Wearable activity tracker study exploring rheumatoid arthritis patients' disease activity using patient-reported outcome measures, clinical measures, and biometric sensor data (the wear study)

Background

Digital health studies using electronic patient reported outcomes (ePROs), wearables, and clinical data to provide a more comprehensive picture of patient health.

Methods

Newly initiated patients on upadacitinib or adalimumab for RA will be recruited from community settings in the Excellence NEtwork in RheumatoloGY (ENRGY) practice-based research network. Over the period of three to six months, three streams of data will be collected (1) linkable physician-derived data; (2) self-reported daily and weekly ePROs through the ArthritisPower registry app; and (3) biometric sensor data passively collected via wearable. These data will be analyzed to evaluate correlations among the three types of data and patient improvement on the newly initiated medication.

Conclusions

Results from this study will provide valuable information regarding the relationships between physician data, wearable data, and ePROs in patients newly initiating an RA treatment, and demonstrate the feasibility of digital data capture for Remote Patient Monitoring of patients with rheumatic disease.

Home-Based Telemedicine in Rheumatology-A Scoping Review

OBJECTIVE

We performed a scoping review of the relevant literature on home-based telehealth in rheumatology to understand its appropriate application in rheumatology practice.

METHODS

We searched the Cochrane Library, PubMed, Web of Science, and scientific meeting abstracts to identify articles that specifically addressed telehealth suitability, barriers to telehealth, patient-reported outcomes (PROs) collected in telehealth settings, and telehealth satisfaction. From the initial search of 4,882 studies, 23 reports were included. In addition, 10 abstracts were also eligible for analysis, resulting in a total of 33 articles: 2 randomized clinical trials, 9 prospective cohort studies, and 22 retrospective studies.

RESULTS

We found that triage appointments or predictive models could be helpful in selecting patients for telehealth and that telehealth interventions were appropriate for follow-up of patients with systemic lupus erythematosus and inflammatory arthritis, but that conducting new patient visits over telehealth was not ideal. Barriers to telehealth include patient factors (age, technology access) and need for physician/process factors (eg, physical examinations). PROs collected in regular practice can be incorporated into telehealth. Several small, single-center studies suggest that telehealth does not lead to negative outcomes compared with in-person visits, and overall, patients report high patient satisfaction with telehealth. In several scenarios, home-based telehealth was equivalent to in-person visits with regard to patient outcomes and satisfaction.

CONCLUSION

The widespread potential of telehealth to manage and deliver care for people with rheumatic disease is significant. As such, further research in the form of randomized controlled trials can help contribute to growing evidence that shapes telehealth implementation for patients with rheumatic diseases.

COVID-19 Vaccine Uptake, Hesitancy, and Flare in a Large Rheumatology Practice Network

OBJECTIVE

The goal of this study was to ascertain COVID-19 vaccine uptake, reasons for hesitancy, and self-reported flare in a large rheumatology practice-based network.

METHODS

A tablet-based survey was deployed by 108 rheumatology practices from December 2021 to December 2022. Patients were asked about COVID-19 vaccine status and why they might not receive a vaccine or booster. We used descriptive statistics to explore the differences between vaccination status and vaccine and booster hesitancy, comparing patients with and without autoimmune and inflammatory rheumatic diseases (AIIRDs). We used multivariable logistic regression to examine the association between vaccine uptake and AIIRD status and self-reported flare and AIIRD status. We reported adjusted odds ratios (aORs).

RESULTS

Of the 61,158 patients, 89% reported at least one dose of vaccine; of the vaccinated, 68% reported at least one booster. Vaccinated patients were less likely to have AIIRDs (44% vs 56%). A greater proportion of patients with AIIRDs were vaccine hesitant (14% vs 10%) and booster hesitant (21% vs 16%) compared to patients without AIIRDs. Safety concerns (28%) and side effects (23%) were the main reasons for vaccine hesitancy, whereas a lack of recommendation from the physician was the primary factor for booster hesitancy (23%). Patients with AIIRD did not have increased odds of self-reported flare or worsening disease compared to patients without with AIIRD (aOR 0.99, 95% confidence interval [CI] 0.94-1.05). Among the patients who were vaccine hesitant and booster hesitant, 12% and 39% later reported receiving a respective dose. Patients with AIIRD were 32% less likely to receive a vaccine (aOR 0.68, 95% CI 0.65-0.72) versus patients without AIIRD.

CONCLUSION

Some patients who are vaccine and booster hesitant eventually receive a vaccine dose, and future interventions tailored to patients with AIIRD may be fruitful.

Participant Engagement and Adherence to Providing Smartwatch and Patient-Reported Outcome Data: Digital Tracking of Rheumatoid Arthritis Longitudinally (DIGITAL) Real-World Study

BACKGROUND

Digital health studies using electronic patient-reported outcomes (ePROs) and wearables bring new challenges, including the need for participants to consistently provide trial data.

OBJECTIVE

This study aims to characterize the engagement, protocol adherence, and data completeness among participants with rheumatoid arthritis enrolled in the Digital Tracking of Arthritis Longitudinally (DIGITAL) study.

METHODS

Participants were invited to participate in this app-based study, which included a 14-day run-in and an 84-day main study. In the run-in period, data were collected via the ArthritisPower mobile app to increase app familiarity and identify the individuals who were motivated to participate. Successful completers of the run-in period were mailed a wearable smartwatch, and automated and manual prompts were sent to participants, reminding them to complete app input or regularly wear and synchronize devices, respectively, during the main study. Study coordinators monitored participant data and contacted participants via email, SMS text messaging, and phone to resolve adherence issues per a priori rules, in which consecutive spans of missing data triggered participant contact. Adherence to data collection during the main study period was defined as providing requested data for >70% of 84 days (daily ePRO, ≥80% daily smartwatch data) or at least 9 of 12 weeks (weekly ePRO).

RESULTS

Of the 470 participants expressing initial interest, 278 (59.1%) completed the run-in period and qualified for the main study. Over the 12-week main study period, 87.4% (243/278) of participants met the definition of adherence to protocol-specified data collection for weekly ePRO, and 57.2% (159/278) did so for daily ePRO. For smartwatch data, 81.7% (227/278) of the participants adhered to the protocol-specified data collection. In total, 52.9% (147/278) of the participants met composite adherence.

CONCLUSIONS

Compared with other digital health rheumatoid arthritis studies, a short run-in period appears useful for identifying participants likely to engage in a study that collects data via a mobile app and wearables and gives participants time to acclimate to study requirements. Automated or manual prompts (ie, "It's time to sync your smartwatch") may be necessary to optimize adherence. Adherence varies by data collection type (eg, ePRO vs smartwatch data).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/14665.

Understanding Heterogeneity in Patients' Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis

OBJECTIVE

Uptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management is low. Our objective was to understand the heterogeneity in patients' conceptualisation of RA treatment to inform interventions improving TTT uptake.

DESIGN

Eligible participants recruited from an online research registry rated 56 items (on 5-point scales) reflecting concepts raised from patient interviews. Using items describing adhering to physician recommendations to create a binary criterion variable for medication adherence, we conducted a principal components analysis on the remaining items using Varimax rotation, describing how these factors predict adherence over and above demographic characteristics. We further use optimal sets in regression to identify the individual concepts that are most predictive of medication adherence.

RESULTS

We found significant heterogeneity in patients' conceptualisation of RA treatment among 621 persons with RA. A scree plot revealed a four-factor solution explained 38.4% of the variance. The four factors expected to facilitate TTT uptake were (% variance explained): (1) Access to high quality care and support (11.3%); (2) low decisional conflict related to changing disease-modifying antirheumatic drugs (DMARDs) (10.1%); (3) endorsement of a favourable DMARD risk/benefit ratio (9.9%); and (4) confidence that testing reflects disease activity (7.2%). These factors account for 13.8% of the variance in full medication adherence, fully explaining the only significant demographic predictor, age of the patient. The individual items most predictive of poor adherence centre on the lack of effective patient-physician communication, specifically insufficient access to information from rheumatologists, along with the need to seek information elsewhere.

CONCLUSION

Patients' conceptualisation of RA treatment varies; however, almost all patients have difficulty escalating DMARDs, even with access to quality information and an understanding of the benefits of TTT. Tailored interventions are needed to address patient hesitancy to escalate DMARDs.

Patient Perceptions of Rheumatoid Arthritis Blood Work: A Cross-Sectional Survey in the ArthritisPower Registry

OBJECTIVE

To examine how patients with rheumatoid arthritis (RA) perceive RA-related laboratory testing and the potential utility of a blood test to predict treatment response to a new RA medication.

METHODS

ArthritisPower members with RA were invited to participate in a cross-sectional survey on reasons for laboratory testing plus a choice-based conjoint analysis exercise to determine how patients value different attributes of a biomarker-based test to predict treatment response.

RESULTS

Most patients perceived that their doctors ordered laboratory tests to check for active inflammation (85.9%) or assess medication side effects (81.2%). The most commonly ordered blood tests used to monitor RA were complete blood counts, liver function tests, and those measuring C-reactive protein (CRP) and erythrocyte sedimentation rate. Patients felt CRP was most helpful in understanding their disease activity. Most worried their current RA medication would eventually stop working (91.4%) and they would waste time trying a new RA medication that may not work for them (81.7%). For patients who would require a future change in RA treatment, a majority (89.2%) reported that they would be very/extremely interested in a blood test that could help predict whether such new medication would be effective. Highly accurate test results (improving the chance RA medication will work from 50% to 85-95%) were more important to patients than low out-of-pocket cost (<$20) or minimal wait time (<7 days).

CONCLUSIONS

Patients consider RA-related blood work important for monitoring of inflammation and medication side effects. They worry about treatment effectiveness and would undergo testing to accurately predict treatment response.

Engaging Multistakeholder Perspectives to Identify Patient-Centered Research Priorities Regarding Vaccine Uptake Among Adults With Autoimmune Conditions

OBJECTIVE

The study objective was to prioritize topics for future patient-centered research to increase uptake of common vaccines, such as for pneumococcal pneumonia, influenza, herpes zoster, human papillomavirus, and severe acute respiratory syndrome coronavirus 2, among adults living with autoimmune conditions.

