Background Spondyloarthritis (SpA) are the diseases in which monitoring of disease activity is required. The frequency of the monitoring should be decided on an individual basis depending on course of symptoms, severity and treatment of the disease [1].

Objective Is to evaluate the difference in adherence to therapy and results of treatment in patients with the different ways of SpA monitoring.

Methods 196 patients with SpA were involved (ASAS criteria for axial SpA [2]). Patients with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4 without the treatment with TNFα-inhibitors (n = 168) were randomised on 3 groups. 96 patients were managed in free way by rheumatologist (group 1); 26 patients were managed actively – visited rheumatologist every 12 weeks (group 2); 46 patients were involved in the group of the remote monitoring – monitor called them every 4 weeks and collected data about treatment and disease activity (group 3). At baseline and after 1 year in all groups were collected data about treatment and disease activity (BASDAI, the Ankylosing Spondylitis Disease Activity Score – ASDAS, the patient acceptable symptom state – PASS, and other parameters recommended by ASAS). Patients were asked if they need the rheumatologist’s consultation. In statistical analyses (SPSS17) the results were considered significant for p < 0.05.

Results Patients of all groups were comparable in age, sex. In group 1 BASDAI at baseline was 5.32 ± 3.2, after one year – 5.17 ± 2.16, ASDAS – 3.45 ± 2.1 and 3.1 ± 1.1, respectively (p > 0.05). In group 3 (remote monitoring) BASDAI at baseline was 5.32 ± 3.2, finally – 3.17 ± 2.12, ASDAS – 3.44 ± 3.1 and 2.6 ± 1.8; in group 2 BASDAI at baseline was 5.21 ± 3.0, in 1 year – 4.77 ± 2.2, ASDAS – 3.42 ± 2.9 and 2.79 ± 2.6, p < 0.05 for difference between final and baseline values and between final values in groups 1 and 3. Positive PASS was achieved in the group 3 in 15 (57.69%, n = 26), in group 2 - in 4 (20%, n = 20), in group 1 – in 0 (0%) of cases.

Non-steroid anti-inflammatory drugs intake recommended at baseline was changed arbitrarily by 5 (19.23%, n = 26), 15 (75%, n = 20), 93 (96.87%, n = 96) patients of groups 3, 2 and 1, respectively. After one year of follow up 3 patients of group 3 (11.5%, n = 26), 19 (95%, n = 20) of group 2 and 96 (100%) patients of group 1 considered that they need to visit rheumatologist.

Conclusion Remote telephone monitoring of SpA every 4 weeks is associated with better adherence to therapy and better treatment outcomes than active monitoring of the disease every 12 weeks or monitoring in free way.

References

1. Braun J, Ann Rheum Dis. 2011; 70: 896–904.

2. Rudwaleit M. Ann Rheum Dis. 2011 Jan; 70(1):25-31.