Roxanne Cooksey | Swansea University (original) (raw)

Papers by Roxanne Cooksey

Research paper thumbnail of OA05 Lower incidence of COVID-19 but higher mortality in patients with inflammatory arthritis compared to controls in Wales, United Kingdom: a population epidemiological study

Rheumatology, Apr 23, 2022

Research paper thumbnail of Curriculum-based outdoor learning for children aged 9-11: A qualitative analysis of pupils’ and teachers’ views

Research paper thumbnail of Proton pump inhibitors and dementia risk: Evidence from a cohort study using linked routinely collected national health data in Wales, UK

PLOS ONE, Sep 18, 2020

Objectives Proton pump inhibitors (PPIs) are commonly prescribed for prevention and treatment of ... more Objectives Proton pump inhibitors (PPIs) are commonly prescribed for prevention and treatment of gastrointestinal conditions or for gastroprotection from other drugs. Research suggests they are linked to increased dementia risk. We use linked national health data to examine the association between PPI use and the development of incident dementia. Methods and findings A population-based study using electronic health-data from the Secure Anonymised Information Linkage (SAIL) Databank, Wales (UK) from 1999 to 2015. Of data available on 3,765,744 individuals, a cohort who had ever been prescribed a PPI was developed (n = 183,968) for people aged 55 years and over and compared to non-PPI exposed individuals (131,110). Those with prior dementia, mild-cognitive-impairment or delirium codes were excluded. Confounding factors included comorbidities and/or drugs associated with them. Comorbidities might include head injury and some examples of medications include antidepressants, antiplatelets and anticoagulants. These commonly prescribed drugs were investigated as it was not feasible to explore all drugs in this study. The main outcome was a diagnosis of incident dementia. Cox proportional hazard regression modelling was used to calculate the Hazard ratio (HR) of developing dementia in PPI-exposed compared to unexposed individuals while controlling for potential confounders. The mean age of the PPI exposed individuals was 69.9 years and 39.8% male while the mean age of the unexposed individuals was 72.1 years and 41.1% male. The rate of PPI usage was 58.4% (183,968) and incident dementia rate was 11.8% (37,148/315,078). PPI use was associated with decreased dementia risk (HR: 0.67, 95% CI: 0.65 to 0.67, p<0.01).

Research paper thumbnail of The coding of telephone consultations in UK primary care databases: are we picking up all the calls?

BMC Research Notes, May 9, 2023

y increased the use of telephone, email and virtual consulting [1]. Both telephone and video cons... more y increased the use of telephone, email and virtual consulting [1]. Both telephone and video consultations have led to great time savings in some UK practices [2] and this seems likely to persist in the future. It may be that remote consultations (both by telephone and by video conferencing) could become a more frequent modality for consultations. With changes in demand for GP services over time, the monitoring of consultation rates in general, and different types of consultation is instrumental in informing the provision of effective GP services [3]. Here we examine the coding of telephone consultations in UK general practice by looking at one clinical computer system, Vision (In Practice Systems Limited). Vision is used by GPs during the course of a consultation with a patient. There are two research databases which provide extracts of the Vision system from some GP practices to BMC Research Notes

Research paper thumbnail of Mixed-methods evaluation comparing the impact of two different mindfulness approaches on stress, anxiety and depression in school teachers

BMJ Open, Jul 1, 2019

et al. Mixedmethods evaluation comparing the impact of two different mindfulness approaches on st... more et al. Mixedmethods evaluation comparing the impact of two different mindfulness approaches on stress, anxiety and depression in school teachers. BMJ Open 2019;9:e025686.

