Date: Monday, October 22, 2018
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Ankylosing Spondylitis Disease Activity Score (ASDAS) was adopted to evaluate the degree of disease activity and the inflammatory response in AS patients. ASDAS score ≤1.3 represents inactive disease (ID) status and achievement of T2T. Hospital anxiety and depression scale (HADS) is commonly used to evaluate the mental health of chronic disease patients.
The purpose of this study is to evaluate pattern shifts and outcome trends of treat-to-target (T2T) under standard of care in ankylosing spondylitis (AS) patients and potential correlation between disease activity and mental health with interactive Smart System of Disease Management (SSDM).
Methods: SSDM is a set of disease management tool based on mobile internet. The patients were trained to master SSDM by health care professionals and conducted their ASDAS and HADS self-evaluations, then were required for repeated self-evaluation after leaving the hospital. After data entry, patients can synchronize data to the mobile terminal of their authorized rheumatologist.
Results: From Jan 2015 to May 2018, 8,175 AS patients from 373 hospitals registered on SSDM, with mean age of 34.17 ± 11.22 years and mean disease duration of 45.01 ± 56.42 months. Among them, 5,480 patients performed ASDAS evaluation at least once, totally 9,601 times; 1,368 (male 906, female 462) patients carried out repeated evaluation for 4,121 times and 551 patients performed HADS for 970 times during >6 months follow-up.
Among patients repeated evaluate ASDAS, the final T2T rate was significantly increased to 38% from the baseline rate of 23% (χ2 = 468.253, p <0.001) after median evaluation of 3 (2-29) times per patient. The mean score of ASDAS decreased from 2.22 ± 1.08 to 1.83 ± 1.07 (mean improvement -0.39 ± 0.58, p <0.001). Among T2T patients in baseline (318/1,368, 23%), 214/318 (67%) remained T2T and 104/318 (33%) relapsed at the end of follow-up. Among patients failed to T2T at baseline (1,050/1,368, 77%), 300/1,050 (29%) patients achieved T2T and 750/1,050 (71%) patients remain failure of T2T. The mean evaluation interval of the T2T achievers was significantly shorter than that of the failures (25 days vs. 42 days and 27 days vs. 40 days, p <0.05). Analysis of the correlation between ASDAS and HADS showed that patients who achieved T2T had lower depress morbidity compared with the group which didn’t achieve T2T (13% vs 27%, p<0.05), but there was no difference of anxiety morbidity between the two subgroups (17% vs 21%, p>0.05).
Conclusion: Significant improvement is observed under applying SSDM through empowering patients. The depress morbidity is higher in AS patients doesn’t achieve T2T but anxiety stay same. Regularly performing self-management with SSDM associates with the achievements of maintaining T2T pattern and converting the patterns from failure of T2T to T2T. SSDM warrant a further evaluation and clinical application.
To cite this abstract in AMA style:Xue J, Song H, Yang J, Zhang Z, Li C, Li H, Wu Z, Wei H, Huang J, Wang H, Li Y, Wang X, Wu H, Zhang M, Jia Y, Xiao H, Xiao F, Wu H. Patterns and Outcomes on As Patients Disease Activity Using Smart System of Disease Management (SSDM): Analysis of T2T Pattern Shift and the Correlation between Disease Activity and Mental Health [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/patterns-and-outcomes-on-as-patients-disease-activity-using-smart-system-of-disease-management-ssdm-analysis-of-t2t-pattern-shift-and-the-correlation-between-disease-activity-and-mental-health/. Accessed January 18, 2020.
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