Understanding flare in axial spondyloarthritis: novel insights from daily self-reported flare experience

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Abstract

Objectives
Our objective was to explore daily self-reported experience of axial spondyloarthritis (axSpA) flare based on data entered into the Project Nightingale smartphone app (www.projectnightingale.org), between 5th April 2018 - 1st April 2020.

Methods
Paired t-tests were conducted for mean_flare_on and mean_flare_off scores for each recorded variable. Mean estimated difference between flare and non-flare values for each variable was calculated with 95% confidence intervals (CI). Mean, standard deviation (SD) and range were reported for flare duration and frequency. Participants with ≥10 days of data entry were included for affinity propagation cluster analysis. Baseline characteristics and mean flare on versuss flare off values were reported for each cluster. Welch’s t-test was used to assess differences between clusters.

Results
143/189 (75.7%) participants recorded at least 1 flare. Each flare lasted a mean of 4.30 days (SD 6.82 days, range 1–78 days), a mean frequency of once every 35.32 days (SD 65.73, range 1–677 days). Significant relationships were identified between flare status and variable scores. Two clusters of participants were identified with distinct flare profiles. Group 1 experienced less severe worsening of symptoms during flare in comparison to Group 2 (p < 0.01). However, they experienced significantly longer flare duration (7.2 versuss 3.5 days, p < 0.01); perhaps indicating a prolonged, yet less intense flare experience. Groups were similar in terms of flare frequency and clinical characteristics.

Conclusions
Two clusters of participants were identified with distinct flare experiences, but similar baseline clinical characteristics. Smartphone technologies capture subtle changes in disease experience, not currently considered in clinical practice.
Original languageEnglish
Pages (from-to)1-10
JournalRheumatology Advances in Practice
Volume5
Issue number3
Early online date15 Nov 2021
DOIs
Publication statusPublished - 31 Dec 2021

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