FRI0267 DIAGNOSING POLYMYALGIA RHEUMATICA: THE IMPACT OF FAST-TRACK CLINIC AT HOSPITALIZATION RATES

Abstract

Background: Polymyalgia Rheumatica (PMR) is a common inflammatory autoimmune rheumatic disease, with the highest incidence rates seen in Scandinavia. One of the challenges in the diagnosis of PMR is the lack of diagnostic tests specific for the disease. The diagnosis may require exclusion of other conditions that can present with polymyalgia symptoms and may lead to hospitalization. Only limited data on hospitalization rates among patients with PMR exists (1). Ultrasound (US) may be useful in differentiating PMR from non-inflammatory conditions and can also be used for the diagnosis of concomitant Giant Cell Arteritis (GCA) GCA Fast Track Clinics (FT) using US as the main diagnostic tool have shown both improvement in patient outcomes and decrease in the cost of care(2) Objectives: To investigate the admission rates of patients diagnosed with PMR and the impact of the FT on these rates. Methods: A FT clinic for patients suspected to have PMR was established at rheumatological outpatient clinic of South-West Jutland Hospital (serving 250.000inhabitants) in January 2018. Collaboration with the Emergency Medical department was established and patients with PMR symptoms referred to the hospital were examined at FT within 0-1 days, thereby avoiding hospitalization. Similarly, patients referred with PMR symptoms to the outpatient clinic by a GP, were examined at FT within 1-2 days. At FT a thorough history and clinical examination were performed including musculoskeletal and vascular US. Retrospectively data from patients diagnosed with PMR from 2013-2018 was analyzed. Results: In a 6 years' period, 336 patients were diagnosed with PMR. 54 patients were diagnosed during hospitalization. Hospitalized patients were older (mean values ± standart deviaton-sd) 73, 61±8, 96 vs 70, 94 ±7, 97 years, p=0, 024, with significantly higher initial C-reactive protein (CRP, mg/l) levels 99±58, 8 vs 43, 9±37, p<0, 0001 and a shorter duration of symptoms(6, 92±5, 5 vs 13, 6±13, 7 weeks, p=0, 0018). No differences were found regarding gender, PMR related symptoms, initial prednisolone dose and response to treatment. An equal annual distribution of the number of new diagnosed cases and hospitalizations rates during the first 5 years was found. After the implementation of the FT at January 2018 a significant decrease in hospitalization rates (19, 4% vs 3, 5% p=0, 001) and inpatient days of care (4, 15±3, 1 vs 1±0, p<0, 0001) was observed. The time from symptoms debut to diagnosis was also significantly decreased from 13, 74 to 6, 79 weeks (Table) Diagnosed atDiagnosed atP values2013-20172018 Conclusion: The annual hospitalization rates in connection with PMR diagnosis at South-west Denmark during a 5 year period were estimated to be 19, 2%. The implementation of a FT ultrasound clinic decreased significantly the hospitalization rates among patients with PMR.