E070 How well is the mental health of rheumatoid arthritis patients assessed in the routine rheumatology clinic?

Abstract

Abstract Background/Aims All patients with rheumatoid arthritis (RA) should have an annual review appointment (NG100). This should involve monitoring for the development of co-morbidities including depression and offer psychological interventions where appropriate. The current literature suggests that the prevalence of depression in RA patients is as high as 38.8% and is associated with poorer disease outcomes. We undertook a retrospective record review of our RA cohort to assess adherence to the NICE RA guidance, including mental health monitoring specifically. Methods 340 patients were selected using convenience sampling from the total population of 3400. The letters 12 months prior to an identified appointment in January 2019 were reviewed looking at: age, gender, DAS28 score, other long-term conditions, whether mental health was discussed that year, and who initiated the conversation. Data was collected, reviewed, and analysed by HC, JE and AA. Results The mean age was 65.9 (SD = 12.3), the female to male ratio was 2.3:1 (70% female), the median DAS28 score was 2.94 (IQR=2.01), and the median VAS score was 40.0 (IQR=63.5). 73.2% (n = 249/340) had at least one other documented co-morbidity, 12.1% (n = 41/340) had a documented chronic pain syndrome, 3.5% (n = 12/340) had a documented mental health diagnosis. 7.9% (n = 27/340) of patients discussed mental health at their appointment; this increased to 58.3% (n = 7/12) of the patients with a known mental health diagnosis. Mental health discussions were initiated by the clinician 18.5% (n = 5/27) of the time, and by the patient 81.5% (n = 22/27) of the time. Of the 5 patients who were asked directly about their mental health: 100% (n = 5/5) were female, the mean age was 63.8, the median DAS28 and VAS scores were lower than the overall cohort at 2.56 (IQR=0.93) and 28.5 (IQR=15.3) respectively. Of the 22 patients who initiated a discussion about their mental health: 72.7% (n = 16/22) were female, the mean age was 62.3, the median DAS28 and VAS scores were higher than the overall cohort at 3.55 (IQR=2.45) and 60.0 (IQR=51.3) respectively. Of the 27 patients who had a mental health discussion: 76.0% (n = 19/27) had another documented co-morbidity, 22.2% (n = 6/27) had a documented chronic pain syndrome, and 25.9% (n = 7/27) had a mental health diagnosis. Conclusion Mental health problems may be under-recognised amongst our patients; this may reflect lack of documentation or limited routine screening. The majority of conversations about mental health appear to be initiated by patients. Patients with lower disease activity appear to be more likely to have mental health discussions. The study is limited by small numbers, and further research in this area would be beneficial. Disclosure H. Cooney: None. J. Ellis: None. B. Mulhearn: None. A. Allard: None.