Analysis of the early inflammatory back pain clinic at the royal national hospital for rheumatic diseases

Abstract Background/Aims The Royal National Hospital for Rheumatic Diseases (RNHRD) has a long-standing history of excellence in the care and management of axial spondyloarthritis (axSpA). Research has shown that early diagnosis of axSpA is associated with health-related benefits. However, because diagnosis earlier in the disease trajectory can be clinically challenging, there is often a significant delay. New referrals of possible axSpA are reviewed in the early inflammatory back pain clinic, and this audit of the demographics and diagnoses of clinic attendees aims to follows-up the patients post clinical evaluation to assess the frequency of missed diagnoses. Methods Electronic medical records of 100 consecutive new referrals attending for back pain between 03/09/2015 and 27/07/2016 were retrospectively reviewed. The information abstracted included sex, age, smoking status, investigations, and diagnosis. Clinic letters and follow-up records at the Royal United Hospitals until July 2022 were reviewed. Results The average age of the patients was 37.4 years; 42% were male and 58% female. The diagnostic breakdown of the 100 patients is presented in Table 1. Of the 21 patients diagnosed with axSpA, 14 (66%) were human leukocyte antigen B27 (HLA-B27) +ve; compared to only 7 (8.8 %) of the 79 patients who did not have an axSpA diagnosis. The electronic records of these 7 HLA-B27+ve patients were reviewed in July 2022, and no indication of a subsequent axSpA diagnosis was found; notably, one patient subsequently developed enteropathic arthritis. Of the 71 HLA-B27-ve patients categorised as having a non-inflammatory cause of their symptoms, three were re-referred to the RNHRD, but none were diagnosed with axSpA. Conclusion We found no evidence of a subsequent diagnosis of axSpA in patients who did not have the disease diagnosed at the time of initial referral. This audit identified a small cohort of HLA-B27+ve patients without evidence of axSpA; a more in-depth analysis of this patient group is planned. Disclosure M. Cowan: None. R. Sengupta: None.