P120 What's driving this disease activity score? A support framework to aid your decision
Authors: Rhys-Dillion Brian , Kent Alison , Painter Julie 
Published: April 2023

Abstract

Background/Aims
NICE now enables patients with a DAS of &gt; 3.1 to &lt; 5.2 to be treated with advanced drug therapies. To ensure correct and cost-effective use of resources it is essential that we identify a moderate DAS that is driven by inflammatory joint disease as opposed to a differential diagnosis. A reference-based tool entitled “DAS drivers: A nursing decision-making algorithm“ was designed to support nurses in their clinical decision making around appropriate treatment for moderate disease.
Clinical trials suggest that advanced therapy provides similar benefits for people with moderate disease as well as those with severe disease. After a pragmatic review of existing evidence. NICE guidance was introduced in 2021 to include patients with a moderate RA DAS (&gt;3.1 - &lt; 5.2) to be eligible for advanced therapies. This is a positive step to improving access to advanced treatment options for patients and will help stem the burden of disability associated with RA.
The algorithm presented was initially developed to support nurses identify and navigate around management plans for patients with moderate RA disease and would be freely available for all of rheumatology community to use in their daily practice.
It is recognised in the BSR report ‘Specialist Nursing in Rheumatology - The State of Play’ that there is a need for succession planning and an increase in appropriately skilled rheumatology nursing workforce. The authors are experienced, longstanding members of the rheumatology workforce and thus are sharing knowledge and experience with the next generation of nurses to allow for continued quality of patient care as part of the succession planning program that rheumatology services now face. The algorithm aims to address these challenges by supporting the identification of patients with active inflammation in moderate RA therefore ensuring that appropriate patients are given access to valuable limited resources within the NHS.

Methods
Round-table discussions between three advanced rheumatology nurse leaders (the authors) with a cumulative and varied rheumatology experience of 70+ years, lead to the development of an algorithm specifically around identifying active inflammation in moderate RA. The authors drew on relevant publications and clinical experience to develop the algorithm and refine over a 12-month period. The intention of the algorithm is to make it user friendly and support standardised decision making in a clinical setting for all nurses working within rheumatology, irrespective of experience.

Results
The algorithm provides a structured approach and promotes ideas to consider when assessing and treatment patients with rheumatoid arthritis.

Conclusion
To endorse and disseminate the algorithm as an education tool and develop a publication. An audit on the use of the algorithm amongst nurses in clinical practice with a pilot audit with nurses who have attended educational events delivered by the authors.
Disclosure
B. Rhys-Dillion: Honoraria; B.R.D. has received honoraria from Galapagos. A. Kent: Honoraria; A.K. has received honoraria from Galapagos, Roche, Pfizer, Gilead, BMS, Amgen, Chugai-Pharma, Sanofi Aventis and UCB Pharma. J. Painter: Honoraria; J.P. has received honoraria from Galapagos, Pfizer, Novartis and Roche/Chugai-Pharma.