Research paper thumbnail of Exploring gender differences, medical history, and treatments used in patients with fibromyalgia in the UK using primary-care data: a retrospective, population-based, cohort study

The Lancet Rheumatology, Sep 1, 2022

Research paper thumbnail of P096 Exploring fibromyalgia patients by gender using routinely collected primary-care data from Wales, UK: a descriptive epidemiological study

Rheumatology, Apr 1, 2023

Background/Aims Fibromyalgia predominantly affects women (80-90%), however contradictory findings... more Background/Aims Fibromyalgia predominantly affects women (80-90%), however contradictory findings show lower estimates (59%). The psychosocial impacts are similar in men and women but men delay seeking treatment and medical advice. Revisions of the 1990 American College of Rheumatology fibromyalgia classification criteria removed the requirement for at least 11 of 18 tender-point sites, which led to various prevalence rates and female-to-male ratios. This study aimed to measure new cases of fibromyalgia, determine the sex ratio following criteria revisions and explore treatments and symptoms by gender. Methods A retrospective population-based cohort study using primary-care electronic health-data from the Secured Anonymised Information Linkage Databank in Wales. Individuals aged 18 years and over with fibromyalgia READ Codes (N239'. and 'N248.') between 2004 and 2018 were included in the study. New cases were defined at first appearance of fibromyalgia READ codes. New cases of fibromyalgia were calculated at three 5-year periods; period 1 (2004-2008), 2 (2009-2013) and 3 (2014-2018). Descriptive analysis performed on variables for individuals by gender. Results Data on 22,568 individuals with fibromyalgia were extracted. The mean age of individuals was 48 years (SD: 13) and 20,040 (88.8%) were female. In period 1, among 5,296 new cases of fibromyalgia, 784 (14.8%) were male and 4,512 (85.2%) were female. In period 2, 642 (10.8%) of 5,958 new cases were male and 5,316 (89.2%) female, while in period 3, 1,102 (9.7%) of 11,314 new cases were male and 10,212 (90.3%) female. Women had a significantly higher BMI compared to men (difference: 1.6%, 95% CI: 1.5-1.7) and experienced more widespread pain (difference: 3.9%, 95% CI: 2.4-5.6). Women also experienced more stress and bereavement (difference: 12.1%, 95% CI: 10.3-13.8) and adverse life events (difference 10.4%, 95% CI: 9.1-11.6) compared to men. Men had significantly more comorbidities however women had more gastrointestinal disorders (difference 10%, 95% CI: 8.4-11.4) and abnormal thyroid function (difference 3.3%, 95%

Research paper thumbnail of Impact of mindfulness for people with arthritis

International Journal for Population Data Science, Apr 13, 2017

Research paper thumbnail of Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality

Rheumatology, May 14, 2022

Objectives. Investigate whether individuals with inflammatory arthritis (IA), their treatments an... more Objectives. Investigate whether individuals with inflammatory arthritis (IA), their treatments and shielding status affect the risk of adverse outcomes from COVID-19 for the entire population of Wales, UK. Methods. Retrospective, population-based cohort study using linked, anonymized electronic health data from SAIL Databank, including primary/secondary care, rheumatology, Office for National Statistics Mortality and COVID-19 laboratory data. Individuals aged 18 years and over testing positive for COVID-19 between March 2020 and May 2021 with READ Codes present for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis formed the study cases.

Research paper thumbnail of SAT0409 Biologic Treatment in Psoriatic Arthritis and Axial Spondylopathy Reduces Sicknotes Issued by GPS, Despite Delays in Diagnosis: A Real-Life Study in Wales

Annals of the Rheumatic Diseases, Jun 1, 2020

Research paper thumbnail of Predicting a diagnosis of ankylosing spondylitis using primary care health records – a machine learning approach

medRxiv (Cold Spring Harbor Laboratory), Apr 25, 2021

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Research paper thumbnail of Patient perspectives of managing fatigue in Ankylosing Spondylitis, and views on potential interventions: a qualitative study

