Developing A Quality Standard To Deliver Evidence-Based Pain Management To People With Inflammatory Arthritis.

Background Inflammatory arthritis is an umbrella-term for diseases involving immune-driven joint inflammation.

Its three main forms - rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axial SpA) - affect 1-2% of UK adults.

Despite significant advances in controlling joint inflammation, pain continues to be a major problem for people with inflammatory arthritis, and the health-area patients most want improving.

Emerging evidence suggests current pain management overuses long-term analgesics, despite their relative inefficacy and risks, and underuses evidence-based non-drug treatments like exercise. Such practice reflects neither the clinical evidence, nor guideline recommendations. The fellowship will address this imbalance.

Aim To facilitate equitable, evidence-based pain management for people with inflammatory arthritis by combining in-depth evaluations of current care with evidence on treatment efficacy and guidance to co-produce a Quality Standard for pain management in inflammatory arthritis.

Objectives Describe analgesia prescribing in inflammatory arthritis, its variability across patient groups, and risks, using existing national electronic healthcare record data.

Evaluate key aspects of pain management unavailable in existing electronic healthcare record data, including the non-drug treatments patients receive, if these vary across patient groups, and how people with inflammatory arthritis use analgesia.

Co-produce a Quality Standard for inflammatory arthritis pain management to deliver safe, equitable, evidence-based care. Methods Three work-packages will address these objectives.

Work-Package 1: Analgesia Prescribing/Risks (Years 1-3) Observational studies will use the Clinical Practice Research Datalink, containing data from 42 million patient lives. Cross-sectional analyses will describe patterns/inequalities in annual analgesia prescriptions. A cohort study will identify predictors of long-term analgesia prescriptions.

Case-control studies will examine specific risks associated with analgesia in people with inflammatory arthritis compared to people with osteoarthritis.

Work-Package 2: Overall Pain Management (Years 2-4) A cross-sectional survey of 1,800 people with inflammatory arthritis from six West Midlands Rheumatology Units will evaluate what pain treatments people receive, and their associated patterns/inequalities.

A nested longitudinal study of 232 patients taking analgesia regularly will use intensive repeated measures delivered via text-messaging over 14-days to examine the frequency of analgesia use together with potential triggers.

Work-Package 3: Quality Standard Development (Years 4-5) An evidence synthesis will combine findings from work-packages 2/3 with umbrella reviews of pain treatment efficacy/risks and guidelines in people with inflammatory arthritis.

Iterative stakeholder workshops will co-produce a set of Quality Standard statements and indicators, subsequently finalised through an online two-stage Delphi study.

Patient and Public Involvement and Engagement 6 people with inflammatory arthritis will meet every 6-months, advising on research design/conduct, and helping with interpreting/disseminating research findings.

Impact and Dissemination Keele's Impact Accelerator Unit will support free-to-access knowledge mobilisation of the Quality Standard and research findings, ensuring rapid adoption into routine care/widespread dissemination. Patient partners will help ensure messages are understandable and relevant.

Existing strong professional, patient and NHS links will facilitate influence of clinical guidelines, healthcare professional/patient resources, and medical education.

It is anticipated the Quality Standard will increase the use of evidence-based pain treatments, leading to reduced pain/improved ability to function despite pain, reduced personal/NHS costs from analgesia prescriptions, and improved patient care/clinician knowledge.