METHODS

A steering committee (SC) was formed that included clinicians, patients, patient advocates, and researchers associated with rheumatic diseases (psoriatic arthritis, rheumatoid arthritis, vasculitis), inflammatory bowel disease, and multiple sclerosis. Through a scoping review and discussions, SC members identified research topics regarding vaccine uptake and/or hesitancy for prioritization. A larger multistakeholder alliance that included patients and patient advocates, clinicians, researchers, policy makers, regulators, and vaccine manufacturers conducted a modified Delphi exercise online with three rating rounds and one ranking round. Frequency analysis and comparisons across stakeholder groups were conducted. A weighted ranking score was generated for each item in the ranking round for final prioritization.

RESULTS

Through the Delphi process, 33 research topics were identified, of which 13 topics were rated as critical by more than 70% of all stakeholders (n = 31). The two highest ranked critical topics per the full stakeholder group were "How well a vaccine works for adults with autoimmune conditions" and "How beliefs about vaccine safety affect vaccine uptake."

CONCLUSION

A multistakeholder group identified key topics as critically important priorities for future research to decrease vaccine hesitancy and improve uptake of vaccines for adults with autoimmune conditions.

Balancing COVID-19 Risk With Physical and Mental Wellness: Perspectives of Patients With Autoimmune Rheumatic Diseases Throughout the Pandemic

OBJECTIVE

Patients with autoimmune rheumatic diseases (ARDs) are at greater risk of COVID-19 infection and hospitalization, increasing the stress and uncertainty already associated with unpredictable conditions. These may be heightened for patients with ARDs from underrepresented minority backgrounds. This study aimed to explore patient experiences and ARD-related challenges during the first year of the pandemic.

METHODS

Between December 2020 and May 2021, 60-minute semistructured interviews were conducted with English- and Spanish-speaking adults, aged 18 years or older with self-reported diagnosis of ARD, via phone or videoconferencing using an interview guide on living with an ARD during the pandemic. Analysis combined methods of phenomenology and content analysis through three steps: 1) summarizing interviews, 2) iteratively refining units of meaning, and 3) axial and selective coding to determine cross-cutting themes. Study procedures were conducted by a multidisciplinary team, a majority also diagnosed with ARDs.

RESULTS

The research team interviewed 22 patients (39.8 ± 15.7 years old; 82.8% female; 31.8% Hispanic or Latino/a/x) with ARDs. Themes included 1) information access and understanding, 2) problem solving access to health care, 3) balancing risks, and 4) mental health implications. Within these themes, patients from underrepresented minority backgrounds faced unique challenges.

CONCLUSION

Patients with ARDs require direct and timely communication about their risk of COVID-19 morbidity and mortality and require increased support for psychosocial and ARD-related implications of the pandemic. Health care systems must consider ways to support patients who are balancing chronic disease management with risk reduction for contracting emerging COVID-19 variants.

POS0088-PARE CHANGES IN PATIENT-REPORTED OUTCOME SCORES DURING COVID-19 PANDEMIC: DATA FROM THE ArthritisPower REGISTRY

Background

The COVID-19 pandemic causes concern among patients with autoimmune and rheumatic disease (ARD) due to increased risk of infection and heightened isolation from social distancing.1

Objectives

Examine how mean patient-reported outcome (PRO) scores for mental, social and physical health fluctuated after COVID-19 vaccine availability was widespread in US.

Methods

We conducted and reported on2 an initial analysis of January 2020 – April 2021 where US participants (pts) of the ArthritisPower (AP) registry completed PROMIS measures of physical health (Physical Function, Pain Interference, Fatigue, Sleep Disturbance), mental health (Anger, Anxiety, Depression) and social health (Social Isolation, Emotional Support). Follow-up analysis was conducted May – December 2021. Only pts from initial analysis were included in follow-up. Null hypothesis was no change in monthly average scores across 23-month pandemic period. Analysis of means compared monthly assessment mean scores to overall mean score for each measure during study period. Pts with < 2 assessment time points and osteoarthritis with no ARD were excluded from analysis.

Results

Total of 49,940 PRO scores were contributed by 2,266 pts during 23-month period, with 8,393 of the scores contributed from May – December 2021. Mean (standard deviation, SD) number of observations per pt was 5.6 (12.5). Pts were 87.6% female, 86.7% white, mean age of 52.1 (12.7) years. Rheumatoid arthritis (n=1,131, 49.9%) was the most common condition. Most commonly reported measures were Pain Interference, Fatigue, Sleep Disturbance and Physical Function, each with >11,000 total results (Table 1).

Table 1.

Avg assessment scores+ by month, mean (SD)

Pain Interf (n= 11536)Fatigue (n= 11591)Sleep Disturb (n= 11257)Physical Func (n= 11202)Depression (n=1489)Anxiety (n= 1066)Social Iso (n=698)Emot Support (n=578)Anger (n=523)Study Period^63.3 (7.8)62.6 (9.5)58.1 (9.0)37.7 (7.6)60.8 (9.2)62.4 (10.5)61.9 (10.2)40.8 (9.8)61.5 (12.8)May 202161.9 (8.2)*60.9 (9.7)*55.2 (8.8)*38.9 (8.5)59.5 (9.2)61.9 (9.8)60.2 (13.3)38.1 (8.3)59.6 (14.5)June61.6 (6.9)*60.9 (9.6)*54.8 (8.9)*38.3 (7.8)59.2 (7.0)60.6 (9.6)61.8 (12.0)39.3 (10.3)60.2 (10.9)July61.8 (7.4)*60.8 (10.2)*56.0 (8.6)*38.1 (7.9)61.0 (7.8)59.9 (12.1)66.8 (8.5)*39.4 (9.7)62.4 (9.7)Aug61.2 (8.5)*60.7 (10.4)*55.8 (9.6)*38.5 (8.5)57.7 (7.9)*58.2 (10.3)*57.2 (11.1)36.9 (12.2)53.3 (19.4)Sep62.4 (8.5)62.3 (10.0)56.2 (8.3)37.3 (7.6)58.7 (8.0)57.7 (11.3)*68.1 (12.8)36.7 (12.1)58.7 (12.0)Oct63.1 (8.4)63.3 (9.9)57.6 (8.6)37.3 (8.0)59.9 (9.9)62.3 (9.0)64.3 (10.3)37.3 (11.4)64.6 (10.2)Nov62.6 (6.8)63.2 (10.0)55.8 (8.6)*36.9 (7.0)59.1 (8.8)61.3 (6.8)61.4 (10.9)38.6 (11.7)60.3 (12.4)Dec62.9 (8.3)64.0 (9.6)56.5 (8.4)37.4 (8.1)60.7 (8.4)63.8 (5.3)65.1 (7.5)38.5 (13.5)68.6 (5.0)*

+PROMIS measures scored 0-100; mean 50 for general US population; 1SD = 10 points

^Study period: January 2020 – December 2021

. *Statistical significance (p<0.05); analysis of means (ANOM)

Pts’ mental and social health assessment scores improved then worsened during last 8 months of 2021 (Figure 1). Overall mean scores were: Anxiety 62.4 (12.5), Social Isolation 61.9 (10.5), and Anger 61.5 (12.8). From July – August, Social Isolation decreased by 1 SD. Compared to overall assessment mean, Anger declined by > ½ SD (53.3 [19.4]) in August and Anxiety declined by ½ SD (57.7 [11.3]) in September. By December, Anger rose by > ½ SD (68.6 [5.0]) of assessment mean. Pain Interference (mean: 63.3 [7.8]), Fatigue (62.6 [9.5]), and Sleep Disturbance (58.1 [9.0]) scores were significantly lower in May, June, July and August compared to the assessment mean, though none decreased by > ½ SD.

Conclusion

ARD members of AP had mental, social and physical health scores improve during summer of 2021, corresponding with widespread availability of vaccines. However mental and social health scores worsened by December as US faced new variants of the virus.

References

[1]George M, et al. Rheumatol. 2021;48:603-7.

[2]Gavigan K, et al. Arth Rheumatol. 2021;73(suppl 10).

Acknowledgements

This work was partially supported through a Patient-Centered Outcomes Research Institute (PCORI) award (PPRN-1306-04811). All statements in this poster, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee.

Disclosure of Interests

Kelly Gavigan: None declared, Esteban Rivera: None declared, Jeffrey R. Curtis Consultant of: Gilead, Novartis, and Samsung, Grant/research support from: AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB, Shilpa Venkatachalam: None declared, Laura Stradford: None declared, David Curtis: None declared, W. Benjamin Nowell Grant/research support from: William B. Nowell is the Principal Investigator on grants/contracts from AbbVie, Eli Lilly and Company, and PCORI, and an employee of the Global Healthy Living Foundation (GHLF). GHLF receives grants, sponsorships and contracts from pharmaceutical manufacturers and private foundations. A full list of GHLF funders is publicly available here: https://www.ghlf.org/our-partners/.

POS1564-PARE EDUCATION TOPICS AND SMARTPHONE APP FUNCTIONS PRIORITIZED BY PEOPLE WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background

Generating information that people living with a rheumatic and musculoskeletal disease (RMD) find useful while making decisions about their treatment requires identifying and understanding educational needs and interests directly expressed from people living with RMD.

Objectives

To identify what types of information US adults with RMD perceive as important to know about their disease and how they express and prioritize such information.

Methods

Using nominal group technique, focus groups of participants (pts) with RMD generated sets of rank-order educational items which were then aggregated across groups into themes. Based on nominal group results, a survey with the final 28 items was administered online, along with a question about desired functions of a smartphone app for RMD, to members of the ArthritisPower registry in January 2022.

