109. WHAT SERVICES DO RHEUMATOLOGY DEPARTMENTS OFFER AXIAL SPONDYLOARTHRITIS PATIENTS IN THE UK?
Bibliographic record
Abstract
Background: There have been significant advances in the definition and management of axial spondyloarthritis (axSpA) during the last 5 years which should be reflected in patient care. We therefore explored the services offered to patients with axSpA by UK rheumatology departments. Methods: During February 2016, a validated web-based questionnaire was sent to 172 named NHS consultant rheumatologists at all acute trusts in the UK. The survey comprised 47 open and closed questions regarding professional views and service delivery relating to axSpA. Results: A total of 83 responses were received (response rate 48%). Eighty-eight percent of participants accepted the concept of axSpA, 7.2% rejected it and 4.8% were uncertain. Fifty-five percent would assign a diagnosis of axSpA to newly diagnosed patients. The term non-radiographic axSpA was used by the majority of respondents (72%) if the patient fulfilled the classification criteria. A majority of centres (57%) looked after between 100 and 499 patients, 13.3% >500, and 8.4% <100. The majority (61%) had at least one clinician with special interest in axSpA, 58% offered a dedicated axSpA clinic and 63% had an MDT with responsibility for axSpA. Patients were routinely reviewed 6-monthly by 61% of centres and annually by 22.9%. In 16 (19.3%) of centres there were combined clinics; 8 dermatology, 2 ophthalmology, 1 gastroenterology, 4 dermatology plus gastroenterology, and 1 dermatology plus ophthalmology. Metrology is routine practice in 96% of centres; in which, BASDAI (100%), BASFI (75%), BASMI (66%), WAPI (19%) were used; 66% of centres used at least 3 metrology tools simultaneously. The first-line investigation is MRI in 37%, X-ray in 22% and both in 34%. When requesting MRI scans, 53.3% ask for full spine, 9.1% sacroiliac joint, and 28.6% both, while 9.1% would request other sequences. Respondents reported that 30% (IQR 22–48%) of their axSpA patients were receiving anti-TNF therapy, however 39% reported restricted access. Seventy-nine percent treat non-radiographic axSpA with biologics; 97% treat MRI-positive patients, 25% MRI-negative/CRP-positive; only one centre would treat if MRI negative/CRP negative. The majority (75%) were confident using biosimilars; 57% reported experience using biosimilar Infliximab. Eighty-three percent of centres had access to specialized orthopaedic spinal surgery in a tertiary centre (59.4%), in the same trust (34.4%) or other centres (6.3%). The majority of centres (94%) have a patient advice line, aiming to respond within same (25%) or next working day (63%). Community clinics are offered by 36%. Fifty-five percent participate in axSpA research, 59% have dedicated databases or other computerized patient records and the majority (70%) contribute data to the BSRBR-AS.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.013 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".