Anupama Nandagudi

E63. Management Pathway for Psoriatic Arthritis: Is there a Window of Opportunity?

Background: PsA and RA are common chronic inflammatory arthritic condition seen in approximately 1% of the European population each. However the diagnosis is delayed due to comparatively poor awareness of PsA in the community including general practitioners (GPs) and patients. It has been proven that there is a window of opportunity for autoimmune disorder like RA where an early referral and treatment improves the outcome. We looked at the management pathway of our cohort of PsA patients from Basildon hospital on these lines. We audited our practice against the published PsA management guidelines set by the EULAR (2011) and the British Society for Rheumatology (2012). Methods: We retrospectively selected 50 patients who were diagnosed with PsA in last 4 years at the Rheumatology Department, Basildon Hospital, and focused on the first year of the management. Results: The age of the patients ranged from 26 to 77 years of age (median 48 years, IQRL 35, IQRH 57). The male to female ratio was 1:1. The median duration of symptoms was 13 months at the time of specialist review with more than 60% patients were reviewed after duration longer than 12 months. Most patients were referred by GPs (80%) and a few by dermatologists (12.5%). Looking at the subtypes of diseases, polyarthritis was the commonest pattern (55%) followed by oligoarthritis (37%). Clinicians measured the disease activity differently as number of tender and swollen joints (80% patients) and Psoriatic Arthritis Response Criteria (PsARC) score (32.5% of patients). The visual analogue scale score for global disease was noted in 5% of patients. Dactylitis and enthesitis were noted in 7.5% of patients respectively. 67.5% of patients had normal CRP at the time of review. DMARDs were used in treatment of 65 % of patients. MTX was first choice in poly (77%) and SSZ in oligo (46%). Conclusion: There is a significant delay between the onset of symptoms and first review by a rheumatologist. Dactylitis and enthesitis did not affect the subcategorization of disease or the plan of management. There were three distinct clinical patterns noted which further decide the treatment pathway and outcome measures. DMARDs were used frequently. Spondyloarthropathy formed a smaller group. Disclosure statement: The authors have declared no conflicts of interest. i194 E-POSTER ABSTRACTS

Muscle disorders 67. Influence of Occupational Factors on Regional Musculoskeletal Disorders in Coal Miners

Background: To determine the prevalence of specific musculoskeletal disorders in coal miners, and associated occupational risk factors in order to provide reliable epidemiologic data for targeted interventions. Methods: 1900 coal miners in China were examined in a crosssectional study. Musculoskeletal disorders in the neck, shoulder, upper-extremity, the back and low limbs were assessed using the Standardized Nordic Questionnaire. Odds ratios and 95% confidence intervals (CIs) were calculated to examine occupational factors in relation to any specific musculoskeletal disorder using logistic regression. Results: There were 1205 coal miners, in a year, who suffered from musculoskeletal disorders. Low back pain was the most common musculoskeletal disorder with 59.5% of prevalence. The prevalence of musculoskeletal disorders increased with age. The prevalence of underground workers was significantly higher than that of the surface workers (79.6% vs 74.5%, P<0.001). Neck/shoulder and upperextremity musculoskeletal disorders were associated with high repetitiveness (OR 1.6, 95% CI 1.3-2.0) and awkward work (OR 1.3, 95% CI 1.1-1.6). High repetitiveness (OR 1.5, 95% CI 1.1-1.8), high physical demand (OR 1.5, 95% CI 1.2-2.0) and extreme stooping posture (OR 1.9, 95% CI 1.4-2.7) were strongly related to low-back pain. Low limb disorders were associated with long standing (OR 1.4, 95% CI 1.1-1.7) and awkward work (OR 1.4, 95% CI 1.1-1.7) Conclusions: This study identified associations between specific musculoskeletal disorders and occupational factors among coal miners. Intervention strategies of occupational factors may be helpful to reduce musculoskeletal disease burden. Disclosure statement: The authors have declared no conflicts of interest.