BMC Musculoskeletal Disorders, May 9, 2013

Background: Fatigue is a major component of living with ankylosing spondylitis (AS), though it ha... more Background: Fatigue is a major component of living with ankylosing spondylitis (AS), though it has been largely overlooked , and currently there are no specific agreed management strategies. Methods: This qualitative exploratory study involved participants who are members of an existing populationbased ankylosing spondylitis (PAS) cohort. Participants residing in South West Wales were invited to participate in a focus group to discuss; (1) effects of fatigue, (2) self-management strategies and (3) potential future interventions. The focus groups were audio-recorded and the transcripts were analysed using thematic analysis. Results: Participants consisted of 3 males/4 females (group 1) and 4 males/3 females (group 2), aged between 35 and 73 years (mean age 53 years). Three main themes were identified: (1) The effects of fatigue were multidimensional with participants expressing feelings of being 'drained' (physical), 'upset' (emotional) and experiencing 'low-mood' (psychological); (2) The most commonly reported self-management strategy for fatigue was a balanced combination of activity (exercise) and rest. Medication was reluctantly taken due to side-effects and worries over dependency; (3) Participants expressed a preference for psychological therapies rather than pharmacological for managing fatigue. Information on Mindfulness-Based Stress Reduction (MBSR) was received with interest, with recommendations for delivery in a group format with the option of distance-based delivery for people who were not able to attend a group course. Conclusions: Patients frequently try and manage their fatigue without any formal guidance or support. Our research indicates there is a need for future research to focus on psychological interventions to address the multi-faceted aspects of fatigue in AS.

Research paper thumbnail of Real-world use of an etanercept biosimilar including selective versus automatic substitution in inflammatory arthritis patients: a UK based electronic health records study

Rheumatology Advances in Practice, 2022

Objective. Biosimilars are approved as an alternative treatment to their originators. We compared... more Objective. Biosimilars are approved as an alternative treatment to their originators. We compared the clinical outcomes of etanercept (ETN) biosimilar compared with ETN originator in real-world practice, from two local health boards in Wales with different policies on switching: automatic vs selective. Methods. Data from the Secure Anonymised Information Linkage (SAIL) databank in Wales were used to create a retrospective cohort study using linked primary and secondary care data. Patients aged !18 years with diagnosis codes for RA, PsA or AS were included. Outcomes included treatment failure and DAS-28 score (for RA). The local health board with a policy of automatic switching (i.e. clinician/nurse involvement not mandated) is labelled as automatic switch area, and the other, which required clinician/nurse supervision, as selective switch. Results. Of 8925 individuals with inflammatory arthritis, 13.3% (365) received ETN biosimilar and 31.5% (863) ETN originator. The treatment discontinuation rate was similar for ETN biosimilar and originator by Kaplan-Meier analysis. More biosimilar failure patients were treated in the automatic switch area (15 vs 4.8%). In the automatic switch area, 28.8% (75 of 260) of patients switched automatically from ETN originator to biosimilar compared with 10.5% (11 of 105) in the selective switch area. ETN biosimilar reduced DAS-28 by 1.6 6 1.8 in the selective switch area vs 0.4 6 0.6 in the automatic switch area. Conclusion. The ETN biosimilar was well tolerated. Fewer people were switched using selective policy, but this was associated with lower failure rates. Automatic switch policy led to more patients being switched and did not lead to significant worsening of disease. Lay Summary What does this mean for patients? People with arthritis are often treated with medicines known as biologics. These medicines reduce symptoms and improve quality of life. However, biologics are very expensive to make because they are complex proteins. When the biologic drug patent expires, other companies are able to make highly similar, but not identical, medicines to treat arthritis. These are known as biosimilars. Biosimilar drugs are much less expensive and therefore, in time, more individuals can access these as treatment. We investigated the biosimilar version of a biologic called etanercept. We found that the biosimilar drug worked well in treating people with arthritis when people were able to choose whether to switch to a biosimilar. However, when automatically switching from biologic to biosimilar, there was a slight worsening of symptoms, suggesting that it is better to involve patients in decisions on biosimilar use.

Research paper thumbnail of Exploring gender differences, medical history, and treatments used in patients with fibromyalgia in the UK using primary-care data: a retrospective, population-based, cohort study

Research paper thumbnail of P096 Exploring fibromyalgia patients by gender using routinely collected primary-care data from Wales, UK: a descriptive epidemiological study

Rheumatology

Background/Aims Fibromyalgia predominantly affects women (80-90%), however contradictory findings... more Background/Aims Fibromyalgia predominantly affects women (80-90%), however contradictory findings show lower estimates (59%). The psychosocial impacts are similar in men and women but men delay seeking treatment and medical advice. Revisions of the 1990 American College of Rheumatology fibromyalgia classification criteria removed the requirement for at least 11 of 18 tender-point sites, which led to various prevalence rates and female-to-male ratios. This study aimed to measure new cases of fibromyalgia, determine the sex ratio following criteria revisions and explore treatments and symptoms by gender. Methods A retrospective population-based cohort study using primary-care electronic health-data from the Secured Anonymised Information Linkage Databank in Wales. Individuals aged 18 years and over with fibromyalgia READ Codes (N239’. and ‘N248.’) between 2004 and 2018 were included in the study. New cases were defined at first appearance of fibromyalgia READ codes. New cases of fibro...

