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Background/Aims Physician-patient discrepancy in the goals of treatment remains an issue in axial spondyloarthritis (AxSpA). The National Axial Spondyloarthritis Society (NASS) has recently launched a national survey on patient values. Bridging the gap and improving alignment of physician-patient goals may lead to better outcomes. The objectives of this study were to investigate what patients wanted to discuss prior to their clinic attendance and to explore if these topics were discussed by the physician. The discrepancies between patient and physician goals were reviewed and steps put in place to bridge this gap. Methods Patients fulfilled the ASAS criteria for AxSpA. At baseline 130 consecutive patients attending the AxSpA clinic between April to December 2021 were sent a pre-clinic questionnaire. Patients were asked 2 questions and these were: 1) What do you wish to discuss at your appointment? 2) What goals do wish to achieve following treatment? Questionnaires were collected prior to the clinic. The medical notes and clinic letters were then reviewed post-clinic to check if questions 1 and 2 were discussed. The patient demographics and disease activity scores BASMI, BASFI and BASDAI were also collected. Results At baseline, 100/130 (77%) patients returned the questionnaire prior to clinic. The mean age was 41 years (range 23-67). 74 patients (74%) were male and 80 patients (80%) were in work. Patients were seen by a doctor (38%), specialist nurse (32%) and physiotherapist (30%). In terms of treatment, patients were currently on biologics (64%), NSAIDs (46%) and DMARDs (30%). The mean BASMI was 1.6 (range 0.2-5.4), BASFI 2.7 (0-9.2), BASDAI 3.5 (0.2-8.6) and CRP 3 (0-20). For pre-clinic question 1, the top three topics were medication, pain management and progression of disease. For question 2, the top three topics were to be pain-free, maintain flexibility and being mobile and active. There were also other topics that were raised including fatigue, sleep, infections and family planning. Post clinic, the topics in question 1 were discussed directly by the physician in 73% and question 2 in 59% of cases. The topics that were most discussed in clinic were medication, exercise and pain. Pooling the topics, the top five themes were pain, medication, flexibility, exercise and disease progression. A limitation is that the post clinic analysis was based on written clinic notes and letters. Conclusion This study confirms a degree of discordance in patient and physician goals. To bridge this gap, we are now focused on the top topics that patients wish to discuss in clinic and what they hope to achieve from their treatment. We have updated our AxSpA pathway to include these topics. Understanding patient goals will help us develop the content for the interventions and educational programmes to improve alignment and clinical outcomes. Disclosure A. Chan: None. A. Suarez: None. K. Rigler: None. J. Hamilton: None.

Background/Aims Mental health issues in axial spondyloarthritis (AxSpA) such as anxiety and depression can affect up to two thirds of patients. We aimed to detect the prevalence of anxiety and depression in our AxSpA patients in order to provide interventions to improve the condition. This is part of our work in the National Axial Spondyloarthritis Society’s (NASS) Aspiring to Excellence programme to improve patient outcomes. We have provided an online mental health assessment and self-management video that signpost patients to psychological help and resources. Methods We used the Hospital Anxiety and Depression Score (HADS) for AxSpA patients attending the clinic in January to March 2020. We also collected the BASDAI, Spinal Pain, BASFI and BASG. The HADS scores are divided into three groups, 0-7 (normal), 8-10 (borderline abnormal) and 11-21 (abnormal). Patients were invited to watch a self-help video on managing anxiety and depression, which we produced in house with our clinical psychologist. Patients were directed to online mental health resources and self-management programmes. Follow up HADS were collected post watching the video. Results All patients met the ASAS criteria for AxSpA. 100 patients were assessed and invited to watch the video. 90/100 (90%) of patients completed the baseline and follow up score. The mean (SD) age was 44.7 (13.2) years. The male:female ratio was 3:1. The mean disease duration was 9 years. The number of patients on biologics was 36 (40%). At baseline, the mean (SD) HADS was 10 (6), BASDAI 4.4 (2.3), Spinal pain 4.2 (3), BASFI 3.7 (2.7) and BASG 4.3 (2.7). The number of patients with a HADS score 0-7 was 28 (31%), 8-10 was 18 (20%) and >11 was 44 (49%). All patients participated in the viewing of the video and used the self-management programme. 34 (38%) patients reported engaging with psychological services such as talking therapies. At follow up, the mean (SD) HADS score was 9 (6), BASDAI 3.7 (2.1), Spinal pain 3.8 (2.2), BASFI 3.4 (2) and BASG 3.9 (2.4). The number of patients with a HADS score 0-7 was 38 (42%), 8-10 was 28 (31%) and >11 reduced to 24 (27%). There was a reduction in the number of patients with HADS >11 (from 49% to 31%) and a trend towards lower HADS (HADS 0-7 increased from 31% to 42%) and AxSpA outcome scores (reduction in all four AS scores from baseline). Conclusion Mental health issues in AxSpA can be improved through the use of digital mental health assessment and self-management programmes. This study shows that this is a useful method of delivering care. There was a trend towards the improvement of the mental health and AS disease activity scores using the digital video. Disclosure A. Chan: None. K. Rigler: None. A. McDougall: None.