Results

Six nominal groups (n=47) yielded 28 unique items for the online survey of educational priorities. To date, a total of 570 pts completed the survey, of whom 85.4% were female, 89.5% white, mean age of 59.6 (SD 11.2) years. Rheumatoid arthritis (52.5%), osteoarthritis (16.0%), psoriatic arthritis (12.5%), and axial spondyloarthritis (7.5%) were the most common RMDs. Knowing how to tell when a medication is not working, how RMD affects other medical conditions, understanding the results of tests used to monitor their RMD, available treatment options and possible side effects, and how life will change as an RMD progresses were each items that > 75% of pts considered extremely important (Table 1). Top functions pts listed as useful for a smartphone app included being able to participate in research, view lab results, record symptoms or flares, share how they are doing with their provider, and get educational information about their disease (Table 2).

Table 1.

Top Education Topics Adults with Rheumatic and Musculoskeletal Disease Consider Extremely Important (N=570).

Itemn (%)Knowing when the medication is not working505 (88.6)Knowing how a rheumatologic condition can affect your other health conditions or medical issues481 (84.4)Understanding the results of tests used to monitor your condition471 (82.6)Knowing the side effects of available drugs, and how the drugs interact with each other461 (80.9)Finding the right rheumatologist453 (79.5)Having realistic expectations of the effectiveness of the medications445 (78.1)Knowing how the disease will progress, even if the news is bad439 (77.0)Knowing the available medications and treatments for your rheumatologic condition437 (76.7)Knowing how long it takes drugs to work436 (76.5)Understanding how your life will change as your disease progresses434 (76.1)Table 2.

Desired Smartphone App Functions Rated By Adults with Rheumatic and Musculoskeletal Disease (N=570).

App Functionn (%)Participate in patient-centered research299 (52.5)View my lab results283 (49.7)Record my symptoms (e.g. pain, fatigue) or disease flares to track my health over time278 (48.8)Record my symptoms and share how I am doing with my rheumatology provider to know if I am meeting my treatment goals230 (40.4)Get educational information about my disease225 (39.5)Keep track of the medications prescribed by doctor200 (35.1)Schedule and keep track of my medical appointments, rheumatology and other199 (34.9)Track the vaccines I get (i.e. vaccination record)188 (33.0)Help me improve some of my health habits (e.g. sleep, diet, exercise)187 (32.8)Keep track of my use of over-the-counter, complementary or alternative therapies (herbs, tinctures, acupuncture, massage, stretching, etc.)174 (30.5)Get support for my disease from trained patients with my same health condition (i.e. ‘peer coaching’)144 (25.3)

Conclusion

People with RMD prioritized information about medications and prognosis in educational materials, providing guidance for the development of educational tools. A sizeable minority felt educational materials were an important component of a smartphone app, but also identified other important features such as participation in research.

Disclosure of Interests

W. Benjamin Nowell Grant/research support from: Research support from AbbVie, Amgen, Eli Lilly and Scipher, Kelly Gavigan: None declared, Kimberly Garza: None declared, Alexis Ogdie: None declared, Michael George: None declared, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly and Company, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Merck, and Pfizer, Maria Danila: None declared, Shilpa Venkatachalam: None declared, Laura Stradford: None declared, Jeffrey Curtis Consultant of: AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Gilead, Janssen, Myriad, Novartis, Pfizer, Regeneron, Roche, and UCB, Grant/research support from: AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB

Medication Interruptions and Subsequent Disease Flares During the COVID-19 Pandemic: A Longitudinal Online Study of Patients With Rheumatic Disease

OBJECTIVE

We aimed to assess trends in anxiety and interruptions in disease-modifying antirheumatic drug (DMARD) use among patients with rheumatic diseases during the COVID-19 pandemic and to evaluate whether DMARD interruptions were associated with disease flares.

METHODS

ArthritisPower, the Vasculitis Patient-Powered Research Network, and other patient organizations invited members to join a 52-week longitudinal study, with baseline surveys completed March 29 to June 30, 2020, with follow-up through May 2021. Logistic regression incorporating generalized estimating equations evaluated associations between interruptions in DMARD use and self-reported disease flares at the next survey, adjusting for demographic characteristics, medications, disease, and calendar time.

RESULTS

Among 2,424 patients completing a median of 5 follow-up surveys, the mean age was 57 years, 87% were female, and the most common conditions were rheumatoid arthritis, vasculitis, and psoriatic arthritis. Average Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety T scores decreased from April 2020 (58.7) to May 2021 (53.7) (P < 0.001 for trend). Interruptions in DMARD use decreased from April (11.2%) to December 2020 (7.5%) (P < 0.001) but increased through May 2021 (14.0%) (P < 0.001). Interruptions in DMARD use were associated with a significant increase in severe flares (rated ≥6 of 10) at the next survey (12.9% versus 8.0% [odds ratio (OR) 1.71 (95% confidence interval [95% CI 1.23, 2.36]) although not any flare (OR 1.18 [95% CI 0.89, 1.58])].

CONCLUSION

Anxiety and interruptions in DMARD use initially decreased over time, but DMARD interruptions increased during 2021, possibly related to an increase in COVID-19 cases or vaccine availability. Interruptions in DMARD use were associated with increased rates of severe disease flares, highlighting the importance of avoiding unnecessary DMARD interruptions.

Protocol for the pilot randomized trial of the CArdiovascular Risk assEssment for Rheumatoid Arthritis (CARE RA) intervention: a peer coach behavioral intervention

Background

Cardiovascular disease (CVD) is the most common cause of death among people with rheumatoid arthritis (RA), with an estimated increased risk of 50–60% compared to the general population. Lipid-lowering strategies have been shown to lower CVD risk significantly in people with RA and hyperlipidemia. Thus, CVD risk assessment has an important role to play in reducing CVD among people with RA. Yet currently only 37 to 45% of this population are receiving primary lipids screening. This paper describes the CArdiovascular Risk assEssment for RA (CARE RA) intervention, which is designed to address this issue. CARE RA is a peer coach intervention, that is, an intervention in which a person with RA coaches another person with RA, which is designed to educate people with RA about the relation between RA and CVD risk and to help them obtain evidence-based CVD risk assessment and treatment.

Methods

This is an open-label pilot study that will test if the participants assigned to complete the CARE RA curriculum with a peer coach will receive a cardiovascular risk assessment more frequently compared to those that complete the CARE RA curriculum by themselves. The CARE RA intervention is guided by Social Cognitive Theory. Participants in the peer coach intervention arm will receive the assistance of a peer coach who will call the participants once a week for 5 weeks to go over the CARE RA curriculum and train them on how to obtain CVD risk assessment. The control arm will complete the CARE RA curriculum without any assistance. Participants will be randomized 1:1 either to the control arm or to the peer coach intervention arm. The primary outcome is a participant’s having a CVD risk assessment or initiating a statin, if indicated. Secondary outcomes include patient activation and RA medication adherence. The RE-AIM implementation framework guides the implementation and evaluation of the intervention.

Discussion

This pilot study will test the feasibility of the peer coach intervention in anticipation of a larger trial. CARE RA pioneers the use of peer coaches to facilitate the implementation of evidence-based treatment guidelines among people with RA.

Trial registration

ClinicalTrials.gov NCT04488497. Registered on July 28, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01041-z.

Employment, Work Productivity, and Biologic Treatments in Self-Reported Axial Spondyloarthritis: a Cross-Sectional Study in a Female Predominant Population from the ArthritisPower Registry

INTRODUCTION

The aim of this study was to characterize employment, work productivity, and biologic disease-modifying anti-rheumatic drug (bDMARD) treatment in a predominantly female population of axial spondyloarthritis (axSpA) patients in a real-world setting.

METHODS

This was a cross-sectional study of axSpA participants within the ArthritisPower registry. Outcomes were assessed with surveys (Work Productivity and Activity Impairment [WPAI], Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], and Patient-Reported Outcomes Measurement Information System instruments) and compared between subgroups (employed vs. not employed; taking vs. not taking a bDMARD).

RESULTS

Among the 195 participants, 117 (60.0%) were employed and 78 (40.0%) were not employed entirely or partially due to axSpA. The mean age of the participants was 47.6 years and 86.7% were female. Current bDMARD use was reported by 57.4% of those surveyed (59.8% employed vs. 53.9% not employed; p = 0.408). Compared to not employed participants, employed participants had more favorable disease activity (BASDAI 6.0 vs. 7.6; p < 0.001) and overall health (self-rated health 2.5 vs. 1.8; p < 0.001). Employed participants, compared to not employed participants, were diagnosed at an earlier age (36.0 vs. 42.5 years, respectively) and experienced a shorter time between symptom onset and diagnosis (9.5 vs. 13.6 years, respectively). Employed participants reported missing on average 6.5 days of work and experienced a 52.7% impairment on work productivity due to axSpA over a 3-month period. Absenteeism and presenteeism were statistically similar between participants taking a bDMARD versus those not taking a bDMARD.

CONCLUSIONS

Although bDMARD treatment rates were similar between employed and not employed participants, disease activity and overall health were better in employed than non-employed participants. Employed participants experienced substantial work productivity impairment due to axSpA.

Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry

Introduction

Despite recent advances in treatment for psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. To further characterize these unmet needs, we evaluated patients’ experiences regarding the burden of PsA symptoms and disease impacts, and patients’ preferences for treatment.

Methods

Patients from ArthritisPower, a rheumatology research registry, completed a web-based survey. Object case best–worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in nine PsA-related disease impacts. BWS data were analyzed using a random-parameters logit model. Patient demographics, preferences for mode and frequency of therapy, and preferences for methotrexate were analyzed descriptively.

Results

Among the 332 participants, most were White (94%), female (80%), with mean age of 54 years (SD 11.4). In the BWS, joint pain was the most bothersome symptom, followed by other musculoskeletal pain and fatigue. The BWS for disease impacts found that improvements in the ability to perform physical activities were most important, followed by improvements in the ability to function independently, sleep quality, and the ability to perform daily activities. The most burdensome symptoms and desired disease impact improvements were similar in patients regardless of their experience with biologic disease-modifying antirheumatic drugs. The most preferred mode and frequency of treatment administration was oral, once-daily medication (preferred by 38% of respondents), and 74% prioritized therapies that significantly improved joint-related symptoms versus psoriasis-related symptoms. The majority of respondents (65%) preferred PsA treatment regimens that did not include methotrexate.

