patients (70%) had the diagnosis confirmed on TAB. In 21 patients (45%) ultrasound was normal. Of these 14 patients were discharged with no further investigations. However, in 9 patients, it was felt that GCA was still possible, so they underwent TAB that was normal in all of them. 8/46 patients had equivocal ultrasound findings, so all went on to have TAB, which was positive in 1 patient. In another patient, TAB was attempted but was not obtained. Among the 21 positive TAB results, the average length of samples was 14.1 mm, compared 14.5mm in negative TAB results. Conclusion: The initial results of the first 12 months are and suggest the pathway is working well to allow a prompt, review and management of GCA patients, to avoid adverse effects unnecessary treatments, and most importantly, to prevent complications. The initial results of ultrasound have shown reliability and seem to correlate with the histopathology TAB Our result showed no significant difference in the length of a sample between positive and negative TAB results, however we appreciate that numbers are small. Disclosures: M. Abusalameh: None. R. Mascarenhas: None. R. Haigh: None. M. Brown: None. S. Earl: None. 187 THE IMPACT OF A FAST TRACK PATHWAY FOR GIANT CELL ARTHRITIS Jonathan Pinnell 1 , Carl Tiivas 2 , Kaushik Chaudhuri 3 , Purnima Mehta 4 and Shirish Dubey 3 1 Rheumatology, Haywood Hospital, Stoke-on-Trent, UNITED KINGDOM, 2 Clinical Physics and Bioengineering, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UNITED KINGDOM, 3 Rheumatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UNITED KINGDOM, and 4 Ophthalmology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UNITED KINGDOM Background: University Hospital Coventry and Warwickshire NHS Trust (UHCW) established its fast track pathway (FTP) for giant cell arteritis (GCA) in 2013. It offers patients a same-day clinical review, ultrasound Doppler, diagnosis, and treatment. It aims to prevent GCA related vision loss by treating affected patients promptly whilst avoiding exposing unaffected patients to corticosteroids. An evalua- tion of this pathway was performed. Methods: The clinical records of all patients attending the UHCW GCA FTP between 2014-2017 were retrospectively reviewed. A previous audit had evaluated the conventional GCA pathway for patients who underwent a temporal artery biopsy between 2011-2013. The out- comes within these two datasets were compared. The outcomes assessed were the occurrence of permanent GCA related visual disturbance and the exposure of unaffected patients to corticosteroids. Ethical approval was granted by the UHCW Research and Development Department. Descriptive statistical analysis was performed using Excel. Results: The FTP saw 652 patients between 2014-2017. Of these, 66% were female and the median age was 70. 143 (22%) patients were diagnosed with GCA; this proportion was consistent each year. 67 had visual symptoms, of which 31 (22%) developed permanent visual disturbances. 509 patients did not have GCA. 140 (28%) of these patients were given corticosteroids for suspected GCA, 369 (72%) patients were not. Complete data was only available for 123 of the 140 patients. Corticosteroid exposure ranged from 1-412 days (median 29). The median duration improved from 52.5 days in 2014 to 8.5 days in 2017. 42 (34%) of the 123 patients received corticosteroids for less than 1 week. The conventional pathway: 62 patients underwent temporal artery biopsies between 2011-2013. Of these, 76% were female and the median age was 69. 28 (45%) patients were diagnosed with GCA. 8 had visual symptoms, of which 7 (25%) developed permanent visual disturbances. 34 patients did not have GCA. 21 (62%) of them received corticosteroids. The duration of corticosteroid exposure ranged from 7-394 days (median 52 days). 1 (5%) of the 21 patients received corticosteroids for less than 1 week. Conclusion: The UHCW GCA FTP exposed proportionally fewer unaffected patients to corticosteroids and reduced the duration of exposure for those that did receive them, thereby minimising the risk of harm with unnecessary treatment. The proportion of patients who developed permanent GCA related visual disturbance was similar for both pathways and was in keeping with rates reported in the literature. The cause is likely to be multifactorial but one recurring problem was late patient presentation. One fifth of patients referred to the FTP are diagnosed with GCA. This has remained consistent despite an increase in referrals in 2017. Disclosures: J. Pinnell: None. C. Tiivas: None. K. Chaudhuri: None. P. Mehta: None. S. Dubey: None. 188 A NURSE-LED BIOLOGIC DOSE TAPERING PATIENTS WITH RHEUMATOID ARTHRITIS Lonsdale 1 , Karen Mills 1 and Karl Gaffney 1 , and Norwich University Hospital, Norwich, purpose of this initiative was to examine the a nurse-led dose tapering service for arthritis (RA) receiving TNF inhibitors (TNFi). has shown that in a specified group of stable patients who are in disease remission, the dose of biologics can be reduced without compromising patient well-being. This ultimately reduces drug exposure, potentially reducing the incidence of side effects and has considerable NHS cost saving implications. Methods: Criteria for selection included patients who have been treated with adalimumab or etanercept for greater than 1 year; who are in disease remission (DAS28 <2.6) or low disease activity (DAS28 <3.2 with zero swollen joint count and have a willingness to participate in dose reduction. Patients were identified for potential participation and offered an initial nurse appointment to discuss the dose tapering pathway and determine baseline DAS28. Once verbal consent was obtained, dose tapering was initiated from the date of last injection. The dose tapering pathway involved reducing to adalimumab 40mgs to every 3 weeks and etanercept 50mgs to every 10 days. Follow-up was arranged on a 3-monthly basis to ensure efficacy and DAS28 data collection for the first year, and will revert to standard 6-monthly monitoring thereafter. All patients were offered access to the biologics advice line for support and were assured that they would be offered an urgent review appointment if they had any concerns. In the event of a confirmed flare (DAS28 >3.2 or increase in DAS28 >1.2) patients were switched back to the original dose, with the option of steroid rescue therapy if clinically appropriate. Results: The results are shown in the table below: Dose tapering: February 2018 - October 2018: 188 TABLE ADALIMUMAB ETANERCEPT Eligible Patients 209 232 (not all screened) Approached 76 44 Tapered 43 19 Declined 22 20 Revert to original dose (Flare/patient choice) 10 5 Left to approach 58 144 Conclusion: This ongoing initiation has demonstrated the feasibility and acceptance of dose tapering RA patients who have stable disease on TNFi therapy. This will result in an overall NHS saving of £60,606 K. for iii118 Thursday 2 May 2019 POSTER VIEWING_III Downloaded from https://academic.oup.com/rheumatology/article/58/Supplement_3/kez107.003/5444393 by guest on 28 April 2022