ARE PSORIATIC ARTHRITIS OUTCOMES BETTER IN EARLY ARTHRITIS SERVICE? STUDY FROM A NATIONAL AWARD WINNING CENTRE
Luton and Dunstable University Hospital, Rheumatology, Luton, United Kingdom
Background: There is good evidence that dedicated early arthritis clinics (EACs) improve referral lag time and reduce delay in establishing disease-modifying therapy. However it remains arguable whether such clinics improve outcomes especially for arthritides other than RA. In the UK, only 57% of units have dedicated EACs. Our early arthritis service won national best practice commendation award for achieving high standards.
Objectives: We analysed our psoriatic arthritis (PsA) population data to ascertain whether this cohort benefits from EACs.
Methods: The department set up an early arthritis service with introduction of six clinics (EACs) every week. An agreed treatment protocol incorporating ultrasound was developed to ensure standardised approach to early initiation of treatment, drug education and timely review. This is a retrospective study of all patients with PsA presenting to the service in the first year
Results: Our catchment area covers a population of 350,000 with 40% ethnic minorities. Of 1884 patients referred, 482 (25.5%) were triaged into EACs based on set criteria. All were reviewed within 3 weeks. 247 (51%) were confirmed to have early inflammatory arthritis (EIA). Mean age was 52.4 years (17-86y). 157 (63.5%) were women. 177 (71.6%) were White, 58 (23.5%) of Asian and twelve of other background. 159 (64.3%) had RA, 55 (22%) with PsA and 33 had other inflammatory arthritides. There was median 26 weeks delay (0.4-1043 weeks) from symptom onset to GP presentation. Median time for GP referral to the department was 4.0 days (0-84 days).
All PsA patients had regular PsARC assessment. Mean tender (TJ) and swollen joint (SJ) counts at first visit were 8.2 (1-35) and 3.5 (0-14) respectively [n=55]. The patient (PtGA) and physician (PhGA) global assessments mean were 3.0 and 2.9 (1-5).
95% commenced their DMARDs within 3 week of initial review. Other 5% who missed the target was owing to patient factors. Target [TJ & SJ ≤2] was achieved for 38 patients (69%) and good PsARC response for a further four (7%). Median time to achieve the target or good response was 22 weeks (0-48 weeks). Of 55, only four (7%) patients required escalation to biologic therapy. Final TJ and SJ mean was significantly better at 1.2 (0-4) and 0.3 (0-2) [p <.0001] with similar improvement in PtGA [mean 1.8 (1-4)] and PhGA [mean 1.6 (1-3)]. Only six (11%) patients were true non-responders as the remaining seven declined therapy.
Conclusion: Dedicated EACs help achieve good clinical outcomes in majority of PsA patients. Nearly 76% of our cohort attained the target or good PsARC response in less than six months. This was despite a significant delay in patients presenting to their GPs and moderately-high disease activity. 100% of our patients were treated to target facilitated by protocol driven escalation of therapy in these clinics. This is in contrast to the national audit findings whereby only 68% of patients were treated with disease modifying drugs within 6 weeks of referral and 89% had treatment to target.
This study shows that the establishment of dedicated EACs improve the prognosis of psoriatic arthritis in terms of primary clinical outcomes compared to patients managed outside of EACs.
Disclosure of Interests: Muhammad Khurram Nisar Grant/research support from: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Novartis, Celgene, Mallinckrodt, UCB and Lilly, Consultant for: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Novartis, Celgene, Mallinckrodt, UCB and Lilly, Speakers bureau: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Novartis, Celgene, Mallinckrodt, UCB and Lilly
Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A617
Session: Public health, health services research, and health economics