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BackgroundFibromyalgia (FM) is a chronic non inflammatory condition characterized by pain and fatigue as well as physical and psychological symptoms. Management can be particularly challenging and a combination of pharmacological and non pharmacological treatments are recommended.ObjectivesThe aim was to study the level of anxiety and depression in fibromyalgia patients and whether these were associated with symptom severity, functional status, social or demographic factors.MethodsA cross sectional survey of 155 consecutive patients attending the nurse-led fibromyalgia clinic was carried out. Patients were diagnosed using the 2010 ACR diagnostic criteria. Demographic data, Widespread Pain Index (WPI), Symptom Severity Score (SSS), VAS pain and VAS fatigue were recorded. Patients filled in the self-administered questionnaires including the Revised fibromyalgia impact questionnaire (FIQR), Hospital Anxiety and Depression Scale (HADS). Patients were classified as suffering from high anxiety or depression if HADS was ≥11, moderate if 8–10 and low ≤7 for each scale respectively.Cross tabs and chi squared were used to study associations between anxiety and depression and social and demographic factors. Logistic regression analysis was performed to identify whether WPI, SSS, FIQR, VAS pain and VAS fatigue were predictors of severe anxiety and depression.ResultsOne hundred fifty five patients (92% female) participated in the survey. The average age was 50.3 years (SD 11.5) and mean duration of symptoms 13.4 years (SD 11.3). The mean HADS-A (anxiety) was 11.8 (SD 4.13), HADS-D (depression) 9.1 (SD 3.8) and FIQR 60.3 (SD 17.6).High levels of depression were reported by 31.5%, moderate 32.1% and low 30.3%. High levels of anxiety were reported by 60%, moderate 21.2% and low 13.3%. Both high levels of anxiety and depression were found in 25.2% of patients.SSS was the single best predictor for anxiety (p=0.001) while disease duration (p=0.01), SSS (p=0.02) and FIQR (0.04) predicted depression. VAS pain and VAS fatigue were not good predictors of severe anxiety and depression. When patients with high levels of anxiety and depression were compared with those with moderate and lower levels no association was found with age or social factors including occupation, marital status, level of education and family support.ConclusionsBoth severe anxiety and depression were highly prevalent in our FM cohort, particularly anxiety. All FM patients need to be screened for anxiety and depression particularly those with high SSS and FIQR scores and longer disease duration.A psychiatrist and psychotherapist with a special interest in FM are essential members of the multidisciplinary team to ensure that anxiety and depression are addressed early prior to starting further interventions for FM.References Jensen KB, Fransson P, Marcus HM, Williams SCR, Choy E, Mainguy Y, Gracely R, Ingvar M, Kosek E (2010) anxiety and depression in fibromyalgia are related to poor perception of health but not to pain sensitivity or cerebral processing of pain. Arthr...

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Background:DMARDs need to be prescribed safely. Screening and monitoring for toxicity is essential when using these medications. The British Society of Rheumatology (BSR) has recently published guidance on screening and monitoring of non-biologic DMARDs.Objectives:The aim of this audit was to assess current practice on synthetic DMARD screening and monitoring within our rheumatology department, in a secondary care setting, using the BSR 2017 guidelines as the standard of care.Methods:81 consecutive adult patients who were started on synthetic DMARDs in 2016 were recruited. The data required was collected from case notes and isoft clinical manager after obtaining data protection clearance. DMARDs included Hydroxychloroquine (HCQ), Methotrexate (MTX), Sulfasalazine (SSA), Azathioprine (AZA) and Leflunomide (Lef). Baseline screening was assessed by checking for documentation of height, weight, baseline blood tests including virology and documentation of known lung disease and smoking with the relevant investigations when necessary. Specialist nurse referral and content of consultation was assessed for discussion regarding fertility/pregnancy when relevant, intercurrent illnesses and vaccinations. Drug-specific screening and monitoring included folic acid prescription (FA) for MTX, TPMT testing for AZA, ophthalmic review for HCQ as well as weight and blood pressure (BP) monitoring for Lef. Finally all patients were checked for regular blood monitoring at weeks 2,4,6 and every 3 months thereafter with the exception of SSA & HCQ monotherapy. Calibri (Body)Results:Weight and height were not documented in 50.6% and 66.7% of patients respectively. Baseline blood tests were present in all but 1 patient with the exception of virology. The latter was present in 6.2% of cases only. Smoking status was assessed in 92.6% of cases. CXR and pulmonary function tests were warranted for 9 patients but were only done in 4 cases. 98.8% of patients were referred to the specialist nurse for DMARD education. Discussion on fertility and pregnancy, where applicable, was discussed in 95% of cases, vaccinations in 97.5% of cases and advice regarding management of intercurrent illnesses in 2.5% of cases. Drug monitoring at 2, 4 and 6 weeks was done in 33.3%, 90.1% and 80.2% of cases respectively. BP and weight were checked for all patients on Lef whilst blood monitoring for SSA monotherapy persisted after 1 year in 80% of cases. Drug specific recommendations including FA prescription, TPMT testing and ophthalmic reviews were done in all patients.Conclusions:This audit showed a high level of concordance with the BSR monitoring guidelines for synthetic DMARDs. Aspects that require improvement have been highlighted. By ensuring that there is proper documentation of all aspects pertaining to the work-up prior to starting a patient on a DMARD, one can then introduce screening and monitoring schedules targeted at the prevention and early detection of adverse treatment outcomes.Disclosure of Interest:None declared