Abstract Background/Aims Peripheral joint disease is a common feature of spondyloarthropathies (SpA). Foot and ankle symptoms are a major problem for people with early and established disease, leading to long-term complications and increasing the disease burden. Advanced clinical practitioner (ACP) roles in rheumatology provide an opportunity to incorporate clinical training and experience with extended skills in musculoskeletal (MSK) ultrasound, independent prescribing and injection therapy. MSK ultrasound alongside clinical assessment plays a crucial role in diagnosing and monitoring SpA, with high sensitivity and specificity in detecting changes in disease features, including peripheral enthesitis, synovitis, tendinopathy, and dactylitis. Whilst referral for MSK ultrasound may be delayed, same-day point of care ultrasound assessment can identify disease activity levels in SpA, which may guide initiation of drug therapies or prevent unnecessary switching or escalation, as well as guide intra-articular and soft tissue corticosteroid injections, and non-drug interventions. Methods A 12-month weekly pilot clinic was conducted within the Leeds Specialist Spondyloarthritis Service where a point of care service was provided by an ACP podiatrist. This included same-day clinical assessment, ultrasound assessment of peripheral joints (upper and lower limb) for disease activity, ultrasound-guided intra-articular and soft tissue injection therapies, and the provision of non-drug interventions for the lower limb (foot orthoses, exercise, footwear). Results Over 12 months, 210 patients were seen in 37 clinical sessions. 104 patients received clinical assessment with the provision of non-drug interventions (physical therapy, foot orthoses, footwear) if indicated, and 106 MSK ultrasound assessments were conducted. MSK ultrasound of disease activity was requested for the feet in 62 patients (58.5%), the hands in 48 patients (45.3%), with 10 patients (9.4%) having ultrasound assessment for symptomatic feet and hands. Fourteen patients (13%) had an ultrasound examination of one/both knees, and the elbow was assessed in one patient (0.9%). Active disease was identified in 44 (41.5%) patients leading to escalation of treatment for 14 (13.2%) patients, 3 (2.8%) patients switching to biologic therapies. and one (0.9%) patient stopping treatment. Fourteen (13.2%) patients had intra-articular/ soft tissue steroid injections. Conclusion The inclusion of an ACP Podiatrist within the Leeds Specialist Spondyloarthritis Service has provided the means of addressing lower limb pathology, a prevalent feature of disease. Personalised management interventions aimed to address mechanical changes associated with foot and lower limb pathologies, can often trigger or perpetuate inflammation or confound treatment non-response. Importantly, point-of-care MSK ultrasound assessment of disease activity can inform the escalation and switching of pharmacological treatment, as well as preventing unnecessary changes to treatment that are burdensome to patients, the NHS and healthcare systems. This novel clinic provides the basis for the development of non-pharmacological treatment pathways for patients with SpA. Disclosure R.A. Wilkins: Grants/research support; Great Foundations and NIHR pre application support fund. H. Siddle: Honoraria; personal payment or honoraria fees from Janssen and Alfasigma UK Ltd, outside the submitted work. T. Dickie: None. H. Marzo-Ortega: None.
Wilkins et al. (Wed,) studied this question.