E063 Pharmacological treatment and mental wellbeing in systemic autoimmune rheumatic diseases

Abstract Background/Aims Systemic autoimmune rheumatic diseases (SARDs) are chronic, multisystem inflammatory disorders causing significant physical and psychological burden. Pharmacological treatments can reduce inflammation and improve physical function. However, their association with patients’ mental wellbeing remains underexplored. Understanding how treatment regimens relate to mental health is essential for holistic, patient-centred care. This study aimed to 1) compare medication use between SARD groups, and 2) investigate the relationship between pharmacological treatment and mental wellbeing. Methods This cross-sectional study, which was part of the INSPIRE project (Investigating Neuropsychiatric Symptom Prevalence and Impact in Rheumatology patient Experiences), recruited adults reporting clinician-confirmed SARDs through online forums, support groups, and social media platforms. Participants completed an online questionnaire assessing demographics, medication use, and mental wellbeing. Medication data included current and past use of corticosteroids, conventional and biologic disease-modifying antirheumatic drugs (cDMARDs, bDMARDs), anti-malarials, opioids, intravenous immunoglobulin (IVIg) and mental health medications. Mental wellbeing was measured using GAD-7, PROMIS Depression Short Form, Warwick-Edinburgh Mental Wellbeing Scale, and the revised Everyday Memory Questionnaire, alongside patient-designed measures regarding adaptation to illness, fatigue, pain, and symptoms. Chi-square and Kruskal-Wallis tests (Bonferroni-corrected) examined the group differences and wellbeing associations. Results Among 1,853 individuals with SARDs, medication use varied significantly across disease groups (all p 0.001). Twelve medication-use patterns were defined based on single or combined therapies. Sjögren’s disease patients had the lowest proportion of individuals taking at least one of the disease-modifying medications (25%), whilst polymyalgia rheumatica, rheumatoid/ inflammatory arthritis (RA/IA), and vasculitis patients had the highest (0.8%, 2.4% and 2.5% reporting no medication use, respectively). Anti-malarials were most common in systemic lupus erythematosus (SLE) (62%) and undifferentiated connective tissue disease (UCTD) (56%), cDMARDs in RA/IA and myositis (59% each), bDMARDs in RA/IA (47%), and opioids in RA/IA (29%) and myositis (27%). Corticosteroid use was positively associated with age and being male (p 0.001). Across disease groups, depression medication use was highest in UCTD (42%), and anxiety medication in SLE (28%). Mental health outcomes also differed by medication use. Participants not taking any medications of interest reported lower depression and fatigue (both p 0.001). However, opioid-treated patients had the poorest outcomes across depression, anxiety, fatigue, pain, and cognition (all p 0.001). Corticosteroid-only users showed comparatively better well-being, while anti-malarial users reported the best memory and cognition relative to other medication groups. Conclusion A higher medication burden is associated with poorer mental wellbeing although causality cannot be inferred. A prospective study is required to ascertain how much this reflects the direct impact of rheumatological medications on mental health and/or the greater illness severity of patients on more intensive medication regimes. Disclosure E. Massou: None. M. Sloan: None. P. Hamilton-Conaty: None. J.A. Bourgeois: None. L. Andreoli: None. D. D’Cruz: None. G. Leschziner: None. T. Pollak: None. S. Tayabali: None. A. Bortoluzzi: None. K. Naidu: None. S. Gnanapavan: None. F. Naughton: None.