E019 Management of idiopathic inflammatory myositis - a Northamptonshire audit of British Society for Rheumatology guidelines

Abstract

Abstract Background/Aims The idiopathic inflammatory myopathies (IIM) are a rare group of multi-system autoimmune conditions characterised by muscle inflammation. They have an incidence of up to 19 per 1,000,000 person years in adults and a UK prevalence of 10,000 people. Last census data estimated the Northamptonshire population at approximately 785,200. The small cohort of patients reflects the limited evidence base for best practice. In March 2022, the first UK evidence guideline on IIM was published from the British Society for Rheumatology (BSR). In view of absence of prior guidance, there is expected variability in patient management within and between centres. To evaluate local practice against these standards an audit was conducted in Northampton General Hospital (NGH). Methods Using local MYOACT registry data and consultant caseload knowledge, a cohort of adult patients with IIM diagnoses consulted within the last 5 years were identified. Retrospective clinical letters were analysed for details of patient care and compared to the 26 recommendations as set out by the myositis guideline. Results A total of 12 patients were sampled as having attended the rheumatology department within the last five years at NGH. All 26 standards will be presented, but for the purposes of this abstract, key results for discussion include: • 100% of corticosteroids were tapered as the patient responded to treatment. • In presence of muscle inflammation 91% were treated with DMARDs. • In presence of active skin disease, 100% received treatment with csDMARD, IVIG or rituximab. • 100% of patients were screened for interstitial lung disease. • In presence of active muscle disease, 56% of patients received an exercise program led and monitored by therapists. • In 45% of patients’ psychological well-being and health was formally considered. Conclusion Initial service evaluation against BSR IIM recommendations reflects typical strengths and weaknesses encountered in delivering rheumatology services. There was strong concordance in diagnostic and pharmacological domains. However greater variability was encountered when considering multidisciplinary psychosocial domains involving access to therapy services and psychological support. Tools such as the 36 Item Short Form Survey, highlighted in BSR recommendations, may offer a validated method for physicians to formally consider and target psychosocial domains in management of idiopathic inflammatory myopathies. Disclosure N. Chauhan: None. S. Abushama: None. R. Jeffery: None.