P177 Management of patients with axSpA: an audit against the NICE diagnosis and management of adults with spondyloarthritis quality standard, QS170, and clinical practice guidelines

Abstract

Abstract Background/Aims The Royal National Hospital for Rheumatic Diseases in Bath is a tertiary centre for axial spondyloarthritis (axSpA). Our objective was to perform an audit to establish compliance with NICE QS170: patients with no radiographic evidence of axSpA receive an MRI scan; patients with axSpA undergo a structured exercise programme from a specialist physiotherapist; and patients receive information about their axSpA and its management. The aim was to identify opportunities for improvements in the care given to people using our service. Methods A retrospective case note review was performed for 300 patients with axSpA who commenced biologic disease-modifying anti-rheumatic drug (bDMARD) therapy between 2011 and 2018, selected at random from 539 patients in our database using systematic random sampling. Using NICE QS170 and clinical practice guidelines for reference, the audit explored the frequency and nature of imaging examination (X-ray or MRI) as part of the diagnostic work up; dissemination of patient information and education regarding their condition; nature and sequence of administered treatments; monitoring for adverse events; and response to treatment. Results 269 patients met the inclusion criteria for the audit. The majority (n = 177; 65.8%) were male, white (n = 242; 90.0%) and had a diagnosis of ankylosing spondylitis (n = 222; 82.5%). Non-radiographic axSpA was diagnosed in 42 (15.6%) patients, reactive arthritis in 4 (1.5%) and psoriatic spondyloarthritis in 1 patient (0.4%). Thirty-one patients did not have a date recorded for symptom onset and for the remaining 238 patients, median (min, max) time from symptom onset to diagnosis was 6.26 (0, 50) years. Baseline median (min, max) BASDAI score was 6.7 (0, 9.7). Of 225 patients with suspected axSpA who had imaging data recorded, 19 had X-rays showing no sacroiliitis and of these, 18 (94.7%) underwent MRI using an inflammatory back pain protocol. Of 267 patients with data regarding education on axSpA, most (n = 228; 85.4%) received education via a leaflet, the National Axial Spondyloarthritis Society website or attendance of a 2-week rehabilitation programme. Regarding exercise education, most (217/259; 83.8%) had evidence of referral to a structured exercise programme. Of 248 patients with data on medical management, 246 (99.2%) received first-line non-steroidal anti-inflammatory drugs (NSAIDs), as recommended in guidelines. Renal function was monitored 6-monthly in 80.3% of patients on NSAIDs. Twelve-week assessment of bDMARD treatment response (BASDAI scoring) occurred for 85.0% of patients (198/233), 74 patients stopped treatment before this timepoint and 3 patients had no BASDAI scores available. Conclusion Performing this audit ensured that we benchmarked our service against NICE QS170 and clinical practice guidelines, to identify deficient care aspects and enable action plans to be developed to improve patient care. Disclosure R. Sengupta: Honoraria; RS has received honoraria/expenses/research grants from AbbVie, Biogen, Celgene, Lilly, MSD, Novartis, Pfizer, UCB. M. Savino: Grants/research support; MS received expenses for data collection within this study from Novartis. E. Reilly: Grants/research support; ER has received research grants from Actelion and Celgene Corporation outside of this work. ER has also received expenses from Novartis, Celgene, UCB, Pfizer. C. Cavill: Grants/research support; CC has received research grants from Abbott, Celgene, Lilly, Novartis, Janssen and Pfizer.