Research paper thumbnail of Predicting a diagnosis of ankylosing spondylitis using primary care health records – a machine learning approach

Ankylosing spondylitis is the second most common cause of inflammatory arthritis. However, a succ... more Ankylosing spondylitis is the second most common cause of inflammatory arthritis. However, a successful diagnosis can take a decade to confirm from symptom onset (via x-rays). The aim of this study was to use machine learning methods to develop a profile of the characteristics of people who are likely to be given a diagnosis of AS in future.The Secure Anonymised Information Linkage databank was used. Patients with ankylosing spondylitis were identified using their routine data and matched with controls who had no record of a diagnosis of ankylosing spondylitis or axial spondyloarthritis. Data was analysed separately for men and women. The model was developed using feature/variable selection and principal component analysis to develop decision trees. The decision tree with the highest average F value was selected and validated with a test dataset.The model for men indicated that lower back pain, uveitis, and NSAID use under age 20 is associated with AS development. The model for wome...

Research paper thumbnail of Real-world use of an etanercept biosimilar including selective versus automatic substitution in inflammatory arthritis patients: a UK-based electronic health records study

Rheumatology Advances in Practice

Objective Biosimilars are approved as an alternative treatment to their originators. We compared ... more Objective Biosimilars are approved as an alternative treatment to their originators. We compared the clinical outcomes of etanercept (ETN) biosimilar compared with ETN originator in real-world practice, from two local health boards in Wales with different policies on switching: automatic vs selective. Methods Data from the Secure Anonymised Information Linkage (SAIL) databank in Wales were used to create a retrospective cohort study using linked primary and secondary care data. Patients aged ≥18 years with diagnosis codes for RA, PsA or AS were included. Outcomes included treatment failure and DAS-28 score (for RA). The local health board with a policy of automatic switching (i.e. clinician/nurse involvement not mandated) is labelled as automatic switch area, and the other, which required clinician/nurse supervision, as selective switch. Results Of 8925 individuals with inflammatory arthritis, 13.3% (365) received ETN biosimilar and 31.5% (863) ETN originator. The treatment disconti...

Research paper thumbnail of OA05 Lower incidence of COVID-19 but higher mortality in patients with inflammatory arthritis compared to controls in Wales, United Kingdom: a population epidemiological study

Rheumatology

Background/Aims To investigate whether inflammatory arthritis (rheumatoid arthritis (RA), psoriat... more Background/Aims To investigate whether inflammatory arthritis (rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) and/or their treatments predisposes patients with an increased risk of contracting COVID-19 and/or more severe infection. Methods A retrospective, population-based cohort study using linked, Welsh anonymised electronic health data from SAIL Databank, comprising primary care, secondary care, rheumatology clinic data, Office of National Statistics Mortality data and laboratory COVID-19-related datasets. Individuals aged 18 years or over who tested positive for COVID-19 in Wales for the period of analysis from 1st March 2020 to 12th May 2021 with READ Codes present for RA, PsA and AS in their primary care records formed the study population cases. The controls were individuals without IA codes present in their records. Results Over 3 million COVID-19 tests had been administered in Wales, UK during the study period. A total of 1966 IA patie...

