Pattern and Influential Factors in Promoting Treat-to-Target (T2T) for Follow-up of Ankylosing Spondylitis (AS) Patients with a Rheumatologist-patient Interactive Smart System of Disease Management (SSDM): A Cohort Study from China

Jing Xue¹, Hui Song ², Hongzhi Wang ³, Jianlin Huang ⁴, Wenqiang Fan ⁵, Hua Wei ⁶, Hongbin Li ⁷, Weili Liu ⁸, Jin Zhang ⁹, Henglian Wu ¹⁰, Bei Wang ¹¹, Jianhua Xu ¹², Yan Huang ¹³, Hongjun Zhao ¹⁴, Zhiguo Wang ¹⁵, Zhiyong Huang ¹⁶, Xiaohong He ¹⁷, Wenhui Huang ¹⁸, Qiwen Ma ¹⁹, Bing Wu ²⁰, Yuhua Jia ²¹, Yuan Liu ²², Hui Xiao ²², Fei Xiao ²³ and Huaxiang Wu ¹, ¹The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (People's Republic), ²Beijing Jishuitan Hospital, Beijing, Beijing, China (People's Republic), ³JiaXing First Hospital, Jiaxing, Zhejiang, China (People's Republic), ⁴The sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (People's Republic), ⁵Central Hospital of XinXiang, Xinxiang, Hainan, China (People's Republic), ⁶Northern Jiangsu People's Hospital, Yangzhou, China (People's Republic), ⁷The Affiliated Hospital of Inner Mongolia Medical University, Huhehaote, Nei Mongol, China (People's Republic), ⁸Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China (People's Republic), ⁹[email protected], Ningbo, Zhejiang, China (People's Republic), ¹⁰Dongguan donghua hospital, Dongguan, Guangdong, China (People's Republic), ¹¹Beijing Hospital of Traditional Chinese Medicine, Beijing, Beijing, China (People's Republic), ¹²First Affiliated Hospital of Medical University Of Anhui, Hefei, Anhui, China (People's Republic), ¹³North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China (People's Republic), ¹⁴The First Xiangya Hospital of Central South University, Changsha, Hunan, China (People's Republic), ¹⁵Tangshan Gongren Hospital, Tangshan, Hebei, China (People's Republic), ¹⁶Huizhou First Hospital, Huizhou, Guangdong, China (People's Republic), ¹⁷Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, Guangdong, China (People's Republic), ¹⁸The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (People's Republic), ¹⁹The First People's Hospital of Foshan, Foshan, Guangdong, China (People's Republic), ²⁰Shanghai Gothic Internet Technology Co., Ltd, Shanghai, China (People's Republic), ²¹Shanghai Gothic Internet Technology Co., Ltd., Shanghai, Shanghai, China (People's Republic), ²²Shanghai Gothic Internet Technology Co., Ltd, Shanghai, Shanghai, China (People's Republic), ²³Shanghai Gothic Internet Technology Co., Ltd., shanghai, China (People's Republic)

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Ankylosing spondylitis (AS), self-management and online patient engagement

Session Information

Date: Sunday, November 10, 2019

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster I: Axial Spondyloarthritis, Clinical Features

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Ankylosing Spondylitis Disease Activity Score (ASDAS) is adopted to evaluate the degree of disease activity and the inflammatory response in AS patients. ASDAS score ≤ 1.3 represents inactive disease status and achievement of T2T.
The objective of this study is to evaluate the patterns of T2T and related influential factors among AS patients after applying SSDM in the real world.

Methods: SSDM is a mobile application for disease management. Patients were trained to master SSDM by healthcare professionals and to conduct ASDAS self-assessments. Patients were also required for repeating self-assessments after leaving the hospital. After entry by patients, data can synchronized to the SSDM terminal of authorized rheumatologists.

Results: From Jan 2015 to May 2019, 13,820 AS patients enrolled in SSDM with the mean age of 33.92±12.61 years old. And median disease duration is 2.91 years. 801 AS patients from 120 hospitals across China were followed up for more than 6 months through SSDM. The results at baseline and in final follow up were summarized in Table 1.
The rate of T2T achievers were 28.34% (227/801) at baseline, and improved significantly to 40.57% (325/801) after 6 months follow up, p< 0.01. Among T2T achievers at baseline, 64.76% (147/227) maintained T2T, 35.24% (80/227) relapsed. Of patients who didn’t achieve T2T at baseline, only 31.01% (178/574) of the other AS patients achieved T2T after 6 months follow up. We further analyzed the impact of the times of self-assessment for ASDAS on T2T. The patients were stratified according to their frequency of self-assessment: more than 3 times, less than or equal to 3 times self-assessments within 6 months follow-up. Results show that the more frequent of the self-assessment, the higher improvement of T2T rate (17.66% vs. 8.35%, Table 2). A linear regression analysis of variables in statistics and parameter estimation was conducted by least square method. The improvement of T2T rate(y) was positively correlated with times of self-assessment for ASDAS(x) independently. The regression equation as “y = 0.0268x + 0.0535 R2 = 0.7989”, p< 0.01. (Figure 1)

Conclusion: Significant improvement was observed under applying SSDM through empowering AS patients. After proactive disease management via SSDM for more than 6 months, Patients with ASDAS≤1.3 score at baseline had a significantly higher retention rate of disease activity. The patients who performed more self-assessments through SSDM had lower probability of relapse and higher rate of T2T. SSDM is a valuable tool for long term follow-up through empowering patients.

Table 1 The T2T results at baseline and in final follow up.

Table 2 The patients were stratified according to their frequency of self-assessment: more than 3 times, less than or equal to 3 times self-assessments within 6 months follow-up.

Figure 1. The improvement of T2T rate-y- was positively correlated with times of self-assessment for ASDAS-x- independently. The regression equation as “y = 0.0268x + 0.0535 R2 = 0.7989”, p<0.01.

Disclosure: J. Xue, None; H. Song, None; H. Wang, None; J. Huang, None; W. Fan, None; H. Wei, None; H. Li, None; W. Liu, None; J. Zhang, None; H. Wu, None; B. Wang, None; J. Xu, None; Y. Huang, None; H. Zhao, None; Z. Wang, None; Z. Huang, None; X. He, None; W. Huang, None; Q. Ma, None; B. Wu, None; Y. Jia, None; Y. Liu, None; H. Xiao, None; F. Xiao, None; H. Wu, None.

To cite this abstract in AMA style:

Xue J, Song H, Wang H, Huang J, Fan W, Wei H, Li H, Liu W, Zhang J, Wu H, Wang B, Xu J, Huang Y, Zhao H, Wang Z, Huang Z, He X, Huang W, Ma Q, Wu B, Jia Y, Liu Y, Xiao H, Xiao F, Wu H. Pattern and Influential Factors in Promoting Treat-to-Target (T2T) for Follow-up of Ankylosing Spondylitis (AS) Patients with a Rheumatologist-patient Interactive Smart System of Disease Management (SSDM): A Cohort Study from China [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/pattern-and-influential-factors-in-promoting-treat-to-target-t2t-for-follow-up-of-ankylosing-spondylitis-as-patients-with-a-rheumatologist-patient-interactive-smart-system-of-disease-management-s/. Accessed .

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