Session Information
Date: Monday, November 9, 2015
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: We previously published quantitative definitions of the ASAS AS management recommendations designed for use with observational data.1 The definitions, developed by consensus with expert rheumatologists, are comprised of one or more clinical actions considered to be markers of ‘non-compliance with’ ASAS recommendations. The DESIR cohort, a longitudinal study of early SpA patients, provides 3 years of observational data suitable for measuring non-compliance according to these definitions.
Methods: We used DESIR cohort data to describe the number of patients with markers of non-compliance at each of 6 follow-up visits (months 0, 6, 12, 18, 24, 36) and at any point over 3 years. We calculated the number of patients with any marker of non-compliance; any ‘core’ marker of non-compliance (i.e., markers applicable to all patients at all times); any marker of non-compliance minus that pertaining to physiotherapy (for which consensus was not achieved); the number of follow-up visits at which patients had at least one marker of non-compliance; and the total number of markers of non-compliance in each patient at each visit. Non-compliance pertaining to anti-TNF agents was analyzed among patients satisfying ASAS criteria for anti-TNF agents. The analysis included all DESIR patients who satisfied ASAS criteria for axial SpA.
Results: A total of 486 patients satisfied ASAS criteria for axial SpA and were included in the analysis. The most frequently observed marker of non-compliance pertained to lack of physiotherapy, noted among 236 patients (48.6%). When including physiotherapy, 311 patients (64.0%) had at least one marker of non-compliance over 3 years; when excluding physiotherapy, 137 patients (28.2%) had at least one marker of non-compliance over 3 years. Among 153 patients who satisfied ASAS criteria for anti-TNF agents, the marker of non-compliance (i.e., failure to receive an anti-TNF when indicated) was noted among 88 (57.5%). Markers of non-compliance unrelated to physiotherapy or anti-TNF agents were infrequently observed.
Conclusion: In a cohort of early SpA patients, almost half had not had physiotherapy in the first 12 months, while over half of those satisfying the criteria for anti-TNFs did not receive one as soon as indicated. This study suggests areas for improvement in SpA care.
1Harvard S, Gossec L, Pham T, Richette P, Dougados M, Anis A,
Fautrel B. Measurable definitions of ankylosing spondylitis management recommendations are needed for use in observational studies. Joint Bone Spine. 2015 Mar 13.
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Table 1. Quantitative Definitions of ASAS Recommendations as Markers of Non-Compliance |
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ASAS Recommendation Category |
Marker(s) of Non-Compliance in Category |
Marker Included in Analysis? |
Marker Number (Label) |
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Non-Pharmacological Therapy |
a. If by the 12-month follow-up visit, patient has had 0 visits to the physiotherapist |
Yes |
1 (Physiotherapy) |
|
Extra-Articular Manifestations and Co-Morbidities |
a. If at a given study visit, a patient has a new diagnosis of uveitis AND has not had an opthamologist consult by the next study visit
|
Yes |
2 (Ophthalmologist) |
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b. If at a given study visit, a patient has a new diagnosis of psoriasis AND has not had a dermatologist consult by the next study visit
|
Yes |
3 (Dermatologist) |
|
|
c. If at a given study visit, a patient has a new diagnosis of pustulosis AND has not had a dermatologist consult by the next study visit
|
No (insufficient data) |
4 (NA) |
|
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d. If at a given study visit, a patient has a new diagnosis of IBD AND has not had a gastroenterologist consult by the next study visit
|
Yes |
5(Gastroenterologist) |
|
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e. If at a given study visit, a patient has a new cardiovascular event and has not had a cardiologist consult by the next study visit |
No (too few cardiovascular events) |
6 (Cardiologist) |
|
|
Non-Steroidal Anti-Inflammatory Drugs |
a. If patient received their first DMARD before their first NSAID
|
Yes |
7 (DMARD) |