Research paper thumbnail of BMC Public Health BioMed Central Research article Risk factors for childhood obesity at age 5: Analysis of the Millennium Cohort Study

© 2009 Brophy et al; licensee BioMed Central Ltd. This is an Open Access article distributed unde... more © 2009 Brophy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License

Research paper thumbnail of Questionnaire and

Severe flare as a predictor of poor outcome in ankylosing spondylitis: a cohort study using

Research paper thumbnail of OA05 Lower incidence of COVID-19 but higher mortality in patients with inflammatory arthritis compared to controls in Wales, United Kingdom: a population epidemiological study

Rheumatology, Apr 23, 2022

Research paper thumbnail of Curriculum-based outdoor learning for children aged 9-11: A qualitative analysis of pupils’ and teachers’ views

Research paper thumbnail of Proton pump inhibitors and dementia risk: Evidence from a cohort study using linked routinely collected national health data in Wales, UK

PLOS ONE, Sep 18, 2020

Objectives Proton pump inhibitors (PPIs) are commonly prescribed for prevention and treatment of ... more Objectives Proton pump inhibitors (PPIs) are commonly prescribed for prevention and treatment of gastrointestinal conditions or for gastroprotection from other drugs. Research suggests they are linked to increased dementia risk. We use linked national health data to examine the association between PPI use and the development of incident dementia. Methods and findings A population-based study using electronic health-data from the Secure Anonymised Information Linkage (SAIL) Databank, Wales (UK) from 1999 to 2015. Of data available on 3,765,744 individuals, a cohort who had ever been prescribed a PPI was developed (n = 183,968) for people aged 55 years and over and compared to non-PPI exposed individuals (131,110). Those with prior dementia, mild-cognitive-impairment or delirium codes were excluded. Confounding factors included comorbidities and/or drugs associated with them. Comorbidities might include head injury and some examples of medications include antidepressants, antiplatelets and anticoagulants. These commonly prescribed drugs were investigated as it was not feasible to explore all drugs in this study. The main outcome was a diagnosis of incident dementia. Cox proportional hazard regression modelling was used to calculate the Hazard ratio (HR) of developing dementia in PPI-exposed compared to unexposed individuals while controlling for potential confounders. The mean age of the PPI exposed individuals was 69.9 years and 39.8% male while the mean age of the unexposed individuals was 72.1 years and 41.1% male. The rate of PPI usage was 58.4% (183,968) and incident dementia rate was 11.8% (37,148/315,078). PPI use was associated with decreased dementia risk (HR: 0.67, 95% CI: 0.65 to 0.67, p<0.01).

Research paper thumbnail of The coding of telephone consultations in UK primary care databases: are we picking up all the calls?

BMC Research Notes, May 9, 2023

y increased the use of telephone, email and virtual consulting [1]. Both telephone and video cons... more y increased the use of telephone, email and virtual consulting [1]. Both telephone and video consultations have led to great time savings in some UK practices [2] and this seems likely to persist in the future. It may be that remote consultations (both by telephone and by video conferencing) could become a more frequent modality for consultations. With changes in demand for GP services over time, the monitoring of consultation rates in general, and different types of consultation is instrumental in informing the provision of effective GP services [3]. Here we examine the coding of telephone consultations in UK general practice by looking at one clinical computer system, Vision (In Practice Systems Limited). Vision is used by GPs during the course of a consultation with a patient. There are two research databases which provide extracts of the Vision system from some GP practices to BMC Research Notes

Research paper thumbnail of Mixed-methods evaluation comparing the impact of two different mindfulness approaches on stress, anxiety and depression in school teachers

BMJ Open, Jul 1, 2019

et al. Mixedmethods evaluation comparing the impact of two different mindfulness approaches on st... more et al. Mixedmethods evaluation comparing the impact of two different mindfulness approaches on stress, anxiety and depression in school teachers. BMJ Open 2019;9:e025686.

