BackgroundThe Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a patient reported outcome (PRO) used in the monitoring of axial spondyloarthropathy (axSpA). It is completed by the patient and based on their assessment of disease severity and therefore quite a subjective measure of disease (1). There has been research around the relationship between ethnicity and patient perception in Rheumatology. Many studies have demonstrated that non-Caucasian patients especially South Asians are less likely to engage with patient education, abandon their disease modifying therapy early and have more mistrust with the medical establishment (2). Quite a large population study in America examining axSpA severity in Caucasians, Afro-Caribbean’s and Latinos found Afro-Caribbean and Latino patients to score themselves higher on BASDAI compared to Caucasians (3).With Leicester being such a diverse area, with a particularly high South Asian population we took this opportunity to investigate whether there were ethnic variations in disease severity.ObjectivesThe aim was to investigate whether there is a relationship between patient-reported outcome BASDAI and ethnicity. The secondary aim was to investigate the relationship between ethnicity and radiographic findings and extra-articular manifestations.MethodsData was collected by retrospective analysis of axSpA patients attending University of Leicester (UHL) axSpA services. Inclusion criteria entailed a diagnosis of axSpA with a documented BASDAI within a year of MRI spine + sacroiliac joints, prior to starting any biological treatment.Data of 149 patients was collected on demographic characteristics, extra-articular manifestations (uveitis, inflammatory back pain, enthesitis, peripheral arthritis, dactylitis, psoriasis, and inflammatory bowel disease), family history, response to NSAIDs, and HLA-B27 status.Data was analysed using Statistical Package for the Social Sciences (SPSS) software to assess the relationship between ethnicity and collected data using Pearson’s chi squared.ResultsOf the 149 patients 68% were White Caucasian, 30% Asian and 1% Black. The average age was 43 and 66% were male and 34% female. The mean BASDAI was 6.5, there was no observable correlation between BASDAI and ethnicity (p=0.668).There was no significant relationship between ethnicity and active sacroiliitis (p=0.926), chronic sacroiliitis (p= 0.218) or axial disease (p=0.307). 64 Caucasian patients were HLA-B27 positive compared with 27 Asian and no Black patients were positive however there was no statistical correlation between ethnicity and HLA-B27 (p=0.383). Overall, Caucasians consistently had a greater incidence of extra-articular manifestations compared with non-Caucasians however no significant p values were observed here or with response to NSAIDs, family history or familial HLA-B27 and BASDAI scores, results are summarised in Table 1.Table 1.Correlation with ethnicity and extra-articular manifestations, family history and HLA-B27.Number of patientsCorrelation with ethnicityUveitis36p=0.470Peripheral arthritis24p=0.304Enthesitis22p=0.959Psoriasis7p=0.062Inflammatory bowel disease7P=0.947Dactylitis6P=0.173HLA-B27103p=0.383Inflammatory back pain139p=0.062Response to NSAIDs46p=0.718Family history of axSpA20p=0.800HLA-B27 in family10p=0.221HLA-B27= Human leukocyte antigen B27, NSAIDs= non-steroidal anti-inflammatory drugs, axSpA= Axial Spondyloarthropathy.ConclusionThis study did not demonstrate statistically significant finding of ethnic variations in BASDAI. There was also no relationship between ethnicity and other data sets. However, the main limitation of this study is the sample size and unequal representation of ethnicities with there being far more Caucasians than non-Caucasian patients. Though this study provides an insight into quite a limited area of research, a larger study with equal ethnic patient population samples is required to obtain more meaningful results.References[1]Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken). 2011;63(11):47-58.[2]Kumar K, Klocke R. Ethnicity in rheumatic disease. Clin Med (Lond). 2010;10(4):370-372.[3]Jamalyaria F, Ward M, Assassi S, Learch T, Lee M. Gensler L et al. Ethnicity and disease severity in ankylosing spondylitis a cross-sectional analysis of three ethnic groups. Clin Rheumatol. 2017;36(10):2359-2364.Disclosure of InterestsNone declared

BackgroundThe prevalence of diabetes mellitus (DM) has often been found to be increased in patients with axial spondyloarthropathy (axSpA) compared to the general population. However, studies conducted in the United Kingdom (UK) have found varying results with regards to prevalence. One study1 found that 5% of patients with axSpA had DM, compared to 4% of patients without axSpA and another UK study2 reported that although findings showed a 1.8% increase in DM in patients with axSpA compared to controls, this result was not significant. There is also the influence of ethnicity to consider as DM is more prevalent in the Asian and Afro-Caribbean population. Therefore, it is evident that more research is required into the relationship between DM and axSpA.ObjectivesThis study aims to investigate the correlation between DM and axSpA, and also explore the influence of ethnicity on DM and axSpA.MethodsRetrospective analysis was carried out for axSpA patients attending University Hospitals of Leicester axSpA services. Inclusion criteria entailed an axSpA diagnosis and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) within a year of MRI spine and sacroiliac joints before starting biological therapy. Patients were excluded if they had an active infection or malignancy, BASDAI was not documented before starting biological therapy or within a year of MRI, or if clinical information was not able to be obtained. Data was obtained from electronic medical records, including age, gender, ethnicity, date of diagnosis of axSpA and DM, and cardiovascular comorbidities.ResultsOf the 149 patients, 8 (5.37%) had a diagnosis of DM. 4 (50%) of these patients were diagnosed with DM prior to diagnosis of axSpA, and 4 (50%) were diagnosed with DM post diagnosis of axSpA. Differences in ethnicity were analysed. Of the 149 axSpA patients, 102 (68.46%) were Caucasian, 45 (30.20%) were Asian, and 2 (1.34%) were Afro-Caribbean. Of the 102 Caucasian patients, 3 (2.94%) had DM, of whom 1 was diagnosed with axSpA prior to diagnosis of DM. Of the 45 Asian patients, 5 (11.11%) had DM, of whom 3 were diagnosed with axSpA prior to diagnosis of DM. Looking at cardiovascular comorbidities, of the 8 patients with axSpA and DM, 2 (25%) had hypertension, and were both diagnosed with axSpA prior to diagnosis of DM.ConclusionThis small study has found a similar prevalence of DM in patients with axSpA (5.37%) compared to the general UK population (6%), which contrasts with published international studies which have found a higher prevalence of DM in the axSpA group. However, the study did find a higher prevalence in the Asian population (11.11%) which is in keeping with ethnic variation for DM. Larger epidemiological studies are needed to understand the reason for reported higher prevalence of DM in patients with axSpA in other countries compared to the UK.References[1]Dregan A, Chowienczyk P, Molokhia M. Cardiovascular and type 2 diabetes morbidity and all-cause mortality among diverse chronic inflammatory disorders. Heart (British Cardiac Society). 2017;103(23):1867-1873.[2]Ahmed N, Prior JA, Chen Y, Hayward R, Mallen CD, Hider SL. Prevalence of cardiovascular-related comorbidity in ankylosing spondylitis, psoriatic arthritis and psoriasis in primary care: a matched retrospective cohort study. Clinical Rheumatology. 2016;35(12):3069-3073.Disclosure of InterestsNone declared