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b. If patient has diagnosis of renal insufficiency (i.e., creatinine clearance < 30 ml/ min) and NSAID use is not interrupted within 15 days of that diagnosis (as assessed at next study visit)
|
No (insufficient data) |
8 (NA) |
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c. If patient has history of GI event other than dyspepsia and receives an NSAID or Cox inhibitor without a concomitant PPI
|
Yes |
9 (PPI) |
|
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Glucocorticoids |
a. If at a given study visit, a patient is receiving oral prednisone or equivalent and has no history of uveitis, peripheral arthritis or inflammatory bowel disease |
Yes |
10 (‘Prednisone’) |
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Disease-Modifying Anti-Rheumatic Drugs |
a. If patient has synovitis ³3 at two consecutive visits and is not prescribed a DMARD at either of these visits |
No (too few synovitis ³3) |
11 (NA) |
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b. If at a given study visit, a patient is receiving MTX and has no history of peripheral arthritis or psoriasis
|
Yes |
12 (MTX) |
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c. If at a given study visit, a patient is receiving SSZ and has no history of peripheral arthritis, IBD, or uveitis |
Yes |
13 (SSZ) |
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Anti-TNF Agents |
a. If at two consecutive study visits, patient has had at least 2 adequate therapeutic trials of NSAIDs (i.e., minimum two NSAIDs over a 4-week period in total since symptom onset), BASDAI is ³4, Physician’s Global Assessment of Disease is ³4 AND an anti-TNF agent has not been prescribed at the 3rd visit
|
Yes |
14 (Anti-TNF) |
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b. If patient is receiving a biological agent other than anti-TNF (*EXCEPTION: psoriatic patients may receive a biologic other than anti-TNF, but then cannot receive a concomitant anti-TNF) |
No (0 patients receiving other biologics) |
15 (NA) |
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Table 2. DESIR Patients with Markers of Non-Compliance Over 3 Years of Follow-Up |
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Number of patients with non-compliance by time point |
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|
Marker |
Baseline |
6M |
12M |
18M |
24M |
36M |
Ever |
|
1: Physiotherapy |
|
|
236 (48.6%) |
236 (48.6%) |
236 (48.6%) |
236 (48.6%) |
236 (48.6%) |
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2: Ophthalmologist |
0 (0.0%) |
0 (0.0%) |
0 (0.0%) |
0 (0.0%) |
0 (0.0%) |
1 (0.2%) |
1 (0.2%) |
|
3: Dermatologist |
0 (0.0%) |
7 (1.4%) |
0 (0.0%) |
0 (0.0%) |
0 (0.0%) |
18 (3.7%) |
18 (3.7%) |
|
5: Gastroenterologist |
0 (0.0%) |
0 (0.0%) |
1 (0.2%) |
1 (0.2%) |
2 (0.4%) |
3 (0.6%) |
3 (0.6%) |
|
7: DMARD |
0 (0.0%) |
23 (4.7%) |
27 (5.6%) |
27 (5.6%) |
27 (5.6%) |
27 (5.6%) |
27 (5.6%) |
|
9: PPI |
6 (1.2%) |
16 (3.3%) |
17 (3.5%) |
19 (3.9%) |
19 (3.9%) |
20 (4.1%) |
20 (4.1%) |
|
10: Prednisone |
3 (0.6%) |
11 (2.3%) |
8 (1.6%) |
5 (1.0%) |
3 (0.6%) |
8 (1.6%) |
23 (4.7%) |
|
12: MTX |
1 (0.2%) |
2 (0.4%) |
2 (0.4%) |
5 (1.0%) |
5 (1.0%) |
6 (1.2%) |
6 (1.2%) |
|
13: SSZ |
2 (0.4%) |
5 (1.0%) |
4 (0.8%) |
4 (0.8%) |
4 (0.8%) |
3 (0.6%) |
7 (1.4%) |
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14: Anti-TNF |
|
|
33 (6.8%) |
42 (8.6%) |
49 (10.1%) |
53 (10.9%) |
53 (10.9%) |
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Any Core Marker (1, 7, 10, 12, 13,14) |
6 (1.2%) |
40 (8.2%) |
275 (56.6%) |
281 (57.8%) |
283 (58.2%) |
288 (59.3%) |
298 (61.3%) |
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Any Marker Excluding Physiotherapy |
12 (2.5%) |
57 (11.7%) |
83 (17.1%) |
92 (18.9%) |
100 (20.6%) |
124 (25.5%) |
137 (28.2%) |
|
Any Marker |
12 (2.5%) |
57 (11.7%) |
281 (57.8%) |
287 (59.1%) |
290 (59.7%) |
302 (62.1%) |
311 (64.0%) |
To cite this abstract in AMA style:
Harvard S, Guh D, Bansback N, Dougados M, Anis AH, Fautrel B. Markers of Non-Compliance with ASAS/EULAR Management Recommendations Among Early Spa Patients: Evidence over 3 Years in the DESIR Cohort [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/markers-of-non-compliance-with-asaseular-management-recommendations-among-early-spa-patients-evidence-over-3-years-in-the-desir-cohort/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/markers-of-non-compliance-with-asaseular-management-recommendations-among-early-spa-patients-evidence-over-3-years-in-the-desir-cohort/