AB0912 The introduction of ankylosing spondylitis annual review clinics at a london teaching hospital
Authors: T. Doherty, J. Lee, V. Sandhu
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> National U.K recommendations<sup>1</sup> have led to the introduction of annual review clinics for patients with rheumatoid arthritis. We considered the benefits of ankylosing spondylitis annual review clinics. <h3>Objectives</h3> Review the diagnosis of ankylosing spondylitis (Modified New York Criteria)<sup>2</sup>,monitor for complications (ophthalmic, valvular heart disease, fibrotic lung disease) &amp; for co-morbidities (including hypertension, ischaemic heart disease, osteoporosis and depression). Assess disease activity, lifestyle &amp; quality of life based on patient completed questionnaires/descriptions &amp; investigation results. If appropriate recommend medications/lifestyle alterations &amp; further investigations. Cross referral to the multidisciplinary team &amp; to psychological/social support networks could be made if required. <h3>Methods</h3> 43 patients were invited to attend a registrar led clinic. Blood tests (lipid profile, glucose, FBC, U/Es, LFTs, vitamin D, PTH, CRP &amp; ESR) were done 1 week before the assessment. Patients completed BASDAI<sup>3</sup>, BASFI<sup>3</sup>, BAS-G<sup>3</sup>, Hospital Anxiety &amp; Depression Score (HADS)<sup>4</sup>, &amp; Medical Outcomes Sleep Study Sleep Scale (MOSS-SS)<sup>5</sup> assessments. Blood pressure (BP), body mass index &amp; spinal mobility (tragus to wall distance, cervical rotation, chest expansion, Shoeber’s distraction test<sup>6</sup>, lateral spinal flexion &amp; intermalleolar distance) were measured. Cardiovascular &amp; respiratory examinations were performed. <h3>Results</h3> 40 (F=12, M=28) patients attended the clinic.33% with fasting cholesterol ≥5.2 mmol/l advised sauturated fat intake reduction &amp; review in 6 months.30% had a BMI ≥25.1 advised low calorie diet adherence &amp; offered dietician input. 25% had BP≥140/90mmHg will be monitored &amp; 2.5% commenced antihypertensives.22% advised on stretches/cardiovascular exercises/NASS hydrotherapy &amp; gym sessions.10% advised to reduce alcohol intake (from≥21units/wk). Smoking cessation advise/support information given to 7.5%. 10% unaware of NASS activities were given information. 25% anxious/depressed (HADS≥11) were offered counseling. 5% who were not coping at home were offered social service referral. DEXA scans were recommended for 67% who had ≥1 risk other factor for osteoporosis. Based on examination findings/family history/symptomatology/disease duration 90% required echocardiography. 87% were referred for pulmonary function tests for symptoms/ausculatory abnormalities. 48% with vitamin D levels ≤40nmol/L were given advice/prescriptions for vitamin D3 supplementation. Anti TNF initiation/increase/reduction was appropriate for 17.5%. <h3>Conclusions</h3> We found annual review clinics for ankylosing spondylitis patients a useful way to optimise &amp; coordinate care in addition to screening for complications and co-morbidities. The concept was welcomed by patients &amp; multidisciplinary team members at our hospital as a worthwhile adjunct to routine clinics. <h3>References</h3> www.nice.org.uk/nicemedia/pdf/CG79guideline Akgul et al. Classification criteria for Spondyloarthropathies. World J Orthop 2011, 2;12:107-1153. Cardee M. Ankylosing Spondylitis Measures. 2003; 49:S197-20094. Snaith P. The Hospital Anxiety and Depression Scale. Health and quality of Life Outcomes 2003, 1:295. Spritzer K et al. MOS Sleep Scale: A Manual for Use and Scoring, Version 1.0. Los Angeles, CA Davis J et al. Spinal Mobility Measures in Spondyloarthritis: Application of The Omeract Filter. J Rheumatol 2007; 34(4):666-670 <h3>Disclosure of Interest</h3> None Declared