Improvement of Disease Management and Cost Effectiveness in Chinese Patients with Ankylosing Spondylitis Using a Smart-phone Management System: A Prospective Cohort Study (Preprint)
Authors: Ji Xiaojian , Wang Yiwen , Ma Yingpei , Hu Zhengyuan , Man Siliang , Zhang Ying , Li Kunpeng , Yang Jinshui , Zhu Jian , Zhang Jianglin , Luo Yiming , Huang Feng 
Published: October 2018

BACKGROUND

Ankylosing spondylitis (AS) is a chronic disease that mainly affects the axial skeleton, leading to decreased mobility, function, and quality of life. With the advent of mobile health (mHealth) technologies, it is now possible to create more economical, sustainable, and user-friendly communication and health monitoring systems to improve the effectiveness of patient care and to gather real-world clinical data for clinical research.

OBJECTIVE

To introduce “smart-phone Spondyloarthritis Management System” (SpAMS), an interactive mobile health (mHealth) tool, specifically designed for longitudinal disease management and prospective ankylosing spondylitis (AS)/spondyloarthritis (SpA) and to evaluate the clinical profile of Chinese (AS) patients.

METHODS

SpAMS integrates the patient’s portal and the physician’s portal in a cell phone application. By using SpAMS, Chinese Ankylosing Spondylitis Prospective Imaging Cohort (CASPIC) was launched from April 2016. All patients fulfilled the 1984 modified New York criteria. Patient self-assessments were completed online at baseline and at every subsequent clinic visit. Physician-reported assessments and treatment regimens were recorded by rheumatologists during each visit.

RESULTS

In total, 1201 AS patients [mean (SD) age, 30.6 (8.7) years; male, 82.6%] were recruited. The mean (SD) disease duration was 8.4 (6.1) years. A history or current symptoms suggestive of acute anterior uveitis (AAU), psoriasis, and inflammatory bowel disease (IBD) were observed in 21.0%, 3.7%, and 9.4% of the patients, respectively. AAU and IBD were found significantly more in patients with a symptom duration > 10 years (31.1%, 12.5%, respectively). At the baseline visit, the most commonly used medications were non-steroidal anti-inflammatory drugs (NSAIDs) (98.2%). Patients using tumor necrosis factor inhibitors (TNFi) accounted for 20.8% of enrolled patients. Additionally, 66.4% of patients used conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs). At baseline, the percentage of patients with inactive disease (ID)/low disease activity (LDA) was 57.2%, and this value improved significantly 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 < .001). By solving problems in SpAMS, 29.1% of clinic visits were unnecessary and therefore time had been saved. At least an average of 5.3 hours and 327.4 RMB per person spent on traffic was saved through SpAMS. The saved traffic expenses were equal to 16% of the Chinese monthly disposable personal income.

CONCLUSIONS

SpAMS is a time- and cost-saving disease management tool, helping AS patients perform self-management and providing valuable data to clinicians. This is the first nationwide real-world study of AS patients in China who use mHealth technology, and our results contribute significantly to characterizing the clinical profiles of Chinese patients with AS.