This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Oxford University Press at http://qjmed.oxfordjournals.org/content/early/2016/08/21/qjmed.hcw142. Please refer to any applicable terms of use of the publisher. University of Bristol -Explore Bristol Research General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above.

Rituximab is a therapeutic option in treatment-refractory CTD-associated ILD. Some disease subgroups may respond better than others, however, more work is needed to define its role in managing these patients.

Standard PR gives initial benefits in participants with ILD who complete the course, however these are not sustained. Tailored approaches to this group would be appreciated by this group and should be explored.

Differentiating somatic from emotional influences on the experience of chronic pain has been of interest to clinicians and researchers for many years. Although prior research has not well specified these pathways at the anatomical level, some evidence, both theoretical and empirical, suggest that emotional reactions influence the experience of disease and non-disease-related pains. Other studies suggest that treatments directed at negative emotional responses reduce suffering associated with pain. The current study was conducted to explore the influence of emotional reactions to pain as a predictor of psychological distress in a sample of adult Blacks with Sickle Cell Disease (SCD). Using cross-sectional survey data, we evaluated whether negative emotional reactions to the experience of pain were predictive of psychological distress after controlling for the somatic dimension of pain and age in n = 67 Black patients with Sickle Cell Disease (SCD). Results showed that greater negative emotion associated with pain predicted Somatization (p < .01), Anxiety (p < .05), Phobic Anxiety (p < .05), and Psychoticism (p < .05). Increased negative emotion associated with pain was also predictive of the General Symptoms Index (p < .05) and the Positive Symptoms Total from the SCL-90-R (p < .01). We believe the current study demonstrates that negative emotional reactions to the experience of pain in adults with SCD are predictive of psychological distress above and beyond the influences of age and the direct nociceptive experience. We also believe these data to be valuable in conceptualizing the allocation of treatment resources toward a proactive approach with early identification of patients who are responding poorly for the purpose of potentially reducing later psychopathology. A deeper understanding of the ways that subpopulations cope with chronic disease-related pain may produce models that can be ultimately generalized to the consumers of the majority of healthcare resources.

BackgroundPulmonary rehabilitation (PR) is important in the management of interstitial lung disease (ILD), however it remains unclear how sustained the initial benefits in exercise capacity and quality of life are in this group of patients. An increasing number of ILD patients are participating in PR courses and it is vital that they be offered the most beneficial approach possible.MethodsWe have analysed prospectively gathered data from a well characterised population of ILD participants with >24 months follow-up, from a well-established PR service. Participants completed incremental shuttle walk (ISWT) and chronic respiratory disease questionnaire (CRDQ) before PR, at course completion, 6 months and 12 months follow-up. These data were compared to establish changes over time compared to baseline. The ILD cohort was compared to a further group with chronic obstructive pulmonary disease (COPD). Semi-structured interviews were conducted with ILD participants to establish qualitative views on existing and possible future PR provision.ResultsData were available for 79 participants with ILD. PR gave initial improvements in ISWT (29.5 m (95% CI 13.7 to 45.2 m)) and CRDQ (11.6 (95% CI 8.5 to 14.7)), however these benefits were not sustained at 6 months (ISWT change 0.0 m (95% CI -23.2 to 23.2 m), CRDQ change 2.5 (95% CI -2.4 to 7.4)) and 12 months (ISWT change -0.7 m (95% CI -37.3 to 35.9 m), CRDQ change 4.0 (95% CI -2.2 to 10.2)). In contrast, the COPD group demonstrated more durable benefit in exercise capacity (ISWT change at 6 months 35.7 m, 95% CI 10.76 to 60.68, p < 0.01). A greater proportion of those who had continued with home exercise maintained an increase in walking distance above the MCID than those who had not (46.4% vs 10.5%, p = 0.01).Interview responses highlighted the value attached to PR by participants with ILD, but also suggested that this could be improved by increased course duration, ongoing supervised exercise following course completion and greater tailoring of content to those with ILD.Abstract S99 Figure 1 ConclusionsPR as currently delivered gives initial benefits to participants with ILD, however these are not sustained. More tailored approaches to this group are needed to improve the sustainability of response to PR.