Conclusions

Patients with PsA from a rheumatology registry found musculoskeletal pain symptoms to be the most bothersome and prioritized improvements to functional impacts of their disease. These findings can better inform development of new therapies and guide shared patient-provider treatment decision-making.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40744-022-00436-x.

Patient Perceptions and Preferences Regarding Telemedicine for Rheumatologic Care during the COVID-19 Pandemic

Objective

To assess the perceptions and preferences of telemedicine among patients with autoimmune rheumatic diseases during the COVID‐19 pandemic.

Methods

We conducted an online survey among patients with autoimmune rheumatic diseases. Attitudes about telemedicine (i.e., telemedicine acceptability), evaluated using the validated Telemedicine Perception Questionnaire (TMPQ), and visit satisfaction were assessed for different telemedicine experiences and types of autoimmune rheumatic disease.

Results

Of 3,369 invitations, 819 responses were received. Participants had a mean ± SD age of 58.6 ± 11.6 years and were mostly White (n = 759, or 92.7%) and female (n = 702, or 85.7%). Of the 618 participants who said that telemedicine was available to them, 449 (72.7%) reported having a telemedicine visit, with 303 (67.5%) reporting attending a telemedicine video visit. On a 0 to 10 scale, the mean ± SD visit satisfaction score was 7.3 ± 1.8, with 25.8% of respondents being very satisfied (scores of 9 or 10). Video visits and higher TMPQ scores were associated with higher satisfaction. Compared to those who did not experience a telemedicine visit, patients who did were more likely to prefer telemedicine (video or phone) for routine visits (73.7% versus 44.3%; P < 0.001), reviewing test results (64.8% versus 53.8%; P < 0.001), when considering changing medications (40.5% versus 26.8%; P < 0.001), and when starting a new injectable medication (18.9% versus 12.7%; P = 0.02).

Conclusion

During the COVID‐19 pandemic, patients with autoimmune rheumatic diseases frequently had telemedicine visits, with the majority held via video, and were satisfied with these visits. These results suggest that because patients prefer telemedicine for certain visit reasons, maximizing effective use of telemedicine will require personalized patient scheduling.

Treatment Satisfaction and Decision-making from the Patient Perspective in Axial Spondyloarthritis: Real-World Data from a Descriptive Cross-sectional Survey Study from the ArthritisPower Registry

Objective

Aims were to 1) to characterize patient decision‐making with treatment for axial spondyloarthritis (axSpA) and 2) to explore relationships among decision‐making, treatment satisfaction, and biologic disease modifying antirheumatic drugs (bDMARDs).

Methods

ArthritisPower participants with physician‐diagnosed axSpA were invited to complete an online survey about their treatment and their most recent physician visit. Analysis compared treatment decision by satisfaction and bDMARD status.

Results

Among the 274 participants, 87.2% were female, and the mean age was 50 years. Of participants, 79.5% had researched treatment before their most recent physician visit, and 56.9% discussed treatment change at their most recent physician visit. Of treatment‐change discussions, 69.2% of them were related to escalation, compared with deescalation (27.6%) and/or switching (39.1%). Among those participants who discussed a change, 73.7% agreed to it because they felt that their disease was not being controlled (54.9%) or felt that it could be better controlled on new treatment (20.3%). Top symptoms prompting change were back/buttock pain (63.3%), other joint pain (55.1%), and fatigue (54.1%). Among bDMARD‐treated participants (n = 128), important factors for treatment decisions were prevention of long‐term axSpA consequences (92.9%) and doctor's advice (87.5%). Among 43.4% of participants reporting treatment dissatisfaction, 37% did not discuss treatment change. Current bDMARD use was more common in satisfied (61.9%) than dissatisfied participants (26.9%).

Conclusion

In this cross‐sectional study of a predominantly female axSpA population, patients frequently researched treatment options and discussed escalation with their providers. Under two‐thirds of participants who were dissatisfied with treatment discussed changes at their most recent visit. Current bDMARD use was associated with higher satisfaction, and bDMARD users considered prevention of long‐term consequences and doctor's advice to be very important for decision‐making.

Social Distancing, Health Care Disruptions, Telemedicine Use, and Treatment Interruption During the COVID-19 Pandemic in Patients With or Without Autoimmune Rheumatic Disease

BACKGROUND

We aimed to compare concerns, social distancing, health care disruptions, and telemedicine use in patients with autoimmune rheumatic disease (ARD) and non-ARD and to evaluate factors associated with immunomodulatory medication interruptions.

METHODS

Patients in a multistate community rheumatology practice network completed surveys from April 2020 to May 2020. Adults with common ARD (rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus) or non-ARD (gout, osteoarthritis, osteoporosis) were evaluated. Concerns about coronavirus disease 2019 (COVID-19), social distancing, health care disruptions, and telemedicine use were compared in patients with ARD versus non-ARD, adjusting for demographics, rural residence, and zipcode-based measures of socioeconomic status and COVID-19 activity. Factors associated with medication interruptions were assessed in patients with ARD.

RESULTS

Surveys were completed by 2319/36 193 (6.4%) patients with non-ARD and 6885/64 303 (10.7%) with ARD. Concerns about COVID-19 and social distancing behaviors were similar in both groups, although patients receiving a biologic or Janus kinase (JAK) inhibitor reported greater concerns and were more likely to avoid friends/family, stores, or leaving the house. Patients with ARD were less likely to avoid office visits (45.2% vs. 51.0%, odds ratio [OR] 0.79 [0.70-0.89]) with similar telemedicine use. Immunomodulatory medications were stopped in 9.7% of patients with ARD, usually (86.9%) without a physician recommendation. Compared with patients with an office visit, the likelihood of stopping medication was higher for patients with a telemedicine visit (OR 1.54 [1.19-1.99]) but highest for patients with no visits (OR 2.26 [1.79-2.86]).

CONCLUSION

Patients with ARD and non-ARD reported similar concerns about COVID-19 and similar social distancing behaviors. Missed office visits were strongly associated with interruptions in immunomodulatory medication.

POS0062-PARE REAL-WORLD PATIENT EXPERIENCE AND TREATMENT PREFERENCES IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:

Despite recent advances in the treatment of psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. An understanding of patients’ experience with PsA and its treatment is needed to bring the patient’s perspective into treatment decision-making and development of new therapies.

Objectives:

To better understand real-world PsA patients’ experience with PsA via evaluation of (1) the burden and importance of common PsA symptoms and disease impacts and (2) treatment preferences.

Methods:

A cross-sectional, web-based survey was developed, informed by published literature and treatment guidelines, expert clinical opinion, and cognitive debriefing interviews with PsA patients. Adults with a self-reported diagnosis of PsA were recruited from a US rheumatology patient-centered research registry and other online patient communities. Object case best-worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in 9 PsA-related disease impacts. BWS data were analyzed using a random parameters logit model. Data on patient demographics and preferences for PsA treatment attributes, including experience with methotrexate and preference for route and frequency of administration, were analyzed descriptively.

Results:

The sample of 247 respondents was 79% female, had a mean age of 53.4 years (range 24-79 years), and had a mean time since PsA diagnosis of 9.4 years, with 86% currently being treated by a rheumatologist. The most common PsA symptoms ever experienced were joint pain, morning stiffness and fatigue, while the least common symptom was skin pain/discomfort related to psoriasis patches. In the BWS, patients reported pain-related symptoms (i.e., joint pain and lower back or spine pain) as the most bothersome, while the least bothersome symptoms were psoriasis-related (Figure 1). Patients reported ability to perform physical activities as the most important disease impact to improve, followed by ability to live/function independently, sleep quality, and ability to do daily activities. Nearly half the sample (49%) stated they would strongly prefer a treatment for PsA that does not include methotrexate. Among patients who were not satisfied with methotrexate, the top reason was dislike of the short-term side effects after each dose. When asked to choose among four different ways of taking their PsA medication (oral once a day, oral twice a day, injection every 2 weeks, injection once a month), the most preferred method was oral once a day (38%) followed by injection once a month (26%), with 24% indicating no preference. Additionally, 49% of the sample felt that mode of administration was an important factor when deciding to start a new therapy.

Conclusion:

Among real-world patients with PsA, the most bothersome PsA symptoms were related to pain while patients most wanted to improve functional impacts of their disease. Patients most preferred an oral once a day treatment option and treatment regimens that do not include methotrexate. These findings can serve to better inform development of new therapies and guide shared patient-provider treatment decision making.

Disclosure of Interests:

Alexis Ogdie Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB, Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB.

Royalties: Novartis to husband, Carol Mansfield: None declared, Kelley Myers: None declared, William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc., and UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc., and UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer Inc, Peter Nash Grant/research support from: Abbvie, Pfizer, Roche, Sanofi, Boerhringer, Lilly, Novartis, BMS, MSD, Janssen, Gilead, and Samsung, Colton Leach: None declared, W. Benjamin Nowell Grant/research support from: AbbVie, Amgen, and Eli Lilly, Kelly Gavigan: None declared, Patrick Zueger Shareholder of: AbbVie, Employee of: AbbVie, Erin McDearmon-Blondell Shareholder of: AbbVie, Employee of: AbbVie, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Merck, Pfizer.

OP0280-PARE A MINDFULNESS PROGRAM DOSING STUDY TO EVALUATE IMPROVEMENT IN EMOTIONAL DISTRESS AMONG PEOPLE WITH RHEUMATIC DISEASE

Background:

Mindfulness-based interventions for chronic pain and emotional distress have increased in popularity as complementary therapies among people living with rheumatic and musculoskeletal disease (RMD).1,2 Despite growing evidence that mindfulness meditation reduces pain and anxiety associated with RMD, more research is needed to specify the optimal duration of mindfulness training necessary to be effective for short- and long-term benefit.

Objectives:

To evaluate and compare the effectiveness of full-length versus brief mindfulness training programs for improving anxiety among people living with RMD.

