Ab1605-HPR Causal Effect of Persistent Disease Activity in a Cohort of Rheumatoid Arthritis Patients With Frequent Follow-Up Appointments in Rheumatology Outpatient Clinics

Background: Rheumatology services are dealing with an increasingly high number of follow-up appointments, ranked third for the highest after Oncology and Haematology. Objectives: To identify the relation between Rheumatoid Arthritis (RA) patients true diseases activity with frequent follow-up appointments aiming for optimising the management and reducing follow up outpatient visits by 30% as per NHS England guidelines [1]. Methods: A retrospective cohort study reviewed the notes of 360 RA follow –up patients attending Rheumatology Outpatient Clinics at Basildon University Hospital. Fifty (13.8%) patient fulfilled the criteria for frequent long-term follow-up of having their first appointment before more than 2 years and had 3 or more visits in the preceding year. The key demographics, disease activity, duration and reason for frequent attendance were analysed. Results: Overall, 68% of the patients were females and 66 % were between 50-80 years of age; 12% older and 22% younger than this range. Most of the patients were on disease modifying anti-rheumatic drugs (DMARDs), taking methotrexate in 50.8% and biologic DMARDs in 20%. None were on long term steroid. Osteoarthritis, Fibromyalgia and Osteoporosis co-existed in 44%, 8% and 14% respectively. Other comorbidities were cardiac, pulmonary and renal diseases. Assessment of disease activity based on EULAR response criteria, revealed 17.4% patients with high, 34.8% with moderate and 15.2% with low disease activity scores whereas 32.6% were in remission. The disease duration (range- 3 to 10 years) had no correlation to the frequency of appointments. The selected 50 patients had a total of 186 appointments during the preceding year; 58% had 3 appointments, 24% had 4, 8% had 5, 8% had 6 and 2% had 7. The reasons for arranging these appointments were flare up in 54% of cases, routine follow up in 30% and 16% were to review the medications in relation to a new or worsening comorbidity. Almost all patients raised possibility of disease flare in at least one of their appointments, but genuine flare up was confirmed only in 74% of the cases whereas the remaining 26% were reviewed for perceived disease flare but diagnosed with other comorbidities. Conclusion: True or perceived flare of rheumatoid arthritis was the commonest reason behind increasing appointments. Educating patients on how to correctly identify their disease flare and a pre-appointment triage system by trained staff may reduce the number of follow-up appointments by nearly 26%. Treatment remains challenging for a group of patients who remain active despite optimal treatment and EULAR has described this group as difficult to treat rheumatoid arthritis patients (D2T). REFERENCES: [1] David Oliver: NHS England targets for new and follow-up outpatient appointments are ill conceived. BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1689. Acknowledgements: NIL. Disclosure of Interests: None declared.