Research paper thumbnail of Exploring gender differences, medical history, and treatments used in patients with fibromyalgia in the UK using primary-care data: a retrospective, population-based, cohort study

The Lancet Rheumatology, Sep 1, 2022

Research paper thumbnail of P096 Exploring fibromyalgia patients by gender using routinely collected primary-care data from Wales, UK: a descriptive epidemiological study

Rheumatology, Apr 1, 2023

Background/Aims Fibromyalgia predominantly affects women (80-90%), however contradictory findings... more Background/Aims Fibromyalgia predominantly affects women (80-90%), however contradictory findings show lower estimates (59%). The psychosocial impacts are similar in men and women but men delay seeking treatment and medical advice. Revisions of the 1990 American College of Rheumatology fibromyalgia classification criteria removed the requirement for at least 11 of 18 tender-point sites, which led to various prevalence rates and female-to-male ratios. This study aimed to measure new cases of fibromyalgia, determine the sex ratio following criteria revisions and explore treatments and symptoms by gender. Methods A retrospective population-based cohort study using primary-care electronic health-data from the Secured Anonymised Information Linkage Databank in Wales. Individuals aged 18 years and over with fibromyalgia READ Codes (N239'. and 'N248.') between 2004 and 2018 were included in the study. New cases were defined at first appearance of fibromyalgia READ codes. New cases of fibromyalgia were calculated at three 5-year periods; period 1 (2004-2008), 2 (2009-2013) and 3 (2014-2018). Descriptive analysis performed on variables for individuals by gender. Results Data on 22,568 individuals with fibromyalgia were extracted. The mean age of individuals was 48 years (SD: 13) and 20,040 (88.8%) were female. In period 1, among 5,296 new cases of fibromyalgia, 784 (14.8%) were male and 4,512 (85.2%) were female. In period 2, 642 (10.8%) of 5,958 new cases were male and 5,316 (89.2%) female, while in period 3, 1,102 (9.7%) of 11,314 new cases were male and 10,212 (90.3%) female. Women had a significantly higher BMI compared to men (difference: 1.6%, 95% CI: 1.5-1.7) and experienced more widespread pain (difference: 3.9%, 95% CI: 2.4-5.6). Women also experienced more stress and bereavement (difference: 12.1%, 95% CI: 10.3-13.8) and adverse life events (difference 10.4%, 95% CI: 9.1-11.6) compared to men. Men had significantly more comorbidities however women had more gastrointestinal disorders (difference 10%, 95% CI: 8.4-11.4) and abnormal thyroid function (difference 3.3%, 95%

Research paper thumbnail of Impact of mindfulness for people with arthritis

International Journal for Population Data Science, Apr 13, 2017

Research paper thumbnail of Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality

Rheumatology, May 14, 2022

Objectives. Investigate whether individuals with inflammatory arthritis (IA), their treatments an... more Objectives. Investigate whether individuals with inflammatory arthritis (IA), their treatments and shielding status affect the risk of adverse outcomes from COVID-19 for the entire population of Wales, UK. Methods. Retrospective, population-based cohort study using linked, anonymized electronic health data from SAIL Databank, including primary/secondary care, rheumatology, Office for National Statistics Mortality and COVID-19 laboratory data. Individuals aged 18 years and over testing positive for COVID-19 between March 2020 and May 2021 with READ Codes present for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis formed the study cases.

Research paper thumbnail of SAT0409 Biologic Treatment in Psoriatic Arthritis and Axial Spondylopathy Reduces Sicknotes Issued by GPS, Despite Delays in Diagnosis: A Real-Life Study in Wales

Annals of the Rheumatic Diseases, Jun 1, 2020

Research paper thumbnail of Predicting a diagnosis of ankylosing spondylitis using primary care health records – a machine learning approach

medRxiv (Cold Spring Harbor Laboratory), Apr 25, 2021

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Research paper thumbnail of Patient perspectives of managing fatigue in Ankylosing Spondylitis, and views on potential interventions: a qualitative study