Methods:

Adult US participants (pts) within the ArthritisPower registry were invited to participate in the Healthy Mind Healthy You study comparing the effectiveness of two online mindfulness training programs of different lengths accessed via the MoodNetwork platform. The full-length mindfulness based cognitive therapy program lasted 8 weeks, while the brief evidence-based mindfulness program lasted 3 weeks. Pts were randomized to one of the two programs and completed assessments every two weeks during the program and then every four weeks during the 12-week follow-up period. Assessments included World Health Organization-Five Well-Being Index (WHO-5), Five Facet Mindfulness Questionnaire (FFMQ), Perceived Stress Scale (PSS), and two measures of emotional distress, PROMIS Short Forms for Anxiety and Depression. Analyses compared demographic characteristics and assessment scores by program length.

Results:

324 pts completed assessments at baseline and 70 pts completed them at week 8, an attrition rate of 78% in each of the program arms. The majority of pts were female, White, with 67% between the ages of 45-64 years. No statistically significant differences were observed at baseline between participants randomized to each of the two programs, and in their assessment scores at week 8 (Table 1); PROMIS Anxiety and Depression scores improved from baseline to week 8 for pts in both programs (Figure 1). Overall, mean (SD) PROMIS Depression scores improved from 58.4 (7.7) at baseline to 55.4 (7.2) at week 8 (p=0.018), a meaningfully important difference, among the 70 pts reporting scores at both time points.

Table 1.

Assessment Scores at Baseline and Week 8, Mean (SD)

BaselineWeek 8All (n=324)8-week course (n=163)3-week course (n=161)p-valueAll (n=70)8-week course (n=35)3-week course (n=35)p-valueWHO-5 b10.6 (4.9)10.4 (4.8)10.9 (5.0)0.37812.0 (5.1)12.5 (5.5)11.6 (4.7)0.488FFMQ c42.7 (6.1)42.7 (6.1)42.7 (6.1)0.93239.2 (5.7)38.9 (6.1)39.4 (5.3)0.741PSS d18.7 (7.5)19.2 (6.8)18.3 (8.2)0.30416.6 (7.3)15.7 (7.8)17.6 (6.8)0.291PROMIS Depression e56.5 (8.3)57.3 (8.0)55.7 (8.6)0.09755.1 (8.5)54.8 (9.3)55.5 (7.8)0.735PROMIS Anxiety f58.7 (8.2)59.0 (8.2)58.4 (8.1)0.47055.4 (7.2)54.6 (7.4)56.1 (7.1)0.404

a denotes use of Fisher’s Exact Test b Range 0 (worse) to 25 (better), c Range 3 (worse) to 15 (better), d Range 0 (better) to 40 (worse), e Range 24.7 (better) to 63.5 (worse), f Range 25.7 (better) to 62.0 (worse)

Conclusion:

People living with RMD who are part of a real-world US registry are willing to participate in an online mindfulness training program study, but may require additional support to remain engaged and adherent throughout the program and to participate to study conclusion. Participation in a mindfulness training program, whether full-length or brief, appears to improve symptoms of emotional distress among people with RMD.

References:

[1]Zhou, B. et al. Comp. Ther. in Clin. Prac. 2020; 39:1-7

[2]Reiner, K. et al. Pain Medicine. 2013; 14(2): 230-242

Acknowledgements:

The authors would like to thank ArthritisPower members for participating in the study, and the Healthy Mind Healthy You study team at Massachusetts General Hospital (see MoodNetwork.org) for leading it. The study was funded by the Patient-Centered Outcomes Research Institute (XPPRN-1512-33786).

Disclosure of Interests:

Julia Thompson: None declared, Nupur Parikh: None declared, Kelly Gavigan: None declared, Shilpa Venkatachalam: None declared, W. Benjamin Nowell Grant/research support from: Full-time employee of Global Healthy Living Foundation, an independent nonprofit organization, which has received funding to conduct research; Principal Investigator for studies with grant support from AbbVie, Amgen and Eli Lilly.

POS1499-PARE PATIENT PERSPECTIVES OF BIOLOGIC TREATMENTS FOR AXIAL SPONDYLOARTHRITIS: SATISFACTION, WEAR-OFF BETWEEN DOSES, AND USE OF SUPPLEMENTAL MEDICATIONS

Background:

Biologic disease-modifying antirheumatic drug (bDMARD) therapy has been shown to be effective in the treatment of axial spondyloarthritis (axSpA).1,2 Little is understood about patients’ experience of axSpA treatment from their own perspective.

Objectives:

To characterize patient experiences and perspectives with bDMARD treatments for axSpA, including satisfaction, and use of supplementary treatments when wear-off between doses is perceived among those currently treated with bDMARD therapy.

Methods:

Adult US participants (pts) within the ArthritisPower registry with physician-diagnosed axSpA were invited to complete electronic PRO measures, such as the BASDAI (0-10 scale, score ≥4 indicates suboptimal disease control), and an online survey about their perspectives of treatment. Analysis compared pt characteristics and treatment satisfaction by whether or not pt reported wear-off between bDMARD doses.

Results:

128 pts with axSpA and on bDMARD therapy met inclusion criteria of whom 82.8% were female, with mean age of 47 years. Mean BASDAI scores indicated poor disease control (6.4, SD 1.8), worse for those perceiving wear-off between doses compared with those who did not [6.8 (1.6) vs. 5.9 (2.0), p=0.01]. A majority of pts on a bDMARD reported being somewhat (57.8%) or very satisfied (26.6%) with their current axSpA treatment, and about 53.1% were satisfied with how well it controls axSpA-related pain. However, 60.9% (n=78) of pts reported that their current bDMARD typically wears off before the next dose. Treatment satisfaction was lower for pts experiencing wear-off compared to pts without wear-off (highly satisfied: 21.8% vs. 34%; somewhat satisfied: 60.3% vs. 54%; dissatisfied: 17.9% vs. 12%). 82.1% (n=64) of pts reporting wear-off used additional medications or supplements when that happened, chiefly NSAIDs (68.8%, n=44), muscle relaxers (42.2%, n=27) and/or opioids (37.5%, n=24). Among the 20 pts not satisfied with current axSpA treatment, side effects (6/20, 30.0%), or worry about risk of side effects (2/20, 10%) were the main reasons.

Conclusion:

In a predominantly female sample of bDMARD-treated axSpA patients with high disease activity, most expressed satisfaction with treatment. However, most experienced wear-off between doses and took supplementary medications, including opioids, to manage.

References:

[1]Dubash S, et al. Ther Adv Chronic Dis. 2018;9(3):77–8.

[2]Van Der Heijde D, et al. Ann Rheum Dis. 2017;76(6):978–91.

Table 1.

Demographic and clinical characteristics by wear-off between bDMARD doses (n=128)

Pts currently on bDMARD(N=128)Wear-off between bDMARD oses(N=78)No wear-off / Not sure(N=50)p-valueNumber or mean (% or SD)Age46.9 (10.3)46.1 (9.2)48.2 (11.8)0.25Female106 (82.8)69 (88.5)37(74.0)0.03White115 (89.8)70 (89.7)45 (90.0)0.96Body Mass Index30.9 (7.8)31.2 (8.5)30.4 (6.6)0.57Current Medications, addition to bDMARDConventional Synthetic DMARD (e.g. methotrexate, sulfasalazine)17 (13.3)15 (19.2)2 (4.0)0.01Prescription NSAID59 (46.1)39 (50.0)20 (40.0)0.27Other prescription medication¥70 (54.7)44 (56.4)26 (52.0)0.62Noticed improvement in symptoms related to axSpA since starting current bDMARD80 (62.5)51 (65.4)29 (58.0)0.40Noticed improvement in symptoms NOT related to axSpA since starting current bDMARD40 (31.3)22 (28.2)18 (36.0)0.35BASDAI‡6.4 (1.8)6.8 (1.6)5.9 (2.0)0.01PROMIS Pain Interference ł65.3 (5.7)66.0 (5.1)64.3 (6.4)0.09PROMIS Physical Function ł36.7 (5.6)36.1 (5.3)37.7 (5.8)0.11PROMIS Sleep Disturbance ł59.8 (8.5)61.2 (7.7)57.6 (9.3)0.02

* Statistical significance between groups of pts who experienced wear-off between bDMARD or not, p < 0.05

¥ Other prescription medications: muscle relaxers, nerve pain medications or anti-depressants, and opioids

‡ BASDAI is scored on a 0-10 scale with score ≥4 indicating suboptimal control of disease

ł PROMIS measures use T-score metric in which 50 is mean, 10 is standard deviation (SD), of US population; higher T-score = more of concept measured

Acknowledgements:

This study was sponsored by Eli Lilly and Company. We thank the patients who participated in this study.

Disclosure of Interests:

W. Benjamin Nowell Grant/research support from: Full-time employee of Global Healthy Living Foundation, an independent nonprofit research organization, which received funding pursuant to a contract from Eli Lilly to conduct the study that is the subject of this abstract; Principal Investigator for studies with grant support from AbbVie, Amgen and Eli Lilly, Kelly Gavigan Grant/research support from: Full-time employee of Global Healthy Living Foundation, an independent nonprofit research organization, which received funding pursuant to a contract from Eli Lilly to conduct the study that is the subject of this abstract, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, William Malatestinic Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Lisse Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Carol Himelein Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Curtis Consultant of: AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Roche, Regeneron, Radius, UCB, Grant/research support from: AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Roche, Regeneron, Radius, UCB, Jessica A. Walsh Consultant of: AbbVie, Amgen, Eli Lilly and Company, Janssen, Merck, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Merck, Pfizer

Which patient-reported outcomes do rheumatology patients find important to track digitally? A real-world longitudinal study in ArthritisPower

BACKGROUND

Patient-reported outcomes (PROs) are increasingly used to track symptoms and to assess disease activity, quality of life, and treatment effectiveness. It is therefore important to understand which PROs patients with rheumatic and musculoskeletal disease consider most important to track for disease management.

METHODS

Adult US patients within the ArthritisPower registry with ankylosing spondylitis, fibromyalgia syndrome, osteoarthritis, osteoporosis, psoriatic arthritis, rheumatoid arthritis, and systemic lupus erythematosus were invited to select between 3 and 10 PRO symptom measures they felt were important to digitally track for their condition via the ArthritisPower app. Over the next 3 months, participants (pts) were given the option to continue tracking their previously selected measures or to remove/add measures at 3 subsequent monthly time points (month [m] 1, m2, m3). At m3, pts prioritized up to 5 measures. Measures were rank-ordered, summed, and weighted based on pts rating to produce a summary score for each PRO measure.

