E090 Secondary care collaborative service to reduce time to diagnosis in axial spondyloarthropathy: retrospective study from Leicester combined rheumatology-uveitis service
Authors: Jubber Ameen , Ganguly Sujata , Sabu Jessy , Betteridge Carol , Kumar Periyasamy , Moorthy Arumugam 
Published: April 2023

Abstract

Background/Aims
The time from symptom onset to diagnosis of axial spondyloarthropathy (SpA) in the UK is 8.5 years. Previous studies show that half of patients with anterior uveitis are HLA-B27 positive and half of those have SpA. At University Hospitals of Leicester, there is a combined rheumatology-ophthalmology clinic to help reduce this diagnostic delay and help foster a collaborative approach.
Our aims are to evaluate the cohort of HLA-B27 positive patients presenting with uveitis to University Hospitals of Leicester (UHL), a busy tertiary centre serving a multi-ethnic region. Secondly, to assess what proportion of these patients are diagnosed with SpA.

Methods
All patients presenting to University Hospitals of Leicester with uveitis between 2011 and 2021 were identified on a database kept by the ophthalmology department. Patient details were examined retrospectively using clinic letters and the electronic reporting system for HLA-B27 status, age, ethnicity, pattern of uveitis, use of systemic therapy, associated rheumatic disease, and whether subsequent imaging was performed to establish a diagnosis of SpA.

Results
Of 2159 patients presenting with uveitis, 482 were tested for HLA-B27 (213 were positive and 269 negative). Of the 213 HLA-B27 positive patients, mean age was 45.5 years (SD 15.6 years). There were 106 males and 107 females. Right eye, left eye and bilateral uveitis was diagnosed in 73, 66, and 74 patients, respectively. Uveitis was classified as acute, recurrent, chronic, and not stated in 88, 77, 46, and two patients, respectively. Among the HLA-B27 positive patients, systemic treatment was used for the uveitis in 51 patients. This includes oral steroids in 32 patients, and methotrexate, mycophenolate mofetil, azathioprine, adalimumab, sulfasalazine, and hydroxychloroquine used in seven, four, four, two, one, and one patient, respectively. Of the 213 patients positive for HLA-B27, 66 had pre-existing diagnoses. The most common was axial SpA in 48 patients. The remaining included four patients with IBD, four with JIA, four with RA, two with psoriatic arthritis, two with psoriasis, one with reactive arthritis, and one with sarcoidosis. Of the remaining 147 patients without an established rheumatic disease, 43 were referred to rheumatology (six of these to the combined clinic). Of these 43 patients, 32 underwent MRI with inflammatory back pain protocol, and 12 of these showed features consistent with axial SpA. Two patients were diagnosed with peripheral SpA. In the remaining patients, four are awaiting a rheumatology appointment, and five did not attend. In the patients referred to rheumatology, there were 39 Caucasians, two Asians, one mixed-race and one Afro-Caribbean patient.

Conclusion
We demonstrated a significant improvement in time to diagnosis with this service. It also demonstrated improvement of patient care and quality of life.
Disclosure
A. Jubber: None. S. Ganguly: None. J. Sabu: None. C. Betteridge: None. P. Kumar: None. A. Moorthy: None.