BMC Musculoskeletal Disorders, May 9, 2013

Background: Fatigue is a major component of living with ankylosing spondylitis (AS), though it ha... more Background: Fatigue is a major component of living with ankylosing spondylitis (AS), though it has been largely overlooked , and currently there are no specific agreed management strategies. Methods: This qualitative exploratory study involved participants who are members of an existing populationbased ankylosing spondylitis (PAS) cohort. Participants residing in South West Wales were invited to participate in a focus group to discuss; (1) effects of fatigue, (2) self-management strategies and (3) potential future interventions. The focus groups were audio-recorded and the transcripts were analysed using thematic analysis. Results: Participants consisted of 3 males/4 females (group 1) and 4 males/3 females (group 2), aged between 35 and 73 years (mean age 53 years). Three main themes were identified: (1) The effects of fatigue were multidimensional with participants expressing feelings of being 'drained' (physical), 'upset' (emotional) and experiencing 'low-mood' (psychological); (2) The most commonly reported self-management strategy for fatigue was a balanced combination of activity (exercise) and rest. Medication was reluctantly taken due to side-effects and worries over dependency; (3) Participants expressed a preference for psychological therapies rather than pharmacological for managing fatigue. Information on Mindfulness-Based Stress Reduction (MBSR) was received with interest, with recommendations for delivery in a group format with the option of distance-based delivery for people who were not able to attend a group course. Conclusions: Patients frequently try and manage their fatigue without any formal guidance or support. Our research indicates there is a need for future research to focus on psychological interventions to address the multi-faceted aspects of fatigue in AS.

Research paper thumbnail of Real-world use of an etanercept biosimilar including selective versus automatic substitution in inflammatory arthritis patients: a UK based electronic health records study

Rheumatology Advances in Practice, 2022

Objective. Biosimilars are approved as an alternative treatment to their originators. We compared... more Objective. Biosimilars are approved as an alternative treatment to their originators. We compared the clinical outcomes of etanercept (ETN) biosimilar compared with ETN originator in real-world practice, from two local health boards in Wales with different policies on switching: automatic vs selective. Methods. Data from the Secure Anonymised Information Linkage (SAIL) databank in Wales were used to create a retrospective cohort study using linked primary and secondary care data. Patients aged !18 years with diagnosis codes for RA, PsA or AS were included. Outcomes included treatment failure and DAS-28 score (for RA). The local health board with a policy of automatic switching (i.e. clinician/nurse involvement not mandated) is labelled as automatic switch area, and the other, which required clinician/nurse supervision, as selective switch. Results. Of 8925 individuals with inflammatory arthritis, 13.3% (365) received ETN biosimilar and 31.5% (863) ETN originator. The treatment discontinuation rate was similar for ETN biosimilar and originator by Kaplan-Meier analysis. More biosimilar failure patients were treated in the automatic switch area (15 vs 4.8%). In the automatic switch area, 28.8% (75 of 260) of patients switched automatically from ETN originator to biosimilar compared with 10.5% (11 of 105) in the selective switch area. ETN biosimilar reduced DAS-28 by 1.6 6 1.8 in the selective switch area vs 0.4 6 0.6 in the automatic switch area. Conclusion. The ETN biosimilar was well tolerated. Fewer people were switched using selective policy, but this was associated with lower failure rates. Automatic switch policy led to more patients being switched and did not lead to significant worsening of disease. Lay Summary What does this mean for patients? People with arthritis are often treated with medicines known as biologics. These medicines reduce symptoms and improve quality of life. However, biologics are very expensive to make because they are complex proteins. When the biologic drug patent expires, other companies are able to make highly similar, but not identical, medicines to treat arthritis. These are known as biosimilars. Biosimilar drugs are much less expensive and therefore, in time, more individuals can access these as treatment. We investigated the biosimilar version of a biologic called etanercept. We found that the biosimilar drug worked well in treating people with arthritis when people were able to choose whether to switch to a biosimilar. However, when automatically switching from biologic to biosimilar, there was a slight worsening of symptoms, suggesting that it is better to involve patients in decisions on biosimilar use.

Research paper thumbnail of Exploring gender differences, medical history, and treatments used in patients with fibromyalgia in the UK using primary-care data: a retrospective, population-based, cohort study

Research paper thumbnail of P096 Exploring fibromyalgia patients by gender using routinely collected primary-care data from Wales, UK: a descriptive epidemiological study

Rheumatology

Background/Aims Fibromyalgia predominantly affects women (80-90%), however contradictory findings... more Background/Aims Fibromyalgia predominantly affects women (80-90%), however contradictory findings show lower estimates (59%). The psychosocial impacts are similar in men and women but men delay seeking treatment and medical advice. Revisions of the 1990 American College of Rheumatology fibromyalgia classification criteria removed the requirement for at least 11 of 18 tender-point sites, which led to various prevalence rates and female-to-male ratios. This study aimed to measure new cases of fibromyalgia, determine the sex ratio following criteria revisions and explore treatments and symptoms by gender. Methods A retrospective population-based cohort study using primary-care electronic health-data from the Secured Anonymised Information Linkage Databank in Wales. Individuals aged 18 years and over with fibromyalgia READ Codes (N239’. and ‘N248.’) between 2004 and 2018 were included in the study. New cases were defined at first appearance of fibromyalgia READ codes. New cases of fibro...

