised into JIA (N = 79,40%), mechanical (N = 56, 29%), systemic rheumatological disease (N = 31, 16%), bone and collagen disorders (N = 12, 6%), other non-inflammatory diagnoses (N = 11, 6%), non-JIA associated uveitis (N = 7, 3%). This cohort was divided into 117 patients with inflammatory paediatric rheumatological conditions and 79 patients with non-inflammatory causes for joint pain. Nine children (see Table 1) had a co-morbidity of autism, of which 6 children had an inflammatory diagnosis and 3 a non-inflammatory cause for joint pain. The prevalence of autism in our cohort of children with paediatric rheumatological disease was 5%, which is higher than expected from a UK prevalence of autism of 1%. P16 Table 1: Patients with Autism in Paediatric Rheumatology cohort. Diagnosis  Age  Age at presentation to paediatric rheumatology  Gender  Inflammatory/ Non-inflammatory  Oligo JIA  5y  4y  Male  Inflammatory  Oligo JIA  11y  10y  Female  Inflammatory  Oligo JIA  13y  7y  Female  Inflammatory  Ext- oligo JIA  18y  8y  Male  Inflammatory  Ext- oligo JIA  14y  7y  Male  Inflammatory  CTD  15y  2y  Female  Inflammatory  Hypermobility  16y  16y  Male  Non-inflammatory  Mechanical  14y  14y  Female  Non-inflammatory  Mechanical  11y  11y  Female  Non-inflammatory  Diagnosis  Age  Age at presentation to paediatric rheumatology  Gender  Inflammatory/ Non-inflammatory  Oligo JIA  5y  4y  Male  Inflammatory  Oligo JIA  11y  10y  Female  Inflammatory  Oligo JIA  13y  7y  Female  Inflammatory  Ext- oligo JIA  18y  8y  Male  Inflammatory  Ext- oligo JIA  14y  7y  Male  Inflammatory  CTD  15y  2y  Female  Inflammatory  Hypermobility  16y  16y  Male  Non-inflammatory  Mechanical  14y  14y  Female  Non-inflammatory  Mechanical  11y  11y  Female  Non-inflammatory  P16 Table 1: Patients with Autism in Paediatric Rheumatology cohort. Diagnosis  Age  Age at presentation to paediatric rheumatology  Gender  Inflammatory/ Non-inflammatory  Oligo JIA  5y  4y  Male  Inflammatory  Oligo JIA  11y  10y  Female  Inflammatory  Oligo JIA  13y  7y  Female  Inflammatory  Ext- oligo JIA  18y  8y  Male  Inflammatory  Ext- oligo JIA  14y  7y  Male  Inflammatory  CTD  15y  2y  Female  Inflammatory  Hypermobility  16y  16y  Male  Non-inflammatory  Mechanical  14y  14y  Female  Non-inflammatory  Mechanical  11y  11y  Female  Non-inflammatory  Diagnosis  Age  Age at presentation to paediatric rheumatology  Gender  Inflammatory/ Non-inflammatory  Oligo JIA  5y  4y  Male  Inflammatory  Oligo JIA  11y  10y  Female  Inflammatory  Oligo JIA  13y  7y  Female  Inflammatory  Ext- oligo JIA  18y  8y  Male  Inflammatory  Ext- oligo JIA  14y  7y  Male  Inflammatory  CTD  15y  2y  Female  Inflammatory  Hypermobility  16y  16y  Male  Non-inflammatory  Mechanical  14y  14y  Female  Non-inflammatory  Mechanical  11y  11y  Female  Non-inflammatory  Conclusion In this cohort of paediatric rheumatology patients there was a higher prevalence of autism than the UK average. Two of these patients were diagnosed with autism after presenting to our service. This association is compatible with the emerging recognition of dysregulation of the immune system as a potential underlying cause of ASD. It is important to consider the co-morbidity of autism in children presenting to paediatric rheumatology clinic and potentially paediatric rheumatological conditions in children already diagnosed with autism, where there may be a delay in their presentation due to communication difficulties. There is the need for a larger UK study to review this association further. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

Presents the program for the conference of the Podiatric Rheumatic Care Association and the British Health Professionals in Rheumatology in Birmingham, England.

Announces the Second Nuffield Conference on Rheumatism on March 1964 at Pendley Manor in England. Theme of the conference; Topics discussed in the convention; Contact information.