P088 Multidisciplinary working in the management of axial and peripheral spondyloarthritis
Authors: Gudu Tania , Jadon Deepak R 
Published: April 2021

Background/Aims 

Multidisciplinary (MD) care is essential in the management of patients with spondyloarthritis (SpA), but evidence supporting its effectiveness and benefits in SpA is scarce.The objectives of this review were to describe the characteristics, effectiveness and feasibility of MD working compared to uni-disciplinary approach in studies of patients with SpA.

Methods 

A literature review was conducted according to the PICO framework. We included studies on patients with axial and/or peripheral SpA, and we assessed several outcomes such as diagnosis, treatment, feasibility, disease and patient-related outcomes (Table 1).

Results 

Fifteen articles met the review’s eligibility criteria, including 13 observational studies and two randomised controlled trials. In total 4,312 patients were analysed, including patients with psoriatic arthritis, enteropathic SpA, ankylosing spondylitis, and SpA with anterior uveitis. Most of the studies included a combined clinic encompassing a rheumatologist and another specialist, most commonly a dermatologist or a gastroenterologist, working in tandem according to predefined referral criteria and treatment algorithms. The main outcomes assessed in studies on MD working in SpA, matched with their outcome measures are depicted in Table 1. MD working was reported to lead to better outcomes in all studies, including: better identification and diagnosis of the disease; earlier and more comprehensive treatment approach; and better outcomes for patients in terms of disease activity, physical function, quality of life and patient satisfaction. However, these results are mostly derived from studies with design issues and without a uni-disciplinary care comparator arm.

Conclusion 

Despite the lack of strong and reliable evidence to support its benefits compared to standard care, MD working is an essential part of the care of patients with SpA. Further studies and initiatives should be developed so that the challenges and limits of MD care can be improved upon. P088 Table 1:Outcomes and outcome measures evaluated in studies of multidisciplinary working in spondyloarthritisOutcomesOutcome measuresDiagnosisEarly diagnosisAssessment of SpondyloArthritis Society (ASAS) criteria; New York criteria The Classification Criteria for Psoriatic Arthritis (CASPAR); Moll and Wright criteria Rheumatologist’s / dermatologist’s (clinical) judgment Not defined ("standard diagnostic criteria for inflammatory bowel diseases and rheumatic diseases")Diagnosis delayThe total lag time from joint symptom onset to the first rheumatologic assessment Diagnostic delay: the time interval between the onset of the symptoms and the correct diagnosis being made Physician-related diagnostic delay: the time interval between the initial visit to a physician and the time of diagnosisReclassification of diagnosisNumber of patients, N (%)Disease relatedDisease activityMusculoskeletal: - The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) - The Ankylosing Spondylitis Disease Activity Score- C-reactive protein (ASDAS-CRP) - Disease Activity in PSoriatic Arthritis (DAPSA) Gastroenterology: - Crohn''s disease activity index (CDAI) - the partial Mayo (pMAYO) Psoriasis: - Psoriasis Area Severity Index (PASI)Physical functionBath AS Metrology Index (BASMI) Bath AS Functional Index (BASFI) Bath Ankylosing Spondylitis Patient Global Score (BAS-G) Health Assessment Questionnaire (HAQ)ComorbiditiesPrevalence of diabetes, hypertension, hyperlipidaemia, and current/past smoking statusComplications during FU/ adverse eventsPrevalence of infection and adverse medication effects (i.e., elevated liver function test, headache).TreatmentTherapeutic adjustmentNumber of patients, N (%) having had their treatment changedPatient reported outcomesQuality of lifeInflammatory Bowel Disease Questionnaire (IBDQ) Short Form (SF36) Dermatology Life Quality Index (DLQI) Psoriatic Arthritis Impact of Disease (PsAID-12)Global wellness• HAQ • SF36 • Patient Global Assessment (PGA)Patient global assessmentPGAActivity limitations and participation restrictionsThe Canadian Occupational Performance Measure (COPM)Patient satisfactionSatisfaction questionnaire (developed by the multidisciplinary team)Feasibility/ costsHealth service utilisationquestionnaire developed by the Stanford University School of Medicine with four indicators (outpatient visits, emergency visits, hospitalizations, and hospitalization days)

Disclosure 

T. Gudu: None. D.R. Jadon: None.