Swiss Ankylosing Spondylitis Association

Background:The Swiss ankylosing spondylitis association (SVMB) aims to implement exercise recommendations [1] for individuals with axial spondyloarthritis (axSpA). A digital training diary (Trainingslog) was developed to promote physical activity (PA) through self-monitoring and feedback and be used for PA counselling [2]. Usability is considered a key factor for the acceptance and use of a mobile health intervention [3] and is defined in terms of user performance and satisfaction and acceptance in terms of product usage [4]. Feasibility indicates the extent to which an innovation can be successfully used or implemented in a particular organisation or environment [5]. The quality of the mobile Health Intervention, as well as the adherence of the end-users is essentially influenced by the knowledge of usability, feasibility and acceptance of the Trainingslog.Objectives:To evaluate usability, feasibility and acceptance of the Trainingslog among individuals with axSpA and their physiotherapists (PTs) and to provide recommendations for further development.Methods:The study has an explanatory sequential mixed-methods design and was performed among the potential end-users of the Trainingslog. Within the development of the Trainingslog a user-centered approach was persued in which the opinions of users were taken into account at every stage of the development process.2 Data were collected through the questionnaires System Usability Scale (SUS, 0-100 scale) and user version of the Mobile App Rating Scale (uMARS, 5 point scale), number of training entries and semi-structured online focus groups or individual interviews. Ethical approval was obtained (BASEC-NR. Rec-2022-00578).Results:A total of 11 PTs and 10 individuals with axSpA participated. The quantitative data showed mean SUS scores for usability of: 82.5 (SD 21.76) for PTs and 77.0 (SD 9.34) for individuals with axSpA, and mean uMARS sector B scores for feasibility of: 4.2 (SD 0.49) for PTs and individuals with axSpA: 4.1 (SD 0.38). Acceptance was given according to the results of the uMARS (Sector E and F mean score >3 in both groups), but lower than expected agreement of the training entries (matching training entries in the Trainingslog and paper diary: 59.86%). The result of the qualitative data analysis revealed good usability and feasibility, but lower acceptance, which is mainly due to the web-based link instead of an app version.Conclusion:The Trainingslog exhibits good usability and feasibility among individuals. Therefore, it shows potential to be used by PTs in PA counselling or as self-monitoring tool for individuals with axSpA. However, to increase acceptance, it is recommended to provide the Trainingslog in an app-based version and implement other suggestions for improvement.REFERENCES:[1] Rausch Osthoff A-K, Niedermann K, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis 2018;77:1251–60.[2] McCurdie T, et al. mHealth Consumer Apps: The Case for User-Centered Design. Biomed Instrum Technol 2012;46:49–56.[3] Zapata BC, et al. Empirical Studies on Usability of mHealth Apps: A Systematic Literature Review. J Med Syst 2015;39:1.[4] Bevan N, et al. What is Usability. Proc 4th Int Conf HCI 1991.[5] Proctor E, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Adm Policy Ment Health Ment Health Serv Res 2011;38:65–76.Acknowledgements:Thanks to all PTs and individuals with axSpA for participation.Disclosure of Interests:None declared.

ObjectiveTo investigate sex differences in spinal radiographic progression in axial spondyloarthritis (axSpA).MethodsAxSpA patients in the Swiss Clinical Quality Management cohort with available spinal radiographs every 2 years were included. Paired radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Progression was defined as an increase of ≥2 mSASSS units in 2 years. The relationship between sex and progression was investigated with binomial generalised estimating equation models, considering baseline spinal damage as an intermediate covariate. Additional analyses included adjustments for explanatory variables and multiple imputations for missingness.ResultsIn a total of 505 axSpA patients (317 men and 188 women), mean±SD radiographic progression over 2 years was 1.0±2.8 years in men and 0.3±1.1 years in women (p<0.001). Male sex was associated with enhanced progression in a small model not including baseline damage (OR 3.41, 95% CI 1.87 to 6.21). Both a direct effect of male sex on spinal progression, and an indirect effect, via enhancement of baseline spinal damage were significant (OR 2.06, 95% CI 1.15 to 3.67 and OR 1.04, 95% CI 1.01 to 1.07, respectively). A significant impact of male sex on spinal radiographic progression was still demonstrated after multiple adjustments for covariates known to potentially affect spinal radiographic progression (OR 1.97, 95% CI 1.04 to 3.71).ConclusionsSpinal radiographic progression in axSpA is more severe in men than in women, with three times higher odds of progression in male patients and an effect that is mediated in part through an increase in baseline radiographic damage.

ObjectivesTo analyse the effect of tumour necrosis factor inhibitors (TNFi) on sacroiliac joint (SIJ) radiographic progression in axial spondyloarthritis (axSpA).MethodsPatients with axSpA in the Swiss Clinical Quality Management cohort with up to 12 years of follow-up and radiographic assessments every 2 years were included. SIJs were scored by two readers according to the modified New York criteria blinded to chronology. The relationship between TNFi use before or during a 2-year radiographic interval and SIJ progression was investigated using generalised estimating equation models with adjustment for potential confounding. Progression was defined as worsening of ≥1 grade in ≥1 SIJ and ignoring a change from 0 to 1 over 2 years, if both readers agreed. A third reading of radiographs was integrated in sensitivity analyses.ResultsA total of 515 patients with axSpA contributed to data for 894 radiographic intervals (24 progression events). In patients with complete covariate data, prior use of TNFi reduced the odds of progression (OR 0.21, 95% CI 0.07 to 0.65). A comparable effect was found for use of TNFi for ≥1 year within a 2-year radiographic interval (OR 0.21, 95% CI 0.08 to 0.55). The inhibitory impact of TNFi was confirmed if progression was demonstrated in 2/3 readings: OR 0.50, 95% CI 0.28 to 0.89 and OR 0.46, 95% CI 0.27 to 0.78 for TNFi treatment before and for ≥1 year within the interval, respectively.ConclusionTNFi are associated with deceleration of SIJ radiographic progression in patients with axSpA if treatment is continued for ≥1 year.

NSAIDs are the first-line medical therapy for patients with axial spondyloarthritis including ankylosing spondylitis and also play an important role for the treatment of the peripheral manifestations of the disease. In this chapter, data about clinical efficacy, influence on systemic and local inflammation as seen by C-reactive protein and active inflammation as seen on MRI, influence on radiographic progression and safety issues of NSAID therapy will be discussed.

Individual inflammatory and autoimmune diseases are discrete clinical entities. The clinical presentation of any specific inflammatory disease is the culmination of complex interactions between genetics, primary and secondary immune effector mechanisms, and environmental triggers. Although often different in clinical presentation, common cellular and molecular immune pathways have been shown to be intimately involved in the destruction of different target tissues in different disease states, which ultimately defines specific diseases. At the genetic level, comparative genomic analysis of autoimmune and inflammatory disorders suggests shared genetic components for these clinically related diseases. This leads to a common genetic hypothesis which states that, unlike classical mendelian genetic disorders, common autoimmune and inflammatory disorders arise from combinatorial interactions of common non-disease specific loci, disease specific loci, and specific environmental triggers.