Background National U.K recommendations1 have led to the introduction of annual review clinics for patients with rheumatoid arthritis. We considered the benefits of ankylosing spondylitis annual review clinics.
Objectives Review the diagnosis of ankylosing spondylitis (Modified New York Criteria)2,monitor for complications (ophthalmic, valvular heart disease, fibrotic lung disease) & for co-morbidities (including hypertension, ischaemic heart disease, osteoporosis and depression).
Assess disease activity, lifestyle & quality of life based on patient completed questionnaires/descriptions & investigation results.
If appropriate recommend medications/lifestyle alterations & further investigations. Cross referral to the multidisciplinary team & to psychological/social support networks could be made if required.
Methods 43 patients were invited to attend a registrar led clinic. Blood tests (lipid profile, glucose, FBC, U/Es, LFTs, vitamin D, PTH, CRP & ESR) were done 1 week before the assessment. Patients completed BASDAI3, BASFI3, BAS-G3, Hospital Anxiety & Depression Score (HADS)4, & Medical Outcomes Sleep Study Sleep Scale (MOSS-SS)5 assessments. Blood pressure (BP), body mass index & spinal mobility (tragus to wall distance, cervical rotation, chest expansion, Shoeber’s distraction test6, lateral spinal flexion & intermalleolar distance) were measured. Cardiovascular & respiratory examinations were performed.
Results 40 (F=12, M=28) patients attended the clinic.33% with fasting cholesterol ≥5.2 mmol/l advised sauturated fat intake reduction & review in 6 months.30% had a BMI ≥25.1 advised low calorie diet adherence & offered dietician input. 25% had BP≥140/90mmHg will be monitored & 2.5% commenced antihypertensives.22% advised on stretches/cardiovascular exercises/NASS hydrotherapy & gym sessions.10% advised to reduce alcohol intake (from≥21units/wk). Smoking cessation advise/support information given to 7.5%. 10% unaware of NASS activities were given information. 25% anxious/depressed (HADS≥11) were offered counseling. 5% who were not coping at home were offered social service referral. DEXA scans were recommended for 67% who had ≥1 risk other factor for osteoporosis. Based on examination findings/family history/symptomatology/disease duration 90% required echocardiography. 87% were referred for pulmonary function tests for symptoms/ausculatory abnormalities. 48% with vitamin D levels ≤40nmol/L were given advice/prescriptions for vitamin D3 supplementation. Anti TNF initiation/increase/reduction was appropriate for 17.5%.
Conclusions We found annual review clinics for ankylosing spondylitis patients a useful way to optimise & coordinate care in addition to screening for complications and co-morbidities. The concept was welcomed by patients & multidisciplinary team members at our hospital as a worthwhile adjunct to routine clinics.
Akgul et al. Classification criteria for Spondyloarthropathies. World J Orthop 2011, 2;12:107-1153.
Cardee M. Ankylosing Spondylitis Measures. 2003; 49:S197-20094.
Snaith P. The Hospital Anxiety and Depression Scale. Health and quality of Life Outcomes 2003, 1:295.
Spritzer K et al. MOS Sleep Scale: A Manual for Use and Scoring, Version 1.0. Los Angeles, CA
Davis J et al. Spinal Mobility Measures in Spondyloarthritis: Application of The Omeract Filter. J Rheumatol 2007; 34(4):666-670
Disclosure of Interest None Declared