Abstract

<h3>Introduction</h3> The overall prevalence of extra-intestinal manifestations (EIMs) of inflammatory bowel disease (IBD) has been estimated at 30-50% (Jansen, 2020) with the joints, eyes and skin being most notably affected. Many biological medications used to treat IBD are also used to manage these EIMs. However, this is usually under separate specialist care. Joint care with combined input from Gastroenterologists and other specialists may reduce clinic time utilisation and improve patient care. A combined Gastroenterology-Rheumatology-Dermatology clinic has recently been set up in the West of Scotland. We aimed to determine the proportion of patients with IBD taking biological medication who had an associated EIM who may benefit from this approach. <h3>Methods</h3> A point-in-time audit of all IBD patients in NHS Greater Glasgow and Clyde (South sector). Relevant demographic, disease and medication parameters were extracted from patient’s electronic health records in order to determine the prevalence of EIMs in the population. <h3>Results</h3> The cohort consisted of 1030 patients with a mean age 43 years. of these, 64% had Crohn’s disease, 32% had Ulcerative colitis and 4% IBD-U or other colitis (microscopic colitis, immunotherapy related colitis). The use of biological medications were as follows: infliximab (29.0%), adalimumab (44.3%), golimumab (0.3%), vedolizumab (16.7%), ustekinumab (7.8%), and tofacitinib (1.9%). The overall prevalence of rheumatological or dermatological EIMs were 19.2% (n=197) with prevalence by individual disease as follows: inflammatory arthritis (6.8%), psoriasis (4.8%), eczema (4.1%), spondyloarthropathy (2.5%) and hidradenitis suppurativa (1%). Based on an estimated saving of 1.2 outpatient appointments demonstrated from previous work<sup>1</sup>, we estimate that a combined clinic could save up to 250 outpatient clinic attendances in this group with a total cost saving of over £33,000. <h3>Conclusions</h3> EIMs of IBD affecting the skin and joints were common in patients with IBD taking biological medication in this cohort. As our results are based on recorded diagnoses, actual prevalence may be higher than stated. A combined clinic with gastroenterology, rheumatology and dermatology input may benefit patients with EIMs by ensuring coordinated decision-making to optimise management of all inflammatory conditions while also delivering significant cost savings. <h3>Reference</h3> I Macdonald, M Parbrook, G Becher, A Makrygeorgou. Assessing the impact of a psoriasis: clinic combining dermatology, rheumatology and gastroenterology: a quality improvement project 2021. (Project done with collaboration between University of Glasgow and NHS Greater Glasgow and Clyde)

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