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OP0002 EARLY INFLAMMATORY BACK PAIN SERVICE – REDUCING TIME TO DIAGNOSIS IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS – THE FIRST 8 YEARS
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  1. Rebecca Adshead1,
  2. Hasan Tahir2,
  3. Philippa Knight3,
  4. Simon Donnelly4
  1. 1Barts Health NHS Trust, Rheumatology, London, United Kingdom
  2. 2Barts Health NHS Trust, London, United Kingdom

Abstract

Background Specialist axial spondyloarthritis (axial SpA) clinics are advocated to promote early diagnosis and treatment and provide essential support and guidance to patients suffering with axial SpA¹. In 2010, we set up an early inflammatory back pain service (EIBPS) to target early diagnosis and management to prevent the consequences of delayed diagnosis.

Objectives We established an EIBPS to reduce time to diagnosis and initiation of biologic therapy. This was accompanied by an education campaign (Back on Track) to local GP’s, allied health practitioners (AHP’s)and secondary care colleagues and to the general public to focus raising awareness of Inflammatory Back Pain (IBP) and axial SpA.

Methods

  • Referred patients with suspected IBP were screened by a specialist physiotherapist.

  • Each patient was assessed for IBP (Berlin Criteria) and other SpA features.

  • Bloods including HLA–B27 were taken for those with IBP or suspected axial SpA.

  • Sacroiliac Joint (SIJ) X–Rays were taken in suspected axial SpA patients and if normal spinal and SIJ MRI’s taken.

  • An educational campaign was undertaken with formal education on axial SpA for AHP’s and doctors, in addition to a suite of promotional and training materials developed and disseminated.

Results Between 2010-2018, 599 patients had an initial assessment appointment in the EIBPS. 312 (52%) were female, mean age 39.6 years (at data collection). Of the 599 referrals, 413 (69%) had symptoms of IBP and fulfilled the Berlin IBP criteria. These were referred for formal screening. 238 (40%) patients had confirmed axial SpA fulfilling ASAS criteria. Of these 238, 59 (10%) had a pre-existing diagnosis from another hospital. The remaining 179 (30%) patients received a new diagnosis, with 128 patients fulfilling radiographic axial SpA criteria and 51 patients fulfilling non-radiographic ASAS criteria. The time between the onset of back pain and diagnosis of axial SpA was 3.0 (0.3-30 years). Of those patients who fulfilled the criteria for biologic therapy, treatment was initiated within a mean 5.6 months of their initial EIBPS appointment.

Conclusion Establishing an EIBPS with an awareness campaign has resulted in a significant reduction in time to diagnosis to a median of 3yrs, with biologic initiation within 5.6 months of their initial EIBPS appointment in appropriate patients. The long term advantage of early patient diagnosis and access to biologic therapy on reducing structural damage, and positive benefits in terms of functional, emotional and socioeconomic factors is well known². We advocate the replication of our specialist EIBPS service within the UK.

References [1] National Ankylosing Spondylitis Society. Looking Ahead: Best practice for the care of people with ankylosing spondylitis. 2010. Available at: http://www.nass.co.uk/campaigning/looking-ahead/. Last accessed: 23 May 2014.

[2] Weiß A, et al. Good correlation between changes in objective and subjective signs of inflammation in patients with short- but not long duration of axial spondyloarthritis treated with tumor necrosis factor-blockers. Arthritis Res Ther. 2014;16:R35.

Disclosure of Interests Rebecca Adshead: None declared, Hasan Tahir: None declared, Philippa Knight Speakers bureau: Educational speaker fees form Novartis, Simon Donnelly: None declared

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