Background/Purpose: Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton and characterized by inflammatory back pain, leading to decreased mobility, function, and quality of life. Management of the disease includes the use of DMARDs, physical therapy, and other lifestyle remedies. There is a global challenge in meeting patients’ needs and discrepancies in access to AS care, highlighting the urgent need to implement cost-effective disease management programs and deliver equal access to care. In modern era, most people having access to smart phones create opportunities for patient care in chronic diseases. This study aims to investigate the impact of smart phone application (HealthCius) on inflammatory disease activity and quality of life in AS patients over a period of one year.

Methods: A total of 80 patients were recruited in this observational study fulfilling the Modified New York Criteria, 1984 for AS. These patients were allocated to two groups: Intervention group (n=50) and Control group (n=30). The ones having facility of smart phones as well as patients who accepted to use the HealthCius application were assigned to the Intervention group and patients who did not have the facility of smart phones were grouped as Control. The patients in the two groups received standard treatment of AS. The application was designed after obtaining feedback from health care providers, patient counselors and AS patients using a questionnaire. To the patients, the app was their individual treatment plan. It helped them comply with the plan by providing an easy to refer checklist, reminders, alerts and a visual dashboard of their progress through the day. The app served as the doctor’s virtual assistant inside the patient’s smart phone. For the doctor, it was a live dashboard of all patients and their real time compliance levels. The data reported by the patients was available to the doctor in the form of time sliced charts and trend lines. Therefore, this app is designed to leverage technology to shift the patients’ focus every day on to their treatment plan thereby driving up compliance and better health outcomes. Outcome measures included ESR, CRP, BASDAI, BASFI and health assessment questionnaire disability index (HAQ-DI) at baseline and after 1 year.

Results: Baseline characteristics were similar between groups with no significant difference. There was a significant difference between the control and intervention group for BASDAI (p ≤0.05), BASFI (p≤0.05), ESR (p≤0.05), CRP (p≤0.05) and HAQ-DI (p≤0.05) after 1 year in favor of smart phone application. Analysis within the groups revealed significant improvement in BASDAI (p≤0.05) (Fig.1A), ESR (p=0.02) (Fig.1B), CRP (p=0.01) (Fig.1C) and HAQ-DI (p=0.01) (Fig.1D) in the application group as compared to control group. Impact of DMARDs usage was also evaluated at the end of the study and it was found that the average drug usage of DMARDs was more in control group than the intervention group.

Conclusion: The study suggested that there was greater improvement in inflammatory disease activity and quality of life in smart phone application assisted AS patients suggesting that smart phone technology can be used to leverage health benefits in AS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-utilising-smart-phone-application-in-ankylosing-spondylitis-smart-as-study/