RESULTS

Among pts who completed initial selection of PRO assessments at baseline (N = 253), 140 pts confirmed or changed PRO selections across m1-3 within the specified monthly time window (28 days ± 7). PROs ranked as most important for tracking were PROMIS Fatigue, Physical Function, Pain Intensity, Pain Interference, Duration of Morning Joint Stiffness, and Sleep Disturbance. Patient's preferences regarding the importance of these PROs were stable over time.

CONCLUSION

The symptoms that rheumatology patients prioritized for longitudinal tracking using a smartphone app were fatigue, physical function, pain, and morning joint stiffness.

Effects of the COVID-19 Pandemic on Patients Living With Vasculitis

Objective

This study aimed to analyze the concerns and health‐related behaviors in patients with vasculitis during the early phase of the coronavirus disease 2019 (COVID‐19) pandemic in North America.

Methods

Patients with vasculitis in North America were invited to complete an online survey through the Vasculitis Patient‐Powered Research Network in collaboration with the Vasculitis Foundation and the Relapsing Polychondritis Foundation. Questions focused on concerns and behaviors related to doctors’ visits, tests, medication, and telehealth use. Factors affecting their concern and health‐related behaviors were determined.

Results

Data from 662 patients were included: 90% of patients were White, 78% were women, 83% expressed moderate or high levels of concern about COVID‐19, and 87% reported that their vasculitis moderately or extremely affected their level of concern. Older age, female sex, lung disease, and immunosuppression were associated with greater concern. Doctors’ visits, laboratory tests, and other tests were avoided by 66%, 46%, and 40% of patients, respectively. Younger age, urban location, higher income, higher concern levels, and prednisone use (>10 mg/day) were associated with greater likelihood of avoiding visits or tests. Ten percent of patients on immunosuppressive therapy stopped their medication. Twenty‐nine percent patients on rituximab avoided an infusion. Forty‐four percent of patients had telehealth visits; more visits were reported for younger patients, for patients on glucocorticoids, and in Canada versus the United States.

Conclusion

During the COVID‐19 pandemic, patients with vasculitis have high levels of concern and exhibit potentially harmful health‐related behaviors. Health care use varies across different demographic groups and geographic regions. Specific strategies are warranted to facilitate engagement of these patients with the health care system during the pandemic.

Concerns, Healthcare Use, and Treatment Interruptions in Patients With Common Autoimmune Rheumatic Diseases During the COVID-19 Pandemic

OBJECTIVE

To assess concerns and healthcare-related behaviors of patients with autoimmune rheumatic diseases during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Adults from the United States with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and systemic lupus erythematosus (SLE) from the ArthritisPower Patient-Powered Research Network and CreakyJoints patient community completed surveys. Concerns and behaviors were compared among patients with different autoimmune conditions, disease-modifying antirheumatic drug (DMARD) use, and geographic measures of urban status, income, education, and COVID-19 activity.

RESULTS

Among 1517 participants (925 RA, 299 PsA, 185 AS, 108 SLE), mean age was 55.1 years, 88.3% were female, and 89.5% were White. COVID-19 concerns were similar across the country and were higher in biologic users (P < 0.001). Avoidance of doctor's office visits (56.6%) or laboratory testing (42.3%) and use of telehealth (29.5%) were more common in urban areas. Among participants receiving a DMARD without COVID-19 or other respiratory illness, 14.9% stopped a DMARD, with 78.7% of DMARD interruptions not recommended by a physician. DMARD stopping was more common in participants with lower socioeconomic status (SES) and in participants who avoided an office visit (OR 1.46, 95% CI 1.04-2.04) or reported lack of telehealth availability OR 2.26 (95% CI 1.25-4.08).

CONCLUSION

In the early months of the COVID-19 pandemic, patients with RA, PsA, AS, and SLE frequently avoided office visits and laboratory testing. DMARD interruptions commonly occurred without the advice of a physician and were associated with SES, office visits, and telehealth availability, highlighting the need for adequate healthcare access and attention to vulnerable populations during the pandemic.

AB0354 STEPPING UP FOR INFLAMMATORY ARTHRITIS: A PILOT TRIAL TO TEST BEHAVIORAL ECONOMICS STRATEGY TO INCREASE PHYSICAL ACTIVITY IN INFLAMMATORY ARTHRITIS

Background:

Regular physical activity may have benefits for patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), but patients with active disease are often reluctant to increase activity. Principles from behavioral economics (BE), a field combining psychology and economics, have been applied to motivate increased physical activity in non-arthritis patients.1No published studies have examined the application of BE concepts in rheumatology to promote exercise.

Objectives:

To assess the feasibiility and efficacy of a loss aversion financial incentive for increasing step counts and improving disease symptoms in RA and PsA patients with active disease.

Methods:

A randomized controlled pilot trial was performed among patients with RA and PsA. Participants were required to have active disease defined by having at least one swollen joint and a Routine Assessment of Patient Index Data-3 (RAPID3) score>3 (range 0-30 with <3 indicating remission). The trial included two visits (baseline and 14-week) and weekly check-ins via virtual trial platforms, Way to Health and the ArthritisPower app. Patients were given a Fitbit Alta at baseline and completed a two-week run-in period to assess average step count. Patients were then prompted to select a step count goal and complete a commitment contract. After selection of a goal, participants randomized to the intervention arm received a financial loss aversion incentive (each month, patients started with $75 in their account and lost $2.50 for each day they did not reach their goal). Patients were blinded to the other study arm and investigators were blinded to assignment. All patients received weekly text message prompts providing feedback about their performance over the previous week, completed weekly PROs, and had the opportunity to report adverse events including flares of joint pain. After 12 weeks of the intervention (at week 14), the incentive was removed and patients were followed to 26 weeks to determine how long the effect persisted.

Results:

In the pilot trial, 71 patients were verbally consented for screening, 34 underwent screening (of these, two were ineligible), 27 were randomized, and 22 patients completed the 14-week study visit. Mean age of participants was 50 (SD 13), 85% were female, 17(63%) had PsA, mean BMI was 30.6 and mean swollen (0-66) and tender (0-68) joint counts were 6.2 (5.6) and 8.1 (9.1), respectively. Baseline RAPID3 was 10.5 (SD 4.6) and the mean step count at baseline was 5,962. By 28 days, 65% of patients increased their step count. Participants receiving the incentive had an average of 714 more steps per day over the first 14 weeks and a greater probability of reaching 10,000 steps per day during follow-up (30% v. 21%, p=0.41). Among patients who achieved their step count goals more than 50% of days, we observed more improvement in sleep quality, fatigue, and overall well-being (p<0.05) (Figure 1). After adjusting for baseline RAPID3, the 14-week RAPID3 scores were lower in the group that achieved their step goals 50% of the time [B: -3.91 (-11.8, 3.99); a difference that approximates the minimal clinically important difference (MCID) for the RAPID3 (3.6).

Figure 1.

Change in fatigue severity among those with greater adherence to step count goals.

Conclusion:

While financial incentives have worked well in patients without arthritis, the estimated effect of the financial incentive in this small study was more modest in patients with RA and PsA. Those that were able to increase their physical activity and meet their step goals had greater improvements in symptoms over the course of the study. These data support further study in this area to promote physical activity by leveraging concepts from behavioral economics.

References:

[1]Ogdie & Asch. Nat Rev Rheumatol. 2019

Disclosure of Interests:

Alexis Ogdie Grant/research support from: Pfizer, Novartis, Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Pfizer, Novartis, Mitesh Patel Shareholder of: Owner, Catalyst Health LLC, Consultant of: Advisory Board Member for Healthmine Services, Life.io, Holistic Industries, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Kelly Gavigan: None declared, W. Benjamin Nowell: None declared, Joshua Baker: None declared

THU0564 PARTICIPANT ENGAGEMENT IN AN ARTHRITISPOWER REAL-WORLD STUDY TO CAPTURE SMARTWATCH AND PATIENT-REPORTED OUTCOME DATA AMONG RHEUMATOID ARTHRITIS PATIENTS

Background:

Clear characterization of how different types of patient-generated data reflect patient experience is needed to guide integration of electronic patient-reported outcome (ePRO) measures and biometrics in generating real-word evidence (RWE) related to rheumatoid arthritis (RA).

Objectives:

To characterize the level of participant (pt) engagement/adherence and data completeness in an ongoing study of 250 RA pts enrolled in the Digital Tracking of Arthritis Longitudinally (DIGITAL) study1of the ArthritisPower real-world registry.

Methods:

ArthritisPower pts with RA were invited to join a digital RWE study with 14-day lead-in and 12-week main study period. In the lead-in, pts were required to electronically complete: a) two daily single-item Pain and Fatigue numeric rating scales and b) longer weekly sets of ePROs. Successful completers of the lead-in were mailed a smartwatch (Fitbit Versa) and study materials. The smartwatch collected activity, heart rate, and sleep duration/quality biosensor data; a study-specific customization of the ArthritisPower mobile application collected ePROs. The main study period included automated and manual reminders/prompts about completing ePROs, wearing the smartwatch and regularly syncing it. Study coordinators monitored pt data and contacted pts via email, text and/or phone to resolve adherence issues during the conduct of the study based on pre-determined rules triggering pt contact. Rules were based chiefly on consecutive spans of missing data. Pts were considered adherent in giving complete data for each week if providing (1) daily ePROs for ≥5 of 7 days/week, (2) weekly ePROs and (3) ≥80% of synced activity data for ≥5 of 7 days/week. Composite adherence for the first month of the main study period required meeting >70% weekly adherence parameters during the first 30 days, ie completing daily ePROs for ≥5 of 7 days/week, weekly ePROs ≥3 of 4 weeks and ≥80% of synced activity data for ≥5 of 7 days/week.

