744 Thursday, 7 June 2012 Health Professionals in Rheumatology Abstracts THU0489-HPR RELATIONSHIP BETWEEN FOOT-RELATED IMPAIRMENT AND DISABILITY, ULTRASOUND FEATURES AND CLINICAL INDICES OF PAIN, FUNCTION AND DEFORMITY IN EARLY RHEUMATOID ARTHRITIS L. Newcombe 1 , J. Woodburn 1 , D. Porter 2 , S. Saunders 3 , D. McCarey 3 , M. Gupta 4 , D. Turner 1 . 1 Institute for Applied Health Research, Glasgow Caledonian University; 2 University of Glasgow; 3 Centre for Rheumatic Diseases, Glasgow Royal Infirmary; 4 Department of Rheumatology Out-patients, Gartnavel General Hospital, Glasgow, United Kingdom Background: Foot involvement is highly prevalent in early RA yet little is understood about the relationship between joint inflammation and damage and foot related impairment and disability [1]. Objectives: To investigate the relationships between foot-related impair- ment/disability and ultrasound features of joint and tendon inflammation and damage, and clinical indices for pain, function and deformity in early RA. Methods: Patients with early RA attending two regional early arthritis clinics were recruited. Foot related impairment and disability were assessed using the impairment/footwear (FIS-RA IF ) and activity/participation (FIS-RA AP ) subscales of the FIS-RA scale. Ultrasound imaging was used to dichotomously score joint effusion, synovitis, erosion and power Doppler signal at the ankle, subtalar, talonavicular, calcaneo-cuboid, metatarsophalangeal and inter- phalangeal joints. Tenosynovitis was scored in the tibialis posterior and anterior, peroneal, flexor and extensor tendons. Cumulative scores for both clinical and ultrasound features were calculated for joints (0-28) and tendons (0-14) in both feet. DAS28, HAQ and tender and swollen joint counts of the foot were recorded. Structural deformity was measured using the structural index and gait analysis was used to measure walking speed, peak pressures and contact areas on the plantar foot region. Results: Forty-four early RA patients (33 female/11 male) with a mean ±SD age of 53.1±13.7 years and disease duration of 10.6±8.3 months were studied. 75% of patients were receiving methotrexate and 5% biological therapy. The mean ±SD score for the FIS-RA IF was 9.9±5.4 and for the FIS-RA AP was 13.8±9.6. The mean ±SD cumulative score for ultrasound confirmed joint effusions was 8.6±4.1, for joint synovitis was 1.9±1.9, for joint erosions was 2.4±2.6, for joint Power Doppler was 1.3±1.5 and for tenosynovitis was 0.7±1.1. The mean ±SD HAQ score was 0.95±0.77 and DAS28 score was 3.8±1.4. Mean ±SD cumulative scores for swollen joints was 2±2.7, for tender joints 4.4±4.4, and for tender/swollen tendons was 3.1±3.1. The mean ±SD Structural Index score for the rearfoot was 4.3±2.7, for the forefoot was 11.5±6.1 and forefoot and rearfoot combined was 15.4±7.7. The mean ±SD walking speed (m/s) was 0.95±0.21, midfoot contact area (cm 2 ) was 137±19.6, toe contact area (cm 2 ) was 299±35.5 and maximum peak pressure (N/cm 2 ) was 108±75. For FIS-RA IF there were statistically significant correlations with DAS28 (r=0.357, p=0.03), HAQ (r=0.386, p=0.02), tender joint counts (r =0.44, p=0.01), and tender/swollen tendons (r=0.334, p=0.04). For FIS-RA AP there were statistically significant correlations with DAS28 (r=0.472, p=0.003), HAQ (r=0.751, p<0.001), deformity in the rearfoot (r=0.337, p=0.04), and walking speed (r=-0.336, p=0.04). Conclusions: In this early RA group foot-related impairment and disability are associated with global measures of disease activity and functional disability, deformity in the rearfoot, and clinical indices of joint and tendon swelling and tenderness but not ultrasound detected features. References: [1] van der Leeden M et al. 2008. Arthritis Rheum.59:1596-1602 Disclosure of Interest: L. Newcombe: None Declared, J. Woodburn: None Declared, D. Porter: None Declared, S. Saunders: None Declared, D. McCarey: None Declared, M. Gupta: None Declared, D. Turner Grant/Research support from: Arthritis Research UK (ref: 17832) THU0490-HPR DEVELOPMENT OF MEDICATION ASSESSMENT TOOLS SPECIFIC FOR RHEUMATOID ARTHRITIS L. Grech 1,2 , B. Coleiro 2,3 , A.A. Borg 3,4 , A. Serracino Inglott 2 , L.M. Azzopardi 2 , V. Ferrito 2 . 1 Pharmacy, Mater Dei Hospital; 2 Pharmacy, University of Malta; 3 Medicine, Mater Dei Hospital; 4 Medicine, University of Malta, Msida, Malta Background: Medication assessment tools,first introduced in heart failure management, are evidence-based instruments intended for the evaluation of prescribing trends and monitoring of adherence to established guidelines. To- date medication assessment tools have been implemented in the management of heart failure, coronary disease, cancer and asthma 1-4 . Objectives: The objective of the study was to develop medication assessment tools specific for rheumatoid arthritis in order to provide a systematic and standardised instrument ensuring evidence based practice. Methods: Guidelines, recommendations and standards on rheumatoid arthritis and its management as set out by the American College of Rheumatology (ACR), the European League against Rheumatism (EULAR), the British Society for Rheumatology (BSR) and the National Institute for Clinical Excellence (NICE) were used to develop the Rheumatoid Arthritis Medication Assessment Tool. The summary of product characteristics for each drug included in the Rheumatoid Arthritis Medication Assessment Tool were used as reference