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P575. Caseload and impact of the Leeds Combined Rheumatology and Gastroenterology Clinic

T. Shuto1, R. Thomas1, S. Bingham1, L. Coates1, P. Emery1, H. Marzo-Ortega1, P.J. Hamlin2, 1University of Leeds, Rheumatic and Musculoskeletal disease, Leeds, United Kingdom, 2Leeds Teaching Hospital, Gastroenterology, Leeds, United Kingdom

Background

The relationship between spondyloarthritis (SpA) and IBD is well established. Musculoskeletal symptoms are commonly reported in IBD [1]; conversely, it has been reported that a high proportion (over 60%) of patients with ankylosing spondylitis, the prototypical SpA exhibit subclinical microscopic gut inflammation [2]. Management of individuals with overlapping IBD and SpA can be challenging for both gastroenterologists and rheumatologists. To improve patient care, a bi-monthly Combined Rheumatology and Gastroenterology Clinic (CRGC) was established in Leeds in 2008. Here we report the diagnoses, reasons for referral and first-visit interventions seen in this clinic.

Methods

A service development review was conducted. The records of all patients referred to the clinic were reviewed and information gathered on diagnosis, source of and reason for referral, and initial outcomes.

Results

A total of 86 individuals (29 male) were referred between the inception of the clinic in June 2008 and April 2012. 41.8% (n = 36) referrals were made by the Gastroenterology department, and the remainder by the Rheumatology department. The most common reason for referral was for an opinion from either a gastroenterologist or rheumatologist (46.5%, n = 40), followed by joint decision-making regarding treatment or ongoing care (40.7%, n = 35). Outcomes from the first CRGC visit are summarised in Table 1. 23.3% (n = 20) of patients received a new diagnosis at this visit. Combined decision-making led to a change in treatment for 51.2% (n = 44) of patients at the first visit.

86% (n = 74) of patients referred had a diagnosis of IBD; the non-inflammatory bowel complaints included dyspepsia and intractable diarrhoea. One patient received a diagnosis of NSAID-induced colitis. 54.7% (n = 47) of patients had a diagnosis of SpA. A further 18.6% (n = 16) had symptoms suggestive of an inflammatory arthritis, while 9.3% (n = 8) had a diagnosis of rheumatoid arthritis.

Table 1. Interventions at first CRGC visita
 InterventionNumber (%)
Change/Start DMARD20 (21.7)
Change/Start Biologic Treatment15 (16.3)
Alter dose of existing synthethic DMARD4 (4.3)
Stop treatment3 (3.3)
Intra-articular injection(s)2 (2.2)
Further investigations requested15 (16.3)
New diagnosis made20 (21.7)
Watch and wait13 (14.1)
aSome patients received >1 intervention; n = 92.

Conclusion

In total, 61 of 86 patients (70.9%) had a change in diagnosis and/or treatment facilitated by attendance at the combined clinic. This highlights the role of the CRGC as an appropriate, efficient setting for the management of patients with complex overlapping gastrointestinal and musculoskeletal manifestations of inflammatory disease.

1. Salvarani C, (2001), Musculoskeletal manifestations in a population-based cohort of inflammatory bowel disease patients, Scand J Gastroenterol, 36(12): 1307–13.

2. Mielants H et al., (1995), The evolution of sponyloarthropathies in relation to gut histology, J Rheumatol, 22(12): 2273–8.