Results:

As of December 2019, 170 ArthritisPower members enrolled and completed at least 30 days of the main study period; 92.9% female with mean (SD) age 52.5 (10.7) and 10.5 (10.4) years since diagnosis. The overall conversion rate from initial interest to successful completion of the lead-in period was 49.0%. Pts who advanced to the main study were significantly more likely than those who did not to be currently employed (52.9% vs. 41.8%, p=0.038) and be on biologic DMARD monotherapy (64.7% vs. 47.5%, p=0.001). Overall, daily ePRO data had the lowest adherence with 70.0% of pts providing >70% of the requested data consistently across the first 30 days of the main study period (Figure 1). Composite adherence was met by 66.5% of pts. The most common time of day to provide ePRO data was morning, in the hours around scheduled app and email notifications at 10 a.m. in pt’s local time zone. Activity data had the highest adherence and persistence, with 92.9% of pts providing 80% or more of activity data for each 24-hour period in the first 30 days (Figures 1 & 2). Observed weekly adherence did not decline over time. Of 5100 possible person days in the study at day 30, we observed 643 days (91.0% of actual to maximum possible total patient days) where activity data was provided for at least 80% of the 24-hour period.

Conclusion:

RWE studies involving passive data collection in RA require pt-centric implementation and design to minimize pt burden, promote longitudinal engagement and maximize adherence. Passive data capture via activity trackers such as smartwatches, along with regular contact such as automated reminders, may facilitate greater pt adherence in providing longitudinal data for clinical trials.

References:

[1]Nowell WB, et al. JMIR Res Protoc. 2019;8(9):e14665.

Disclosure of Interests:

W. Benjamin Nowell: None declared, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Fenglong Xie: None declared, Hong Zhao: None declared, David Curtis: None declared, Kelly Gavigan: None declared, Shilpa Venkatachalam: None declared, Laura Stradford: None declared, Jessica Boles: None declared, Justin Owensby: None declared, Cassie Clinton: None declared, Ilya Lipkovich Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Amy Calvin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Virginia S. Haynes Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company

SAT0150 CHANGES IN PATIENT-REPORTED OUTCOME (PRO) SCORES FOR NAUSEA AND FATIGUE FOLLOWING WEEKLY METHOTREXATE DOSE IN A REAL-WORLD SAMPLE OF RA AND PSA PATIENTS IN THE ARTHRITISPOWER REGISTRY

Background:

Methotrexate (MTX) is frequently used in patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) because of its beneficial effects in both populations1-3. Despite the well-known benefits of MTX, it is associated with a number of potential side effects4-6These include nausea and fatigue, are often temporally related to the timing of weekly MTX administration, and can be severe. The combined patient-reported side effects, along with potential of long-term toxicity, may make use of MTX more burdensome. Currently, there is a gap in patient-centered studies that focus on patients’ experience with MTX.

Objectives:

Examine patient temporal experience of fatigue and nausea relating to oral MTX therapy for the treatment of RA and PsA.

Methods:

Adult US patients in the ArthritisPower registry with self-reported RA or PsA taking MTX for less than 10 years were invited to participate in the study via email invitation. Participants (pts) completed a screener and brief online survey. In an ancillary study to the ArthritisPower registry and using a self-controlled case series study design where pts serve as their own control to avoid between-person confounding, pts were asked to complete a set of up to 8 assessments within 6-36 hours (‘risk’) and 96-144 hours (‘control’) after taking their oral dose of MTX each week, for up to 4 weeks. Risk and control windows were selected based on the expected temporal relationship between MTX use and peak onset of these symptoms. Assessments included PROMIS short forms for same-day Fatigue, same-day Nausea/Vomiting, and Patient Global. Descriptive statistics were conducted using paired t-tests two-way comparisons. Within-person change in PROMIS scores between the risk (1-2 days after MTX) and control (4-6 days after MTX) windows were analyzed using mixed models for repeated measures, stratified on whether pts reported fatigue or nausea with MTX at baseline. Recruitment for this study is ongoing.

Results:

As of December 2019, 91 pts had participated, of whom 76.9% were living with RA and 28.6% with PsA, with mean baseline PROMIS Patient Global score (SD) of 39.5 (7.1). Mean age (SD) was 50.9 (12.0) years, 84.6% female, 92.3% White, with mean BMI 33.7 (8.8). Mean duration of MTX treatment among current users was 2.1 (2.8) years. Among pts, 41.8% were on a biologic DMARD and 58.2% on non-biologic DMARDs only. Among pts reporting baseline nausea (n=30, 33.0%) where paired within-week measures were observed (n=64 observations among 20 pts), the mean increase in the PROMIS Nausea score was 4.5 units (adjusted p=0.003). Among those reporting MTX-associated fatigue (n=39, 42.9%) as a side effect of MTX on their baseline survey where paired within-week measures were observed (n=96 observations among 28 pts), the mean increase in PROMIS Fatigue was 4.7 (adjusted p=0.004) units. In those pts, the proportion of pts with worsened nausea and fatigue with minimally important difference of >5 units7-8was 40.0% (nausea), and 60.7% (fatigue) [Figures 1 and 2].

Conclusion:

People taking MTX to manage RA or PsA commonly experience bothersome side effects, notably fatigue and nausea, that are temporally related to weekly MTX dosing. In this sample, one-third or more of pts were bothered by nausea or fatigue shortly after MTX dosing, many of them with clinically meaningful symptoms.

References:

[1]Singh JA, et al.Arthritis Rheumatol. 2016;68:1-26.

[2]Singh JA, et al.Arthritis Rheumatol. 2019;71:5-32.

[3]Mease P.Bull NYU Hosp Jt Dis. 2013;71.(suppl 1):S41.

[4]Wang W, et al.Eur J Med Chem. 2018;158:502-516.

[5]Wilsdon TD, et al.Cochrane Database Syst Rev. 2019;1:CD012722.

[6]Husted JA, et al.Ann Rheum Dis. 2009;68:1553-1558.

[7]Norman GR, et al.Med Care. 2003;41:582-92.

[8]Bingham CO, et al.J Patient Rep Outcomes. 2019;3:14.

Disclosure of Interests:

W. Benjamin Nowell: None declared, Elaine Karis Shareholder of: Amgen Inc., Employee of: Amgen Inc., Kelly Gavigan: None declared, Laura Stradford: None declared, Scott Stryker Shareholder of: Amgen Inc., Employee of: Amgen Inc., Huifeng Yun Grant/research support from: Bristol-Myers Squibb and Pfizer, Shilpa Venkatachalam: None declared, Greg Kricorian Shareholder of: Amgen Inc., Employee of: Amgen Inc., Lang Chen: None declared, Hong Zhao: None declared, Fenglong Xie: None declared, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB

PARE0026 WHICH PATIENT-REPORTED OUTCOMES DO RHEUMATOLOGY PATIENTS FIND IMPORTANT TO TRACK DIGITALLY? A REAL-WORLD LONGITUDINAL STUDY IN ARTHRITISPOWER

Background:

Development of a standardized approach to assess key elements of disease activity in rheumatology clinical trials has been the goal of Outcome Measures in Rheumatology Clinical Trials (OMERACT), American College of Rheumatology (ACR), and European League Against Rheumatism (EULAR).1,2,3The core sets of measures developed include assessments and composite indices incorporating use of patient-reported outcomes (PROs) and clinical measures and clinicians’ assessments to quantify disease activity over time.2PROs are important indicators of disease activity and variability, and they are increasingly used to evaluate treatment effectiveness. Little is known about PROs that patients with rheumatic conditions find most important to convey their experience with their condition and its treatment.

Objectives:

To examine PROs selected by patients with rheumatic conditions in the ArthritisPower registry to identify symptoms they found most important to track digitally.

Methods:

Adult US patients within the ArthritisPower registry with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), osteoporosis (OP), osteoarthritis (OA), and fibromyalgia syndrome (FMS) were invited via email to participate in this study. Enrolled participants (pts) were prompted to select ≤10 PRO symptom measures they felt were important to track for their condition at baseline via the ArthritisPower app. At 3 subsequent time points (Month [m] 1, m2, m3), pts were given the option to continue tracking their previously selected PRO measures or to add, remove and/or select different measures. At m3, pts completed an exit survey to prioritize ≤5 measures from all measures selected during study participation and to specify other symptoms not available that they would have wanted to track. Measures were rank-ordered based on number of pts rating the item as their 1st, 2nd, 3rd, 4th or 5th choice and weighted by multiplying the rank number by its inverse for a single, weighted summary score for each measure. Values were summed across all pts to produce a summary score for each measure.

Results:

Among pts who completed initial selection of PRO assessments at baseline (N=253), 184 pts confirmed or changed PRO selections across m1-3. Mean (SD) age of pts was 55.7 (9.2) yrs, 89.3% female, 91.3% White, mean disease duration of 11.6 (10.6) yrs. The majority (64.8%) self-reported OA, followed by RA (48.6%), FMS (40.3%), PsA (26.1%), OP (21.0%), AS (15.8%) and SLE (5.9%), not mutually exclusive, and were similar to the overall ArthritisPower population. The average number of instruments (SD) selected for baseline completion was 7.0 (2.5), 7.1 (2.4) at m1, 7.2 (2.4) at m2, and 7.0 (2.5) at m3. The top 5 PROs ranked by pts overall as most important (weighted summary score) for tracking were Fatigue (71), Physical Function (58), Pain Intensity (50), Pain Interference (49), Duration of Morning Joint Stiffness (41) (Figure 1). Fatigue, Physical Function, and Pain were consistently in the top 5 across diseases while Depression was more frequent among pts with OA, AS and FMS. Pts’ PRO selections showed stability over time except for the RA Flare measure which decreased from 70.5% of RA pts at baseline to 13.6% at m3.

Conclusion:

The symptoms prioritized by pts included fatigue, physical function, pain, and joint stiffness. Pts‘ choices were consistent over time. These findings provide insights into symptoms rheumatology patients find most important and will be useful to inform design of future patient-centric clinical trials and real-world evidence generation.

References:

[1]Boers M, et al. J Rheumatol Suppl. 1994;41:86–89.

[2]Felson DT, et al. Arthritis Rheum. 1993;36:729–740.