for criteria related to pharmacological properties. The medication assessment tool was designed in the form of a table bearing in mind that the tool will be used in a busy clinic where documentation can be time consuming. The Rheumatoid Arthritis Medication Assessment Tool was reviewed by a panel of experts (n=8) who assessed applicability of the tool to the practical scenario, presentation, robustness and validity of the data provided. Results: The developed Rheumatoid Arthritis Medication Assessment Tool was designed in the form of a table consisting of 11 separate sections. Each section included an average of 5 (SD =1.95) criteria. The table design of the medication assessment tool allows the investigator to easily tick whether each criteria included in the medication assessment tool is being adhered to or not. References for each criteria included were also given in the medication assessment tool. Conclusions: Medication assessment tools have been documented as effective instruments providing systematic checklist approach to evidence based medicine. The developed Rheumatoid Arthritis Medication Assessment Tool was designed to be used in a busy adult rheumatology out-patient clinic as part of an ongoing pharmaceutical care service in order to further improve the overall multidisciplinary service offered. References: [1] Hakonsen GD, Hudson S, Loennechen T. Design and validation of medication assessment tool for cancer pain management. Pharm World Sci. 2006;28(6):342-351. [2] Hakonsen GD, Strelec P, Campbell D, Hudson S, Loennechen T. Adherence to medication guieline criteria in pain management. Journal of pain and symptom management. 2009;37(6):1006-1018. [3] Hui-Ping L, You-Mei L, Hudson S, Johnson J, Hsiu-Yu C. Design and validation of a medication assessment tool to evaluate the quality of medication use based on international guidelines of asthma management in children aged from 5-12 years. Abstract presented at the ACCP-ESCP 2009 conference, Florida. [4] McAnaw J, Hudson S, McGlynn S. Development of an evidence-based medication assessment tools to demonstrate the quality of drug therapy use in patients with heart failure. International Journal of Pharmacy Practice. 2003;11:R17. Disclosure of Interest: None Declared THU0491-HPR PATIENT SURVEY DRIVEN DESIGNING OF CLOTHES FOR RHEUMATOID ARTHRITIS PATIENTS WITH DEFORMITIES (INDIAN SENARIO) R. Chandra , N. Anand. National Institute of Fashion Technology, NewDelhi, India Background: Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that affect multiple small and large joints. 1 It can be a disabling and painful condition and leads to substantial loss of functioning and mobility. RA is predominantly a disease of women with F:M ratio 2-3:1. 1 A simple task of self dressing becomes a big struggle for all the women across globe with the disease. There have been work done in west to reduce the struggle of these self dressers, 2 but no such work has been done for Indian women. Indian dressing is very different from the western counterparts and their troubles go unaddressed. This research was undertaken to provide solutions to the self dressing Indian women suffering from RA. Objectives: Primary: To design adaptive garments for women suffering from arthritis. Secondary: To understand the challenges of the self dressers. To identify the movement restriction and limitation while self dressing. To understand the garment needs of the patients. Methods: The methodology was in 4 stages. 1) Determine functional limitations of joints in patients with RA through an interview of occupational therapists. 2) Undertake a survey of patients to understand the pertinent areas of difficulty in dressing with Indian garments and their garment preferences. 3) Designing and prototyping of garments as per the analysis of the survey undertaken in stage 2. 4) Undertake a survey of patients to determine acceptability of the designed garments in stage 3. Results: Forty female RA patients of average age 52yrs, and mean disease duration of 11.65 years were included. RA adversely affects the daily life activities of 83% patients whereas 75% face problems in self dressing and may need assistance. Patient preferred garments that provided ease in self dressing, and set of modifications among commonly used Indian clothing providing easy access to the closures. The styles should not change the look of the garment keeping the comfort into consideration. The common features and pattern alterations incorporated in garments to aid dressers were to make silhouettes loose with round necks having front opening with big buttons for upper garments. For lower garments, loose silhouettes, crotch point was dropped and length maintained till ankle level. Apart from this innovative trims were designed and were strategically placed in garment for easy manipulation. Tactical solutions were provided for the drawstring problem of lower garments and for pleating of saree phallus and front pleats. The designed features were found to be acceptable to the patients. Conclusions: A large proportion of Indian women with rheumatoid arthritis who have deformities have significant difficulty in everyday dressing. The designed garments provided social dignity as well as easy donning and doffing to the patients. on 5 May 2018 by guest. Protected by copyright. http://ard.bmj.com/ Ann Rheum Dis: first published as 10.1136/annrheumdis-2012-eular.2455 on 23 January 2014. Downloaded from