The Investigating Medication Adherence in Psoriasis (iMAP) study was initially funded by a Medical Research Council (MRC) doctoral fellowship and studentship award by the Psoriasis Association of Great Britain and Ireland awarded to R.J.T. Subsequent funding came from an MRC (MR/ 1011808/1) award to the Psoriasis Stratification to Optimise Relevant Therapy (PSORT) consortium. The British Association of Dermatologists Biologics and Immunomodulators Register (BAD-BIR) is coordinated by the University of Manchester. The BADBIR is funded by the British Association of Dermatologists. The British Association of Dermatologists has received income from AbbVie, Eli Lilly, Janssen Cilag, Novartis, Pfizer, and Samsung Bioepis for providing pharmacovigilance services. This income finances a separate contract between the British Association of Dermatologists and the University of Manchester, which coordinates the BADBIR. C.E.M.G. and D.M.A. are funded in part by the MRC (MR/ L011808/1) and the NIHR Manchester Biomedical Research Centre. The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

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2 Coleman E, Ko C, Dai F et al. Inflammatory eruptions associated with immune checkpoint inhibitor therapy: a single-institution retrospective analysis with stratification of reactions by toxicity and implications for management.

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Background. Patients with psoriasis have a level of physical activity below that recommended for cardiovascular health, which is significantly limited by disease severity and other psoriasis-specific barriers. We hypothesized that physical activity is important for cardiovascular health in patients with psoriasis and that its objective measurement could have clinical utility. Aim. To explore whether physical activity influences the risk of cardiovascular disease (CVD) in patients with psoriasis. Methods. In total, 242 patients with chronic plaque psoriasis were recruited. History, examination and physical activity were assessed and arteriography, the noninvasive measurement of arterial function, was performed for each participant. Results. We observed a significant relationship between volume of physical activity and the likelihood of future CVD as measured by pulse wave velocity (PWV; P < 0.02). We identified a significant relationship between the diastolic reflection area (DRA) and health-promoting levels of physical activity (P < 0.001), in addition to a significant correlation between DRA and the likelihood of future CVD (P < 0.001). The DRA is a complex, dimensionless variable that describes the intensity of diastolic wave reflection and the duration of diastole, which are key determinants of the blood supply to the left ventricle. Our data suggest that DRA may represent a surrogate marker for cardiorespiratory fitness. Conclusion. Our study describes a significant relationship between exercise, cardiorespiratory fitness and PWV, a preclinical indicator of future CVD risk, in patients with psoriasis. The DRA offers a noninvasive, objective measurement of exercise adherence, which could have clinical utility in the future.

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BackgroundPain is the most common symptom of Juvenile Idiopathic Arthritis (JIA), and it is known to cause significant distress for young people. Despite advances in treatment, pain is often still poorly managed. Multidimensional approaches are needed to help children with JIA communicate better about their pain experiences with healthcare professionals and parents. A new interactive iPad application called “This Feeling” has been developed in collaboration with children and healthcare professionals to aid communication about pain in children with JIA. “This Feeling” enables young people to describe the pain type, intensity, location, spread and emotional impact at a given time, by using an interactive manikin, adjustable pain icons, facial expressions, drawing tools and free text description.ObjectivesThe aim of this research was to explore the acceptability, usability and feasibility of “This Feeling” to communicate pain experiences in children with JIA by comparing the tool with self-report measures commonly used in clinic: the Visual Analogue Scale (VAS) and The Faces Pain Scale, Revised (FPS-R).MethodsYoung people aged between 5 and 16 and consenting caregivers were recruited from a city centre hospital in England, which was part of the Childhood Arthritis Prospective Study (CAPS), a large scale prospective inception cohort. A cross-sectional design using mixed methods compared self-report measures (the VAS and FPS-R) with “This Feeling”. The measures were administered in random order to young people attending an outpatients' clinic. Semi-structured interviews were used to elicit views on completing “This Feeling” compared with standardised measures.ResultsThe sample consisted of 43 young people and their caregivers. All participants were able to use “This Feeling” to describe their pain experiences (average completion time 8 minutes). The majority (95%) preferred using “This Feeling” over the VAS and FPS-R, and found it easier and more interesting to communicate their pain experiences. Participants suggested modifications including a zoom function as well as an icon to indicate “No Pain”. Usability feedback indicated that the shading function interfered with pain icons which young people had already placed on the manikin. Parents praised “This Feeling” for capturing the multidimensional nature of pain in an easy and “child friendly” nature, over the conventional pain measures.Conclusions“This Feeling” appears to be a feasible, usable and acceptable system for communicating the multidimensional nature of pain in children with JIA. Future modifications will be addressed. Plans are being made to validate the different components of “This Feeling”, specifically, the facial expressions, the body map and pain severity and intensity scales to develop this further as a pain assessment tool.AcknowledgementsThe Childhood Arthritis Prospective StudyDisclosure of InterestNone declared

Background The curriculum for professionals working in paediatric rheumatology should include pain but it is unclear to what extent this currently occurs. The aim of this study was to identify pain-related curriculum content and the context in which pain is presented in educational and training documentation for healthcare professionals in this clinical speciality. Methods Core curricula documents from UK based professional organisations were identified in partnership with healthcare professionals. Documents were analysed using a summative content analysis approach. Key pain terms were quantified and weighted frequencies were used to explore narrative pain themes. Latent content was interpreted qualitatively to explore the context within which pain terms were positioned. Results Nine curriculum documents were identified and analysed from doctors, nurses, physiotherapists and occupational therapists specialising in paediatric rheumatology. Pain themes represented a mean percentage of 1.51% of text across all documents. Pain was rarely presented in the context of both inflammatory and non-inflammatory condition types despite being a common feature of each. Musculoskeletal pain was portrayed simply as a ‘somatic’ symptom, rather than as a complex phenomenon involving biological and psychosocial processes. Content around the assessment and management of pain was vague and inexplicit. Conclusion Current educational and training documentation in paediatric rheumatology do not include core pain topics. Curricula for these healthcare professionals would benefit from updates in contemporary pain theories and examples of in-context, evidence-based pain practices. This should be a priority starting point for optimising patient pain care in paediatric musculoskeletal healthcare.