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AB0564 A review of ankylosing spondylitis complications and associations.
  1. T. Doherty1,
  2. J. Pilcher2,
  3. N. Njegovan3,
  4. V. Sandhu1
  1. 1Rheumatology
  2. 2Radiology, St Georges Hospital, London
  3. 3Statistics, London, United Kingdom

Abstract

Background Ankylosing spondylitis (AS) is a chronic inflammatory condition of the spine with variable frequency & severity of extra-articular manifestations & co-morbidities. Delayed diagnosis or failure to identify/manage its associations have major health/social consequences in these patients.

Objectives To determine the prevalence of AS complications and associations in our cohort.

Methods We set up annual review AS clinics to screen for extra-articular disease +/- co-morbidities. We checked for uveitis, psoriasis & inflammatory bowel disease. Current treatments and treatment failures were noted. Smoking & alcohol histories were taken. Employment +/- incapacity benefit histories were also checked. Each had cardio-respiratory examinations & spinal mobility measurements. Hospital Anxiety & Depression Scales(HADS-A and HADS-D respectively) & Medical Outcomes Sleep Study (MOSS) questionnaires assessed mood and sleep quality respectively. Blood pressure measurements & Body Mass Index (BMI) calculations were done.

Echocardiograms, pulmonary function tests (PFTs) & DEXAs were performed.

Results 59 AS patients (M=41, F=18) attended our annual review clinic. Mean age=45yrs. 51 were HLA-B27 positive. Of 42 patient x-rays available for review 34 had radiographic sacroilitis +/- vertebral AS. Of 42 MRIs, 39 had AS features. 24 took daily NSAIDS, 6 intermittently. 9 took sulphasalazine (6 in the past), 1 methotrexate. 19 patients were currently on biologics & 7 had failed these.

12 had a history of uveitis, 3 had psoriasis, none had evidence of inflammatory bowel disease.

Smokers=15, 14=ex-smokers. Alcohol consumption was low in 35, moderate in 8, > 30 IU/week in 8, & 7 were abstinent.

5 received incapacity benefits, 10 were retired due to age, & 43 were in full time employment/studies.

23 had hypertension (>140/90mmhg).

17 had hypercholesterolaemia (fasting>5.1mmol/L).

31 had BMIs ≥ 25, and 18 had a BMI ≥ 30. 8 had osteopenia.

10 had abnormal PFTs (4 obstructive and 6 restrictive defects). 21 had abnormalities reported on echocardiographs.

19 had subclinical enthesopathy detected by ultrasound. 28 had high HAD scores for anxiety and/or depression. 29 had BASDAI ≥4, 21 has BASFI ≥4, 25 BAS-G ≥4 and 24 with spinal pain VAS scores ≥4. As determined by MOSS questionnaires, 33 had a sleep disturbance on (SLPD4).

Conclusions AS annual review clinics are useful to screen for occult extra-articular disease/co-morbidities.

Cardiovascular risks and complications were high with 39% hypertensive, 53% obese, 36% with abnormal echocardiograms and 29% with hypercholesterolaemia. Subclinical enthesopathy (32%), anxiety/depression (28%) andsleep disturbance (56%) were also prevalent. Patients’ treatment regimes were rationalised according to their response to current treatments a multiprofessional approach was adopted to manage their complication and associations if present.

Patient feedback was extremely positive and mostly they did not feel burdened by the extra screening.

Acknowledgements St. Georges cardiology department for echocardiograms, radiology for ultrasound and DEXAs and respiratory department for pulmonary function tests.

Disclosure of Interest None Declared

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