Background/Aims Despite the considerable impact axial spondyloarthritis (axSpA) has on quality of life, condition-specific group education programmes are not routinely offered. Many people with axSpA report feeling isolated and often have never met anyone else with the condition. In 2020, the National Axial Spondyloarthritis Society (NASS) worked with patients and rheumatology departments to co-produce a pilot self-management programme (SMP) to explore demand from and assess the impact on patients and healthcare professionals (HCPs). Methods NASS identified six NHS centres to host the pilot SMP sessions. These centres represented a range of axSpA services. HCPs invited their axSpA cohort to attend by post or e-mail and NASS invited local NASS members. Attendees booked online via private URL. NASS developed content following consultation with rheumatology HCPs and people living with axSpA. The first session covered pain, flares, fatigue and emotional wellbeing. Following attendee feedback, three centres hosted a second session on medication and exercise. One centre held a third session covering night pain, sleep and stress. Sessions were delivered via online meeting software and included teaching, group discussions, polls and exercise. HCPs of the host rheumatology departments led these sessions in tandem with NASS staff, one of whom has lived experience of axSpA. Content and format were continually reviewed and improved using feedback from attendees and HCPs (Table 1); feedback was gathered by email, informal focus groups and anonymous surveys. Results A total of 266 patients attended. 55% were female and 27% were aged under 45. 10% were diagnosed within the past year; 26% within the last 5 years; >50% more than 10 years ago. No attendees had previously attended a hospital axSpA SMP session. Conclusion There is demand from patients and HCPs for an axSpA virtual patient SMP. Co-producing the programme can be effective for: engaging with a range of patients; educating and empowering patients to self-manage their condition; building relationships between HCPs and patients; reducing patient isolation; enabling appropriate self-referral to rheumatology services. This pilot has informed our next steps to expand the online sessions to new centres and explore co-producing an e-learning programme. Disclosure Z.E. Clark: Grants/research support; National Axial Spondyloarthritis Society receives grant funding from AbbVie, Biogen, Eli Lilly, Janssen, Novartis, UCB. W. Gregory: Honoraria; Speaker, conference registration and advisory board fees from AbbVie, Pfizer, Novartis, UCB. A. Chan: Member of speakers’ bureau; UCB, Novartis, Sanofi, AbbVie, Jannsen. A. Coy: None. Z. Cox: None. S. Dickinson: Grants/research support; National Axial Spondyloarthritis Society receives grant funding from AbbVie, Biogen, Eli Lilly, Janssen, Novartis, UCB. K. Gaffney: Shareholder/stock ownership; SpA Academy. Honoraria; Novartis, AbbVie, UCB, Lilly, Pfizer, Biogen. Member of speakers’ bureau; Celltrion, Novartis, UCB, AbbVie. Grants/research support; NASS, AbbVie, Pfizer, UCB, Novartis, Lilly, Jannsen, Gilead, Biogen. Other; Meeting expenses: AbbVie, Lilly, Roche, Novartis, Pfizer, UCB. B. Harrison: None. H. Herbert: None. C. Lewis: None. C. McCoy: None. K. Noel: None. K. Porthouse: None. K. Rigler: None. K. Weight: None. T. Williams: None. D. Webb: Grants/research support; National Axial Spondyloarthritis Society receives grant funding from AbbVie, Biogen, Eli Lilly, Janssen, Novartis, UCB. L. Dunkley: Honoraria; Honoraria with UCB, AbbVie, Pfizer.

Background NICE guidelines (NG65) for diagnosis and management of spondyloarthritis (SpA) in over 16s provide evidence-based recommendations for provision of care and services for patients, with an aim to improving quality of care. There often appears to be misdiagnosis/under diagnosis of psoriatic arthritis (PsA), as well as unmet needs of achieving treatment to target and low disease activity. Our objective was to audit our PsA service against the guidelines to benchmark current service provision compared to the National recommendations, highlighting potential key areas to improve quality of SpA and PsA patient care and enable service development including our new electronic patient pathway. Methods The NICE baseline assessment tool was used to audit 100 patients diagnosed with PsA, attending the outpatient rheumatology clinic between 2017-2019. The mean age was 54, with a 3:2 female to male ratio. 30% of patients included were on a biologic disease modifying anti-rheumatic drug (bDMARD). Data was collected from clinic letters/medical/physiotherapy records. Data was collated to identify areas of compliance of our service against the guidelines, with the key outcomes scrutinised being assessment and diagnosis, imaging, information and support, pharmacological management and long-term condition management. Results 78% of patients with PsA had documentation of meeting the CASPAR or peripheral ASAS Criteria. 83% of patients who had symptomatic hands/feet obtained X-rays, and 82% had imaging of other peripheral or axial sites. 58% of patients with PsA had documented evidence of having received information on PsA. Out of 100% of patients that were started on a conventional synthetic DMARD (csDMARD), 83% that were on monotherapy were escalated to either an additional csDMARD or a bDMARD. Largely by month 3 the csDMARD was switched or the patient started combination therapy, in comparison to those that started a bDMARD which occurred largely around month 6. 100% of patients had access to flare management advice and flare clinic, but only 30% had documented discussions about cardiovascular (CV) and skin cancer risks on anti-TNF therapy. Subsequent action plans for service improvement included: a best practice pathway developed on the electronic patient records (EPR), including the CASPAR and ASAS criteria, the Group for Research and Assessment of Psoriasis (GRAPPA) 6 domains of PsA, CV and skin cancer risk. All patients are seen in the Nurse/therapist led education sessions for information on the disease. Conclusion Performing an audit of patients against the NG65 guidelines ensured that we were using real-world data to benchmark our service, enabling robust action plans to be developed to address low compliance areas. Consequently, the audit allowed us to justify changing and developing the service for improved patient care. Disclosures E.J. Papadopoulos: Other; Paid work with Novartis Pharmaceuticals. A. Chan: Member of speakers’ bureau; Novartis, Celgene, Janssen, Sanofi. Other; Advisory Board for: Novartis, Celgene, Lilly. K. Rigler: Other; aid work for Novartis Pharmaceuticals. A. Kachwaha: None. J. Gunn: None. N. Zabbey: None. E. Walsh: None.