Radiographic versus non-radiographic axial spondyloarthritis: comparison of daily self-reported flare experience

Rosie Barnett, Stanley Ng, Charlotte Cavill, Raj Sengupta

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Introduction. Axial spondyloarthritis (axSpA) is a chronic, inflammatory condition of the spine; comprised of radiographic (ankylosing spondylitis-AS) and non-radiographic (nr-axSpA) disease. Although nr-axSpA is considered an earlier stage of disease, the natural history of axSpA remains to be elucidated. Daily tracking of subtle changes in symptoms, disease activity and disease flares via smartphone technologies may facilitate further understanding of the axSpA disease spectrum.
Methods. At the Royal National Hospital for Rheumatic Diseases, patients with axSpA can log daily self-reported symptoms, behaviour and flare experience between clinic appointments via the Project Nightingale smartphone app. Users with ≥10 days of data entry were included for the analysis. Baseline (date closest to app registration) clinical measures collected at hospital appointments were also assessed. Mean (SD) daily symptom scores, behaviour, flare on/off values and baseline characteristics were reported for AS versus nr-axSpA. Welch’s t-test was used to assess differences between diagnoses.
Results. Between 5th April 2018-1st April 2020, 179 patients consented to research and 137 logged ≥10 days of data in the Project Nightingale app. Results are presented in Table 1. Experience of flare was similar in terms of frequency, duration and symptom patterns for patients with AS and nr-axSpA. Although, individuals with nr-axSpA maintained slightly higher levels of recommended exercise during flare (mean 3.7 versus 3.2, p=0.03). Anti-inflammatory use was significantly greater during flare for individuals with AS versus nr-axSpA (58.4% versus 37.9%, p=0.03). While caffeine intake reduced during flare for patients with AS, it increased for patients with nr-axSpA (-0.08 versus 0.13, p=0.003). Baseline disease activity (BASDAI) was greater in nr-axSpA than AS (4.4 versus 3.4), this difference exceeding the minimal clinically important difference for BASDAI, although not statistically significant (p=0.08).
Conclusions. Experience of flare is similar in AS and nr-axSpA, including frequency, duration and symptoms. However, exercise and medication behaviour during flare differed. Burden of disease is similar in AS and nr-axSpA.

Acknowledgements. UCB supported use of the Project Nightingale smartphone application, hosted by uMotif. The time of R Barnett was funded by the Sir Halley Stewart Trust.
Original languageEnglish
Number of pages1
JournalClinical and Experimental Rheumatology
Issue number5
Publication statusPublished - 31 Aug 2021
EventTwelfth International Congress on Spondyloarthitides - Ghent, Belgium
Duration: 9 Sept 202111 Sept 2021


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