LAUSR

Background Early inflammatory arthritis (EIA) has been a flagship subject for Rheumatology in the last few years. There has been a lot of interest in the patients diagnosed with EIA but less is known about those who enter the EIA pathway and are subsequently found not to have EIA. Objectives This study looks at the diagnoses and management of those discharged from the EIA pathway and what impact this has on resources, management and time. Croydon University Hospital Rheumatology Department has been running an Early Inflammatory Arthritis service incorporating ultrasound since 2014. In this study we are looking at patients that were referred to the EIA Pathway from August 2014 to August 2015. Methods To collect the data we looked at the patient records from our clinical system, Cerner Millennium. We recorded the clinical impression on first appointment, final diagnosis, additional investigations, referrals to therapies and other specialists and those that were discharged within the 6 weeks of referral. The data was analysed using .Microsoft Excel 2010 Results Of the 368 patients who were referred to the EIA pathway 140 (38%) were not diagnosed with EIA. The final diagnosis of these patients was osteoarthritis 29 (26%), no rheumatological diagnosis 16 (14%), soft tissue abnormality 11 (9.8%), gout 7 (6.3%), fibromyalgia/hypermobility 7 (6.3%), SLE 5 (4.5%) and polymyalgia rheumatica 4 (3.6%). The remainder, 29 (26%), had miscellaneous rheumatological diagnoses. Of the 140 patients, 28 were thought to have possible EIA on the first consultation. The final diagnosis in this group was osteoarthritis 7 (25%), no rheumatological diagnosis 7 (25%), soft tissue/musculoskeletal injury 3 (11%) and fibromyalgia 2 (7%). The remainder had miscellaneous diagnosis 9 (32%). All patients had routine bloods and x-rays. In addition, musculoskeletal ultrasound was carried out in 22, MRI in 12, CT in 3, EMG in 4 and 3 patients underwent bone density scanning. 13 were referred on to physiotherapy (8 were to hand therapy). 5 were referred to other medical specialities. 30 patients were discharged within 6 weeks. Conclusions This is the first study looking at those who did not have EIA. The Best Practice Tariff for EIA states that those without EIA should be discharged back to the GP within 6 weeks. We have shown that these patients have a variety of rheumatological diagnoses that require investigation, referral and treatment with the majority (79%) remaining under our care at 6 weeks. This study highlights the resources needed to manage the patients attending rheumatology via the EIA pathway who do not have EIA and this should be taken into account when such a service is developed. Disclosure of Interest None declared