AB0817 CAN RHEUMATIC CONDITIONS ASSOCIATED INTERSTITIAL LUNG DISEASES BE MANAGED IN A DISTRICT GENERAL HOSPITAL – RESULTS FROM A LONGITUDINAL OUTCOMES SURVEY
Authors: A. Francioni, J. Gnanapragasam, N. Ramsundar, V. Joshi, M. K. Nisar
Journal: Annals of the Rheumatic Diseases (2021)

Background: Interstitial lung disease is a well described extra-articular manifestation in a range of rheumatic diseases. It carries significant morbidity and mortality. Management of rheumatic diseases associated ILD (r-ILD) requires expertise as the needs of such patients are complex and treatment options limited. Historically, such complex ILD has been managed in tertiary referral centres. We set up a combined service incorporating both rheumatology and respiratory domains in a district general hospital (DGH) to help patients avoid long journeys and improve their experience whilst focusing on an integrated care pathway. Objectives: We evaluated the outcomes of all patients managed over three years in this pilot service model. Methods: Referrals were accepted from any hospital specialist involved in the management r-ILD. They were triaged by lead ILD pulmonologist to monthly ILD MDT comprising a rheumatologist, respiratory physician, a radiologist and ILD specialist nurse. Appropriate patients were booked into combined clinic, run by the respective rheumatology and chest specialists with ILD interest, attracting a multi-speciality tariff. All the data was recorded electronically with full access to demographics, disease parameters, investigations and drug management. Results: 111 consecutive patients were included in this evaluation. Mean age was 66.4 yrs (19-92 yrs) and 36% (n=40) were male. 34 (30%) had RA, 31 (28%) had CTD, 20 (18%) had IPAF and 26 others. Most predominant HRCT pattern was NSIP (n=40,36%) followed by UIP (n=31, 28%). Mean FVC was 2.59 L/min (1.93-4.13) with DLCOc of 52.7% (28.9-90.1%) predicted. Only two patients had all antibodies negative whilst 109 had at least one antibody positive with ANA being the most common (n=38). Most (83%) patients were treated with immunomodulators including 11 with rituximab. 49 (44.1%) patients had significant improvement in clinical, imaging and pulmonary parameters with DLCOc improving to 56.57% and FVC to 2.70 L/min. There were similar improvements in six minute walk test. 21 patients died and 23 patients required long term oxygen therapy. Conclusion: This pilot real world study confirms the utility of a combined specialist service in a district general hospital. Nearly half of this complex and resource intensive patient cohort had good clinical outcomes and derived benefit from the expertise in one room. Feedback from both patients and referrers was unanimously positive. No patient required tertiary centre referral and all could be managed adequately in the clinical setting. Our report confirms that r-ILD can be managed in a DGH setting with a stream-lined service offering clear benefits to patients. We would argue that r-ILD service, congruent to satellite pulmonary hypertension clinics in secondary care with hub-and-spoke model liaison with tertiary centre, can be established on similar principles and could help over-stretched tertiary care with repatriation of services whilst helping develop local expertise in the management of chronic ILD. Disclosure of Interests: None declared