Pos1426 Outcomes From a Real-World Dedicated Fast-Track Polymyalgia Rheumatica Clinic

Background: The 2023 EULAR/ACR recommendations for the management of polymyalgia rheumatica (PMR) and an international expert consensus have highlighted the need for early assessment in specialist clinics for many patients with PMR 1,2. Despite this, referral to secondary care has typically been reserved for cases with an incomplete response or treatment-related adverse events with few centres offering an early referral pathway. Objectives: Our objectives were to establish a rapid access PMR clinic to enable early diagnosis and treatment, prevent treatment with long-term corticosteroids in patients with alternative diagnoses, and screen patients with new PMR for underlying large vessel vasculitis. Methods: Primary care physicians were invited to refer patients with suspected PMR to our rapid-access clinic. Referral criteria included new onset shoulder or pelvic girdle pain and/or stiffness with elevated inflammatory markers. All patients referred were seen within 48 hours of referral and had a full clinical and laboratory evaluation. Patients who met a clinical diagnosis for PMR had an ultrasound (US) of temporal and axillary arteries. US of all 6 branches of the superficial temporal arteries and both axillary arteries was performed using a GE P9 system and vasculitis was diagnosed as per EULAR recommendations 3. A randomly selected subset of patients with a clinical diagnosis of PMR had an ultrasound of both shoulder joints. Results: Between July 2022 and August 2023, a total of 157 patients were referred with new suspected PMR. 78 (49.7%) patients met a clinical diagnosis of new PMR with agreement between two rheumatologists and were treated with a starting dose of corticosteroid between 12.5-25mg. 14/78 patients (18%) had ultrasound features of subclinical giant cell arteritis. 27/78 (34.6%) PMR patients suffered a relapse during the first year of treatment, including 7/14 (50%) of the patients with US-identified subclinical GCA in PMR. 21 patients (13%) were already on corticosteroid treatment >10mg from primary care for suspected PMR with a good response to initial treatment and without active features of PMR and normal vascular US. These patients were discharged to primary care with a management plan. A subset of 24/78 (31%) patients had bilateral shoulder joint ultrasound completed with 58% of these having bilateral subacromial subdeltoid (SASD) bursitis, 33% having unilateral SASD bursitis, and bilateral biceps tendon pathology in 21%. 58 patients (37%) had an alternative diagnosis to PMR including 6 patients with carcinoma and 16 with other autoimmune/inflammatory disease osteoarthritis (26), malignancy (6), fibromyalgia (5), rotator cuff disease (3), ANCA-associated vasculitis (3), myositis (3), seronegative arthritis (3), crystal arthropathy (3), rheumatoid arthritis (2), Parkinson's disease (1), polyarteritis nodosa (1), unilateral humeral fracture (1), and sarcoid (1). 33/58 (57%) of these patients required at least one further consultation. Conclusion: This study suggests that a rapid access clinic for PMR should be provided by all rheumatology units to improve clinical outcomes. 99/157 patients were confirmed to have PMR with 21 discharged to primary care with a management plan but 14/78 patients (18%) had ultrasound features of subclinical GCA requiring closer follow up with a higher relapse rate (50% v 27%) and higher use of steroid sparing therapy. 37% of patients referred had an alternative diagnosis to PMR and avoided delayed diagnosis and inappropriate potentially harmful therapy with corticosteroid. Of particular concern was the diagnosis of malignancy in 6 (3.8%) patients and significant autoimmune/inflammatory disease in 16 (10%) patients. REFERENCES: 1 Dejaco, C., et al., Recommendations for the management of PMR. Ann Rheum Dis, 2015. 74(10): p. 1799-1807. 2 Keller, K.K., et al., Recommendations for early referral of individuals with suspected PMR. Ann Rheum Dis, 2023. 3 Dejaco, C., et al., EULAR recommendations for the use of imaging in LVV in clinical practice. Ann Rheum Dis, 2018. 77(5): p. 636-643. Acknowledgements: Meath Foundation, Tallaght Hospital. Disclosure of Interests: Sharon Cowley Janssen, Novartis, Patricia Harkins Janssen, Colm Kirby: None declared, Richard Conway Janssen, Abbvie, Fresenius Kabi, Galapagos, UCB, Viatris, Janssen, Abbvie, Celltrion, Nordic Pharma, Novartis, David Kane Janssen, Novartis.