Research paper thumbnail of Predicting a diagnosis of ankylosing spondylitis using primary care health records – a machine learning approach

Ankylosing spondylitis is the second most common cause of inflammatory arthritis. However, a succ... more Ankylosing spondylitis is the second most common cause of inflammatory arthritis. However, a successful diagnosis can take a decade to confirm from symptom onset (via x-rays). The aim of this study was to use machine learning methods to develop a profile of the characteristics of people who are likely to be given a diagnosis of AS in future.The Secure Anonymised Information Linkage databank was used. Patients with ankylosing spondylitis were identified using their routine data and matched with controls who had no record of a diagnosis of ankylosing spondylitis or axial spondyloarthritis. Data was analysed separately for men and women. The model was developed using feature/variable selection and principal component analysis to develop decision trees. The decision tree with the highest average F value was selected and validated with a test dataset.The model for men indicated that lower back pain, uveitis, and NSAID use under age 20 is associated with AS development. The model for wome...

Research paper thumbnail of Real-world use of an etanercept biosimilar including selective versus automatic substitution in inflammatory arthritis patients: a UK-based electronic health records study

Rheumatology Advances in Practice

Objective Biosimilars are approved as an alternative treatment to their originators. We compared ... more Objective Biosimilars are approved as an alternative treatment to their originators. We compared the clinical outcomes of etanercept (ETN) biosimilar compared with ETN originator in real-world practice, from two local health boards in Wales with different policies on switching: automatic vs selective. Methods Data from the Secure Anonymised Information Linkage (SAIL) databank in Wales were used to create a retrospective cohort study using linked primary and secondary care data. Patients aged ≥18 years with diagnosis codes for RA, PsA or AS were included. Outcomes included treatment failure and DAS-28 score (for RA). The local health board with a policy of automatic switching (i.e. clinician/nurse involvement not mandated) is labelled as automatic switch area, and the other, which required clinician/nurse supervision, as selective switch. Results Of 8925 individuals with inflammatory arthritis, 13.3% (365) received ETN biosimilar and 31.5% (863) ETN originator. The treatment disconti...

Research paper thumbnail of OA05 Lower incidence of COVID-19 but higher mortality in patients with inflammatory arthritis compared to controls in Wales, United Kingdom: a population epidemiological study

Rheumatology

Background/Aims To investigate whether inflammatory arthritis (rheumatoid arthritis (RA), psoriat... more Background/Aims To investigate whether inflammatory arthritis (rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) and/or their treatments predisposes patients with an increased risk of contracting COVID-19 and/or more severe infection. Methods A retrospective, population-based cohort study using linked, Welsh anonymised electronic health data from SAIL Databank, comprising primary care, secondary care, rheumatology clinic data, Office of National Statistics Mortality data and laboratory COVID-19-related datasets. Individuals aged 18 years or over who tested positive for COVID-19 in Wales for the period of analysis from 1st March 2020 to 12th May 2021 with READ Codes present for RA, PsA and AS in their primary care records formed the study population cases. The controls were individuals without IA codes present in their records. Results Over 3 million COVID-19 tests had been administered in Wales, UK during the study period. A total of 1966 IA patie...

Research paper thumbnail of BMC Public Health BioMed Central Research article Risk factors for childhood obesity at age 5: Analysis of the Millennium Cohort Study

© 2009 Brophy et al; licensee BioMed Central Ltd. This is an Open Access article distributed unde... more © 2009 Brophy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License

Research paper thumbnail of Questionnaire and

Severe flare as a predictor of poor outcome in ankylosing spondylitis: a cohort study using