Background Monitoring is an important part of the disease management in patients with axial spondyloarthritis (axSpA) .
Objectives is to evaluate the differences in adherence to therapy and in treatment outcomes in patients with the different ways of SpA monitoring.
Methods A total of 168 TNFα-blockers naïve patients with axial SpA fulfilling the ASAS criteria with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4 were involved in the current study and followed-up for one year. Ninety six patients were managed in by a local rheumatologist, who determined the frequency of monitoring and treatment required (group 1); 26 patients were managed actively – they visited rheumatologist every 12 weeks (group 2); 46 patients were involved in the group of the remote telephone monitoring – a monitor called them every 4 weeks and collected data about treatment and disease activity (group 3). Data on treatment and disease activity (BASDAI, the Ankylosing Spondylitis Disease Activity Score – ASDAS, and the patient acceptable symptom state – PASS) were collected at baseline and after 1 year of follow-up. Patients were asked if they need a rheumatologist's consultation.
Results 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 2 BASDAI at baseline was 5.21±3.0, after 1 year – 4.77±2.2, p<0.05, ASDAS – 3.42±2.9 and 2.79±2.6, respectively, p<0.05. In group 3 (remote monitoring) BASDAI at baseline was 5.36±3.5, after one year – 3.17±2.12, p<0.05, ASDAS – 3.44±3.1 and 2.6±1.8, respectively, p<0.05. Positive PASS at one year was achieved in the group 3 in 15 (57.69%, n=26), in group 2 - in 4 (20%, n=20), and in group 1 – in 0 (0%) of the cases. During one year non-steroid anti-inflammatory drugs intake recommended at baseline was changed arbitrarily (canceling the treatment/reducing the dose of medication) by 5 (19.23%, n=26), 15 (75%, n=20), 93 (96.87%, n=96) patients in 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 a rheumatologist.
Conclusions Regular monitoring is associated with a better therapy outcome in axSpA. Remote telephone monitoring of SpA every 4 weeks seems to beneficial regarding better adherence to therapy and better treatment outcomes than active monitoring of the disease every 12 weeks or irregular monitoring.
Braun J. Ann Rheum Dis. 2011; 70: 896–904.
Disclosure of Interest : None declared