Development Of Smart-phone Spondylo Arthritis Management System And Real-world Study Of Chinese Patients With Ankylosing Spondylitis

Objectives:1)To develop an interactive mobile health(mHealth)tool designed for ankylosing spondylitis(AS)/spondyloarthritis(SpA),Smart-phone SpA Management System(SpAMS),and evaluate its effectiveness of disease management and cost;2)To set up Chinese AS Prospective Imaging Cohort(CASPIC)based on real-world evidence from SpAMS to evaluate clinical characteristics of Chinese patients with AS;3)To comparethe clinical manifestations in human leucocyte antigen(HLA)-B27 positive and negative patients with AS;4)To investigate the relationship between AS-related work productivity impairment and serum C-reactive protein(CRP)level;5)To investigate the efficacy of tumor necrosis factor inhibitors(TNFi)against AS in a real-world setting.Methods:SpAMS integrates patient’s and physician’s portals in WeChat,Outpatients with AS(according to the 1984 modified New York criteria)were consecutively recruited in CASPIC using SpAMS from April 2016 to April 2018.Patient self-assessments were completed online at baseline and at every subsequent clinic visit.Physician-reported assessments were recorded by rheumatologists during each visit.Results:In total,1201 patients with ASwere enrolled[age,(30.6±8.7)years;male,82.6%].Disease duration was(8.4±6.1)years.Past or current symptoms of acute anterior uveitis(AAU),inflammatory bowel disease(IBD),andpsoriasis were observed in 21.0%,9.4%,and 3.7%of patients,respectively.AAU and IBD occurred significantly more in patients with a symptom duration>10 years.At baseline,57.2%of patients had inactive disease(ID)/low disease activity(LDA);this rate significantly improved to 79.2%after a mean follow-up of(13.3±5.9)months.Compared with relapsed patients,new achievers of ID/LDA underwent more online patient assessments(P<0.001).Problems solved in SpAMS caused 29.1%of clinic visits to a tertiary hospital unnecessary.SpAMS saved an average of 5.3 hours and 327.4 RMB per person on traffic expenses;these expenses equalled 16%of the Chinese monthly disposable personal income(2016 data from the National Bureau of Statistics of China).Males were significantly more in HLA-B27(+)patients(83.8%vs.75.0%,P=0.047).The average age at disease onset was(22.3±7.6)years in HLA-B27(+)patients and(24.4±8.7)years in HLA-B27(-)ones(P=0.028).There was significant difference in diagnose delay between two groups[14.3(2.5,43.6)months vs.20.3(5.0,67.4)months,P=0.041].AAU was found to be significantly more common in HLA-B27(+)patients(19.0%vs.7.3%,P=0.005),and knee involvement significantly less coumon in HLA-B27(-)patients(4.0%vs.10.0%,P=0.010),conversely.Patients with paid employment were evaluated the associations between CRP and work productivity.The rates of absenteeism,presenteeism,overall work impairment,and activity impairment were(11.9±27.4)%,(19.3±18.8)%,(28.1 ±28.8%)%,and(21.8±21.1)%,respectively.The presenteeism,overall work impairment,and activity impairment rates increased by 1.4%(1.1%,1.8%),1.1%(0.5%,1.6%),and 1.7%(1.3%,2.1%),respectively,for every 10m/L increase in CRP level after adjusting for covariates241 TNFi users and 563 nonusers were compared the efficacy of TNFi against AS.The mean duration of TNFi treatment was(6.9±3.2)months.The decline in the AS disease activity scoreswas significantly greater in users than in nonusers at 3,6,and 12 months(0.61,0.56,and 0.46,respectively,allP<0.05).Similarly,the improvement in the Bath AS functional indexwas significantly greater in users than in nonusers at 3,6,and 12 months(0.31,0.75,and 0.74,respectively,allP<0.05).The Bath AS metrology index(BASMI)increased in nonusers at 6 and 12 months(0.27 and 0.66,respectively,allP<0.05),but did not change in users.At 12 months,the difference in BASMI changes between the two groups was statistically significant(-0.60,P=0.47).Conclusions:SpAMS is a time-and cost-saving disease management tool that can provide valuable data to clinicians.HLA-B27(+)patients had a higher proportion of males,a younger age of onset and a greater risk for occurrence of AAU.Increased CRP may contribute to work efficiency impairment.Even with tapering or discontinuation,TNFis were efficacious against disease activity,improved physical functionality and may retard the limitations to spinal mobilityof patients with AS.