Abstract Background/Aims Inflammatory screening is an essential part of clinical practice in musculoskeletal and rheumatology consultations. Questioning highlights suspicion of inflammatory disease and the need for investigation/referral to rheumatology services. Documented evidence of inflammatory screening is a frequent omission in practice within all practice settings. Existing tools are available to prompt and guide clinicians, but do not include all key features and risk factors. There remains a need to provide further guidance to aid the development of knowledge, skills and confidence for inflammatory screening to be embedded into clinical practice as standard. Methods Key features and risk factors for spondyloarthritis (SpA) found in existing publications and NICE guidance ‘Spondyloarthritis in over 16s: diagnosis and management’ (2017) were used to develop a ‘THINK INFLAMMATORY’ mnemonic. Key questions following the flow of questioning within a consultation were entered at each letter. The mnemonic is intended to be used as a prompt to ensure all key inflammatory screening questions have been asked. The NICE recommendations for referral for suspected spondyloarthritis are included to ensure disease suspicion is acted upon. Results The ‘THINK INFLAMMATORY’ mnemonic was developed. The visual of each letter alongside the suspicious feature is clear and easy to follow. Time since symptoms- chronic (3 months), History- insidious and age 45years first onset, Inflammatory Back Pain- including (alternating) buttock pain, Night/sleep- waking in the second half of the night, Known or family history of psoriasis- skin or nails, IBD- Crohn’s, ulcerative colitis (including family history), NSAID responsiveness- good response often within 48 hours, Fatigue or systemic features- fever or flu like, Long Early Morning Stiffness 30 minutes, Aggravating /Easing- improvement with activity and not improved with rest, Multiple or persistent joint pain and/or swelling, current or past, Marked swelling/’sausage’ finger or toes (dactylitis), Acute Anterior Uveitis- Acute, severely painful photosensitive red eye, Tendon pain- Enthesitis (at insertion site). Often multiple sites, Other risk factors- known history of autoimmune disease and/or family history of SpA, Recent infection- e.g. food poisoning, STI 1-4 weeks before symptom onset, Yes? Think Inflammatory, think Spondyloarthritis. Refer to rheumatology for possible axial or peripheral spondyloarthritis if LBP onset 45years and duration over 3 months + 4 or more of the above OR dactylitis or persistent joint pain and swelling or enthesitis with a history of psoriasis, IBD or uveitis, or FH of psoriasis or Inflammatory Arthritis. Note that inflammatory markers in blood tests may be normal. Conclusion The mnemonic as a poster is available to all clinicians involved in musculoskeletal and rheumatology practice settings. It is a support tool to increase knowledge, skills and confidence in inflammatory screening and recognition of when rheumatology referral is required. The aim is to drive improvements in practice and reduce delay to diagnosis. Disclosure H. Chambers: None. C. McCrum: None.
Chambers et al. (Wed,) studied this question.