POS1426 OUTCOMES FROM A REAL-WORLD DEDICATED FAST-TRACK POLYMYALGIA RHEUMATICA CLINIC
Authors: S. Cowley, P. Harkins, C. Kirby, R. Conway, D. Kane
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The 2023 EULAR/ACR recommendations for the management of polymyalgia rheumatica (PMR) and an international expert consensus have highlighted the need for early assessment in specialist clinics for many patients with PMR [1,2]. Despite this, referral to secondary care has typically been reserved for cases with an incomplete response or treatment-related adverse events with few centres offering an early referral pathway. <h3>Objectives:</h3> Our objectives were to establish a rapid access PMR clinic to enable early diagnosis and treatment, prevent treatment with long-term corticosteroids in patients with alternative diagnoses, and screen patients with new PMR for underlying large vessel vasculitis. <h3>Methods:</h3> Primary care physicians were invited to refer patients with suspected PMR to our rapid-access clinic. Referral criteria included new onset shoulder or pelvic girdle pain and/or stiffness with elevated inflammatory markers. All patients referred were seen within 48 hours of referral and had a full clinical and laboratory evaluation. Patients who met a clinical diagnosis for PMR had an ultrasound (US) of temporal and axillary arteries. US of all 6 branches of the superficial temporal arteries and both axillary arteries was performed using a GE P9 system and vasculitis was diagnosed as per EULAR recommendations [3]. A randomly selected subset of patients with a clinical diagnosis of PMR had an ultrasound of both shoulder joints. <h3>Results:</h3> Between July 2022 and August 2023, a total of 157 patients were referred with new suspected PMR. 78 (49.7%) patients met a clinical diagnosis of new PMR with agreement between two rheumatologists and were treated with a starting dose of corticosteroid between 12.5-25mg. 14/78 patients (18%) had ultrasound features of subclinical giant cell arteritis. 27/78 (34.6%) PMR patients suffered a relapse during the first year of treatment, including 7/14 (50%) of the patients with US-identified subclinical GCA in PMR. 21 patients (13%) were already on corticosteroid treatment &gt;10mg from primary care for suspected PMR with a good response to initial treatment and without active features of PMR and normal vascular US. These patients were discharged to primary care with a management plan. A subset of 24/78 (31%) patients had bilateral shoulder joint ultrasound completed with 58% of these having bilateral subacromial subdeltoid (SASD) bursitis, 33% having unilateral SASD bursitis, and bilateral biceps tendon pathology in 21%. 58 patients (37%) had an alternative diagnosis to PMR including 6 patients with carcinoma and 16 with other autoimmune/inflammatory disease [osteoarthritis (26), malignancy (6), fibromyalgia (5), rotator cuff disease (3), ANCA-associated vasculitis (3), myositis (3), seronegative arthritis (3), crystal arthropathy (3), rheumatoid arthritis (2), Parkinson's disease (1), polyarteritis nodosa (1), unilateral humeral fracture (1), and sarcoid (1)]. 33/58 (57%) of these patients required at least one further consultation. <h3>Conclusion:</h3> This study suggests that a rapid access clinic for PMR should be provided by all rheumatology units to improve clinical outcomes. 99/157 patients were confirmed to have PMR with 21 discharged to primary care with a management plan but 14/78 patients (18%) had ultrasound features of subclinical GCA requiring closer follow up with a higher relapse rate (50% v 27%) and higher use of steroid sparing therapy. 37% of patients referred had an alternative diagnosis to PMR and avoided delayed diagnosis and inappropriate potentially harmful therapy with corticosteroid. Of particular concern was the diagnosis of malignancy in 6 (3.8%) patients and significant autoimmune/inflammatory disease in 16 (10%) patients. <h3>REFERENCES:</h3> [1] Dejaco, C., et al., <i>Recommendations for the management of PMR.</i> Ann Rheum Dis, 2015. <b>74</b>(10): p. 1799-1807. [2] Keller, K.K., et al., <i>Recommendations for early referral of individuals with suspected PMR.</i> Ann Rheum Dis, 2023. [3] Dejaco, C., et al., <i>EULAR recommendations for the use of imaging in LVV in clinical practice.</i> Ann Rheum Dis, 2018. <b>77</b>(5): p. 636-643. <h3>Acknowledgements:</h3> Meath Foundation, Tallaght Hospital. <h3>Disclosure of Interests:</h3> Sharon Cowley Janssen, Novartis, Patricia Harkins Janssen, Colm Kirby: None declared, Richard Conway Janssen, Abbvie, Fresenius Kabi, Galapagos, UCB, Viatris, Janssen, Abbvie, Celltrion, Nordic Pharma, Novartis, David Kane Janssen, Novartis.