LAUSR

Background The Rheumatology Unit of University Malaya in Kuala Lumpur is located in the University Malaya Medical Centre which is a strategically placed 1008 bed, tertiary healthcare institution. An audit of the rheumatology patients was carried out in 2017. Objectives The main objective is to create a database and registry of all the cases that are managed as outpatient over a period of 1 year. The data is analysed to provide the required information Details regarding therapy with biologics and small molecules are collected and analysed. Methods A case report form was designed for each patient, which include fields capturing first time visit and subsequent visits. Information captured were demographic data, disease diagnosis and duration, clinical features, laboratory values, co-morbidity and current medications. Longitudinal data was captured. All information were enterd into RedCap software with an institutional license. SPSS statisitcal analyisis software was used. Results Total number of patients in 2017 was 2329. The total number of patient visits was 8255. There was preponderance of females (1,856, 79.7%) compared to males (473, 20.3%). For ethnicity, Chinese patients constitute the most (1,041, 44.5%), followed by Malay (697, 29.8%), Indian (565, 24.2%) and others ethnicities (34, 1.5%). In this population, 3 most common rheumatological diseases seen are Rheumatoid arthritis (760, 32.6%), osteoarthritis (610, 26.2%) and Systemic Lupus Erythematosus (514, 22.1%). Following in descending order are gout (158, 6.8%), soft tissue rheumatism (153, 6.6%), psoriatic arthritis (118, 5.1%), Sjogren syndrome (102, 4.4%), scleroderma (58, 2.5%), mixed connective tissue diseases (49, 2.1%), vasculitis (44, 1.9%), ankylosing spondylitis (36, 1.5%), overlap syndrome (29, 1.2%), Adult onset Still’s disease (26, 1.1%), dermatomyositis/polymyositis (25, 1.1%), and fibromyalgia (20, 0.9%). Most recent management activity after clinical assessment, majority of patients (1391, 60.8%) were noted to have no change in management (same therapy continued, but not in remission), followed by those in remission (544, 23.6%). 215 (9.3%) patients require escalation therapy. 13 patients (0.6%) required hospitalisation. 112 (4.9%) had de-escalation therapy[. There were 13 deaths (0.6%). Most patients on biologics or small molecules are diagnosed with either Rheumatoid arthritis, SLE, Ankylosing Spondylitis and Psoriatic Arthritis. 44.7% of the patients on biologics have moderate disease activity while 33% of them have mild disease activity. 13.8% of them had achieved remission and 8.5% of them continued to have severe disease activity. The overall assessment of disease activity noted that 57 (2.5%) had severe disease activity, 550 (23.9%) had moderate disease activity, 1139 (49.5%) considered as mild disease activity and 557 (24.2%) were considered to be in remission. Conclusions This study has created a database and registry from which important data has been derived. Majority of the patients are being managed sub-optimally, most likely due to limited access to advanced therapies in prominent rheumatological diseases that are intrinsically active and respond modestly to conventional DMARDs and therapy. Further analysis is ongoing Disclosure of Interest None declared