POS0136 IMPACT OF A RAPID ACCESS CLINIC ON REFERRALS, DIAGNOSIS AND PREDNISOLONE INITIATION IN SUSPECTED POLYMYALGIA RHEUMATICA

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Background: Diagnosing polymyalgia rheumatica (PMR) is challenging, and 50% of individuals with suspected PMR initiate glucocorticoids before rheumatological evaluation, which may mask symptoms of differential diagnoses [1]. To ensure an accurate diagnosis and prevent unnecessary treatment, rapid assessment of individuals with suspected PMR is recommended in a recent guideline by the international giant cell arteritis (GCA) and PMR study group [2, 3]. However, few studies have evaluated the effects of rapid access strategy (RAS) clinics for patients with a confirmed PMR diagnosis, and no study have focused on all individuals with suspected PMR. Objectives: To compare the impact of a newly implemented RAS clinic with the previous standard referral approach on referral rates, pre-evaluation prednisolone initiation, and diagnosis in individuals with suspected PMR. Methods: This retrospective cohort study from Aarhus University Hospital, Denmark, compared individuals with suspected PMR assessed in a RAS clinic (referred 2021–2023) with a historical cohort (referred 2018–2020). Referral criteria to the RAS clinic included age above 50 years, symptoms consistent with PMR, and elevated C-reactive protein levels. Furthermore, general practitioners were instructed to defer from prednisolone initiation. No specific referral criteria were established for the historical cohort. Data were obtained from electronic patient records and included the time of referral and rheumatological evaluation, PMR-associated symptoms and signs, medical history, and laboratory- and imaging results. Individuals with an established PMR diagnosis prior to referral or cranial symptoms indicating concurrent GCA were excluded. PMR diagnosis was confirmed at 12 months for patients with accessible data. Results: A total of 364 individuals with suspected PMR were identified, with 137 in the historical cohort and 227 in the RAS cohort. One year following diagnosis, 95% of patients in both cohorts maintained the initial PMR diagnosis (Table 1). Referral rates increased after implementation of the RAS clinic, but the proportion of individuals receiving a PMR diagnosis remained stable (Table 1 and Figure 1). Likewise, the clinical presentations of individuals with suspected PMR remained unchanged (data not shown). Examinations for GCA with vascular ultrasonography among PMR patients increased significantly with implementation of the RAS clinic (Table 1). Significantly fewer individuals in the RAS cohort initiated prednisolone prior to rheumatological evaluation (7%) compared with the historical cohort (17%) (Table 1 and Figure 1). Additionally, the median time from referral to rheumatological evaluation was shorter in the RAS cohort (7 days) compared with the historical cohort (9 days) (Table 1). Implementation of the RAS clinic led to a significantly higher proportion of individuals being evaluated within both one (57%) and two weeks (89%) of referral, compared with the historical cohort (36% and 76%) (Table 1). For the RAS cohort, evaluation within two weeks of referral was associated with a lower proportion of patients initiating prednisolone compared with later than two weeks (6% [95 CI: 3–9] vs . 19% [95 CI: 4–34], p<0.05). However, this reduction in prednisolone initiation was not observed for evaluations in the RAS clinic within or later than one week of referral (6% [95 CI: 2–10] vs . 9% [95 CI: 3–15], p=0.56). Conclusion: Implementation of a RAS clinic for individuals with suspected PMR increased referral rates, while the proportion of confirmed PMR diagnoses remained stable, suggesting that the use of healthcare resources was efficient. Additionally, the RAS clinic reduced the proportion of individuals initiating prednisolone before rheumatologic evaluation, potentially enhancing the diagnostic accuracy of PMR. The reduction in the proportion of patients initiating prednisolone before evaluation was prominent when patients were evaluated within two weeks, but not one week, indicating that a two-week evaluation period may be sufficient. Finally, the low prevalence of GCA indicates that concurrent GCA may not be common among the entire population of PMR patients. Figure 1Change over Time in Referral Rate and Proportion of Individuals Initiating Prednisolone before Rheumatological Evaluation. Dotted line marks average referrals per month. Solid line marks pre-evaluation prednisolone initiation amongst individuals with suspected PMR. Stars mark specific events with promotion initiatives of the RAS clinic to primary care. Vertical dotted line marks official establishment of RAS clinic 01.01.2021. Average monthly referrals are calculated over a 6-month period. * After-work-meetings for GPs November 2020 and November 2021. ** Newsletters dedicated to GPs in May and August 2021. *** Regional PMR recommendation for GPs published in January 2022. RAS: rapid access strategy; GPs: general practitioners; PMR: polymyalgia rheumatica. REFERENCES: [1] Donskov, A.O., et al., An international survey of current management practices for polymyalgia rheumatica by general practitioners and rheumatologists. Rheumatology (Oxford), 2023. 62 (8): p. 2797-2805. [2] Keller, K.K., et al., Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group. Annals of the Rheumatic Diseases, 2024. 83 (11): p. 1436-1442. [3] Frølund, L.L., et al., Fast track clinic for early diagnosis of polymyalgia rheumatica: Impact on symptom duration and prednisolone initiation. Joint Bone Spine, 2021. 88 (5): p. 105185. Acknowledgements: NIL . Disclosure of Interests: Elisabeth Lindrup Nielsen: None declared, Andreas Wiggers Nielsen: None declared, Agnete Overgaard Donskov: None declared, Christoffer Våben: None declared, Line Lier Frølund: None declared, Ib Hansen: None declared, Line Thorndal Moll LTM has received speaking fees unrelated to this manuscript from Lilly, Berit Dalsgaard Nielsen BDN has received speaking fees unrelated to this manuscript from Novartis and AbbVie, Christoffer Mork: None declared, Ellen-Margrethe Hauge EMH has received grants unrelated to this manuscript from Novo Nordic Foundation, Roche, Novartis and personal fees from AbbVie, Sanofi, SOBI, Merck Sharp & Dohme and Union Chimique Belge, Kresten Keller: None declared. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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