AB0564 A review of ankylosing spondylitis complications and associations.
Authors: T. Doherty, J. Pilcher, N. Njegovan, V. Sandhu
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Ankylosing spondylitis (AS) is a chronic inflammatory condition of the spine with variable frequency &amp; severity of extra-articular manifestations &amp; co-morbidities. Delayed diagnosis or failure to identify/manage its associations have major health/social consequences in these patients. <h3>Objectives</h3> To determine the prevalence of AS complications and associations in our cohort. <h3>Methods</h3> We set up annual review AS clinics to screen for extra-articular disease +/- co-morbidities. We checked for uveitis, psoriasis &amp; inflammatory bowel disease. Current treatments and treatment failures were noted. Smoking &amp; alcohol histories were taken. Employment +/- incapacity benefit histories were also checked. Each had cardio-respiratory examinations &amp; spinal mobility measurements. Hospital Anxiety &amp; Depression Scales(HADS-A and HADS-D respectively) &amp; Medical Outcomes Sleep Study (MOSS) questionnaires assessed mood and sleep quality respectively. Blood pressure measurements &amp; Body Mass Index (BMI) calculations were done. Echocardiograms, pulmonary function tests (PFTs) &amp; DEXAs were performed. <h3>Results</h3> 59 AS patients (M=41, F=18) attended our annual review clinic. Mean age=45yrs. 51 were HLA-B27 positive. Of 42 patient x-rays available for review 34 had radiographic sacroilitis +/- vertebral AS. Of 42 MRIs, 39 had AS features. 24 took daily NSAIDS, 6 intermittently. 9 took sulphasalazine (6 in the past), 1 methotrexate. 19 patients were currently on biologics &amp; 7 had failed these. 12 had a history of uveitis, 3 had psoriasis, none had evidence of inflammatory bowel disease. Smokers=15, 14=ex-smokers. Alcohol consumption was low in 35, moderate in 8, &gt; 30 IU/week in 8, &amp; 7 were abstinent. 5 received incapacity benefits, 10 were retired due to age, &amp; 43 were in full time employment/studies. 23 had hypertension (&gt;140/90mmhg). 17 had hypercholesterolaemia (fasting&gt;5.1mmol/L). 31 had BMIs ≥ 25, and 18 had a BMI ≥ 30. 8 had osteopenia. 10 had abnormal PFTs (4 obstructive and 6 restrictive defects). 21 had abnormalities reported on echocardiographs. 19 had subclinical enthesopathy detected by ultrasound. 28 had high HAD scores for anxiety and/or depression. 29 had BASDAI ≥4, 21 has BASFI ≥4, 25 BAS-G ≥4 and 24 with spinal pain VAS scores ≥4. As determined by MOSS questionnaires, 33 had a sleep disturbance on (SLPD4). <h3>Conclusions</h3> AS annual review clinics are useful to screen for occult extra-articular disease/co-morbidities. Cardiovascular risks and complications were high with 39% hypertensive, 53% obese, 36% with abnormal echocardiograms and 29% with hypercholesterolaemia. Subclinical enthesopathy (32%), anxiety/depression (28%) andsleep disturbance (56%) were also prevalent. Patients' treatment regimes were rationalised according to their response to current treatments a multiprofessional approach was adopted to manage their complication and associations if present. Patient feedback was extremely positive and mostly they did not feel burdened by the extra screening. <h3>Acknowledgements</h3> St. Georges cardiology department for echocardiograms, radiology for ultrasound and DEXAs and respiratory department for pulmonary function tests. <h3>Disclosure of Interest</h3> None Declared