Objective: To assess the reproducibility of patient-reported tender (TJCs) and swollen joint counts (SJCs) of patients with rheumatoid arthritis (RA) compared to trained clinicians.Methods: We conducted a systematic literature review and metaanalysis of studies comparing patient-reported TJCs and/or SJCs to clinician counts in patients with RA. We calculated pooled summary estimates for correlation. Agreement was compared using a Bland-Altman approach.Results: Fourteen studies were included in the metaanalysis. There were strong correlations between clinician and patient TJCs (0.78, 95% CI 0.76–0.80), and clinician and patient SJCs (0.59, 95% CI 0.54–0.63). TJCs had good reliability, ranging from 0.51 to 0.85. SJCs had moderate reliability, ranging from 0.28 to 0.77. Agreement for TJCs reduced for higher TJC values, suggesting a positive bias for self-reported TJCs, which was not observed for SJCs.Conclusion: Our metaanalysis has identified a strong correlation between patient- and clinician-reported TJCs, and a moderate correlation for SJCs. Patient-reported joint counts may be suitable for use in annual review for patients in remission and in monitoring treatment response for patients with RA. However, they are likely not appropriate for decisions on commencement of biologics. Further research is needed to identify patient groups in which patient-reported joint counts are unsuitable.

Background Transition clinics facilitate transition to adult services for adolescents and young adults (AYAs). This service for rheumatology patients was audited in 2018/19 to understand their experiences and how it may be improved. Patients reported wanting to see a youth worker and physiotherapist on the same day as transition clinic. They also sought more information about their condition, its management and help in dealing with their emotions. Objectives To improve the satisfaction of the rheumatology service for AYAs, including providing a good service as described by the AYAs themselves. This quality improvement project (QIP) aimed to achieve this by making changes through three PDSA cycles to the transition clinic these AYAs attend. Methods The current service was compared to European Alliance of Associations for Rheumatology (EULAR) guidelines on transitional care, which recommend that the service should address psychosocial needs of AYA and provide access to a physical therapist. Additionally, British Society for Paediatric and Adolescent Rheumatology (BSPAR) standards of care for juvenile idiopathic arthritis was also used to consult changes and it was found that AYA should have access to a multidisciplinary team which includes a paediatric clinical psychologist and a physiotherapist. These recommendations were also in the patient’s feedback and made them suitable domains for improvement. This led to the introduction of parallel psychology and physiotherapy services to the clinic, achieved by liaising with relevant teams to see if this could be feasible and sustainable. A leaflet was also designed and distributed by the QIP team which included who to contact with health concerns, signposting to information relating to their condition and suggestions of where to go for careers advice or emotional support. Results 2018–2019 audit data showed that less than 60% of patients were satisfied with the transition clinic. Following 3 PDSA cycles, satisfaction increased to at least 75% in the evaluated domains. The addition of a psychologist was well received by patients and the percentage of patients wanting to know where they can get help in dealing with their emotions dropped from 83% to 75%. Feedback showed patients mostly thought favourably of all evaluated areas of the leaflet. Principally, they found the leaflet satisfactorily explained what transition is, who to contact about health concerns and resources available for emotional support. Evaluation of the parallel physiotherapy service remains to be conducted. Conclusions The project produced positive results and there was an improvement in patient satisfaction. Some barriers were encountered; the clinics take place once a month, so it was not possible to collect data from the same patients due to the time constraints of the project. A physiotherapist was difficult to arrange due to funding and was not integrated until late into the project, meaning its effect was not evaluated. Nevertheless, the QIP shows the positive impact of the three interventions and could provide a model for other transition services.

Radiotherapy remains a cornerstone of cancer treatment, yet treatment response continues to be limited by tumour radioresistance and considerable biological heterogeneity. Although advances in radiation delivery have substantially improved dose conformity and reduced toxicity, increasing evidence suggests that optimising therapeutic outcomes will require greater integration of tumour biology into treatment strategies. This review examines emerging molecular approaches that seek to enhance anti-tumour responses to radiotherapy beyond direct tumour cell killing. We discuss the DNA damage response as a therapeutic target for radiosensitisation, highlighting the evolving role of DNA damage response inhibitors in promoting both tumour cytotoxicity and immune activation. We further examine the mechanisms linking radiation-induced DNA damage to anti-tumour immunity, including immunogenic cell death, cGAS–STING signalling, and remodelling of the tumour microenvironment, together with the opportunities and challenges of combining radiotherapy with immune checkpoint inhibition. Finally, we review emerging concepts in precision radiation oncology, including spatially tailored irradiation strategies, genomically informed radiation prescription, radiogenomics, and the influence of the gut microbiome on treatment response. Collectively, these advances support a shift from anatomically guided radiotherapy towards biologically personalised treatment, integrating molecular, immunological and genomic information with normal-tissue susceptibility to improve the therapeutic ratio and enable more precise, patient-centred cancer care.