[3]Tugwell P, et al. J Rheumatol. 1993;20:555–556.

Disclosure of Interests:

W. Benjamin Nowell: None declared, Carol L. Kannowski Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kelly Gavigan: None declared, Zhihong Cai Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Anabela Cardoso Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Shilpa Venkatachalam: None declared, Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jennifer Workman Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB

FRI0018 USING SELF-REPORTED OUTCOMES TO DETECT NEW-ONSET FLARE IN A REAL-WORLD STUDY OF PARTICIPANTS WITH RHEUMATOID ARTHRITIS - INTERIM RESULTS FROM THE DIGITAL TRACKING OF ARTHRITIS LONGITUDINALLY (DIGITAL) STUDY

Background:

Patients with rheumatoid arthritis (RA) experience fluctuating symptoms, increased pain, decreased function and variable quality of life; such changes often occur between visits to clinicians. Digital Tracking of Arthritis Longitudinally (DIGITAL) study2is evaluating the use of electronically captured patient-reported outcomes (ePRO) and passive data collection from a Fitbit device to identify disease worsening in a real-world study of participants (pts) with RA.

Objectives:

Evaluate agreement between self-reported new-onset flare and ePROs in an interim analysis from DIGITAL using a classification model.

Methods:

Members of the ArthritisPower registry with RA were invited to participate in DIGITAL. Pts who successfully completed a two-week Lead-in period entered the Main Study in which they wore a smartwatch and provided daily (pain and fatigue numeric rating scales (NRS)) and weekly ePROs, including the OMERACT RA Flare Questionnaire (FLARE) and PROMIS measures. This interim analysis is of ePRO data from pts who completed at least 30 days of the Main Study. A “Yes” response to the FLARE item, “Are you having a flare now?” identified flare. For modeling association between new-onset flare and ePRO, the dataset was split into training (the first 30 days of the Main Study) and test data (Day 31 and following). Within each dataset, repeated binary outcomes (Flare/No Flare) per pt were defined each week. To focus on new-onset flare, within each dataset, outcomes for patient weeks for which flare was present in the previous week were excluded.

Candidate variables for the model included baseline and current FLARE score (0-50 scale) and each of its 5 items, daily pain, daily fatigue, and several PROMIS weekly instruments and their lagged values (last week or last 6 days for daily). ‘Baseline’ was calculated in non-flare weeks. Training data was used for logistic regression model selection combining clinical expertise with backward elimination. Performance of the final model was evaluated using test data.

Results:

The training data was composed of outcomes from 128 pts who reported 388 weekly flare assessments as no flare or onset flare over 2800 days during the first month of the Main Study. Of pts in the training dataset, 92.2% were female, 87.5% white, with mean age (SD) 52.7 (11.0) and years since RA diagnosis 10.4 (10.3); 62.5% were on a biologic. Among those in the training dataset, 58 flare outcomes occurred in 50 (39.1%) unique pts.

The test data comprised outcomes from 123 pts who reported 442 weekly flare assessments as no flare or onset flare over 3366 days in which 64 flare outcomes occurred, and primarily included continued observations from pts who contributed to the training dataset.

The best-performing model to classify flare in training data included the current and baseline FLARE instrument activity question (i.e. “Considering how active your rheumatoid arthritis has been, how much difficulty have you had when taking part in activities such as work, family life, social events that are typical for you during the last week”), current daily pain, and baseline daily pain average and standard deviation. In test data, this model had an area under the receiver operator curve of 0.81 (Figure). At a cut point requiring specificity to be ≥0.80, sensitivity to detect flare was 0.62 and overall accuracy was 0.78.

Conclusion:

New-onset flare is common among RA patients, and the FLARE instrument and daily pain scores appear effective to classify it. Evaluation of passive data as a proxy for self-reported new-onset flare is ongoing.

References:

[1]Bartlett SJ, et al. JRheumatol, 2017;44:1536-43.

[2]Nowell WB, et al. JMIR Res Protoc, 2019;8:e14665.

Disclosure of Interests:

Virginia S. Haynes Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Fenglong Xie: None declared, Ilya Lipkovich Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Hong Zhao: None declared, Carol L. Kannowski Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jiat-Ling Poon Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kelly Gavigan: None declared, David Curtis: None declared, Sandra K. Nolot Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, W. Benjamin Nowell: None declared

AB0710 PATIENT PERCEPTIONS OF FIBROMYALGIA SYMPTOMS AND THE OVERLAP WITH AXIAL SPONDYLOARTHRITIS

Background:

In clinical practice, it is often challenging to distinguish fibromyalgia syndrome (FMS) from axial spondyloarthritis (axSpA), which includes ankylosing spondylitis and non-radiographic axSpA.1,2Early stages of axSpA may present with an onset similar to FMS,3and likewise patients with FMS may have symptoms that are similar to axSpA. Differentiating between axSpA and FMS can also be challenging for patients and cause confusion about their diagnosis.

Objectives:

To examine the prevalence of axSpA symptoms among patients with FMS and differences in the pathway to diagnosis among patients with and without concomitant axSpA.

Methods:

Adult US patients with FMS without concomitant rheumatoid arthritis or psoriatic arthritis in the ArthritisPower registry received email invitations to participate. Participants (pts) were asked whether they had a diagnosis of axSpA or ankylosing spondylitis and completed patient-reported outcome measures including Patient Reported Outcomes Measurement Information System (PROMIS) measures for Pain Interference, Sleep Disturbance and Fatigue, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Pts then responded to a 57-item customized survey developed by the researchers in collaboration with patient partners. Results are descriptively reported.

Results:

As of January 2020, 231 pts completed the survey; 97% female, 89% White, mean (SD) age of 52 (11). Mean (SD) Pain Interference score was 68 (5); Sleep Disturbance 63 (8); Fatigue 68 (7); and BASDAI 46 (9). Of the pts, 40 (17%) reported concomitant axSpA, 64% osteoarthritis, 6% gout, 5% Crohn’s or ulcerative colitis, and 4% lupus. Half of all pts perceived their FMS to be ‘rarely’ or ‘never’ well managed and 80% felt that they have had an undiagnosed condition in addition to their FMS and their other current diagnoses. Three-fourths (75%) of pts reported being able to tell the difference between their FMS pain and pain they experience as a part of the concomitant disorder. Back pain lasting >3 months was reported by 95% of axSpA pts and 94% of non-axSpA pts and 12% reported all of the symptoms consistent with patient reported versions of the Assessment of SpondyloArthritis International Society (ASAS) criteria (back/buttock pain >3 months; age of symptom onset <45; sacroiliitis diagnosis; at least on spondyloarthritis feature) (Figure 1), and of these, 39% reported an axSpA diagnosis. More pts with axSpA received their FMS diagnosis by a rheumatologist (45%) than without (41%) (Figure 2), and of the pts without an axSpA diagnosis (n=191), only 6% had recalled their provider ever discussing with them the possibility of axSpA, including non-radiographic axSpA diagnosis. Half (53%) of pts with axSpA believe that their axSpA should have been diagnosed earlier, with 33% reporting that one reason for the delay was their doctors’ belief that FMS was the cause of any axSpA symptoms they experienced.

Conclusion:

Patients with FMS often experience symptoms of axSpA and the two conditions can occur concomitantly. Additional research is needed to improve the triage, diagnosis, and education of patients with FMS and symptoms of axSpA.

References:

[1]Roussou E, et al. Clin Ex Rheum Suppl. 2012;30(74):24-30.

[2]Kaskari D, et al. Mod Rheum. 2017;27(5):875-880.

[3]Hauser W, et al. Pain Rep. 2017;2(3):e598.

Disclosure of Interests:

Kelly Gavigan: None declared, W. Benjamin Nowell: None declared, Regan Reynolds: None declared, Laura Stradford: None declared, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Alexis Ogdie Grant/research support from: Pfizer, Novartis, Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Pfizer, Novartis

EP30 Understanding which patient-reported outcomes are important to rheumatology patients: findings from ArthritisPower

Background

Little is known about PRO measures patients find most important for disease, treatment effectiveness/health outcomes. In this study, we examined PROs selected by patients with rheumatologic conditions to further elucidate which disease symptoms they found most important to track within ArthritisPower registry. As the study is ongoing, we discuss initial PRO selections of study participants.

Methods

Adult US patients with self-reported rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), osteoporosis (OP), osteoarthritis (OA), fibromyalgia syndrome (FMS) in ArthritisPower were invited to participate and prompted to select up to ten PRO (symptom) measures they felt were important to track their condition at baseline via ArthritisPower smartphone and Web-based app. PROs Measurement Information System (PROMIS) instruments focusing on symptoms of pain, physical and cognitive function, mental health, fatigue, social function, work impact, sexual function, and sleep, and Outcomes Measures in Rheumatology (OMERACT) RA flare instrument (only for those with RA) and Lilly-developed morning joint-stiffness duration question were offered. At Month (m)1, m2, m3, participants were given the option to continue tracking their selected PRO measures or change. At m3, participants complete an exit survey prioritizing all measures selected during participation and specifying other symptoms not available they would have wanted to track. Descriptive statistics were conducted on baseline data.

Results

As of May 2019, 292 participants enrolled (251 completed baseline assessments). Mean age was 55.6 (9.2) years, 89.6% female, 91.2% White, mean disease duration of 12 (10.7) years; similar to the overall ArthritisPower population. Majority (64.1%) self-reported OA, followed by RA (49.0%), FMS (40.6%), PsA (26.3%), OP (20.3%), AS (15.5%), SLE (5.6%), not mutually exclusive. Top 3 PRO domains chosen at baseline were fatigue, mental health, pain (Table 1). Average number of instruments selected for baseline completion was 6.9 (2.4).

Conclusion

Participants prioritised tracking fatigue, aspects of mental health, pain, physical function, social function, sleep, morning stiffness. These findings provide insights into symptoms rheumatology patients find most important; useful to inform the design of future patient-centric clinical trials and real-world evidence generation.

Disclosures

T. Daud (Non-Author Presenter) None. W.B. Nowell: Shareholder/stock ownership; WN has Ownership Interest (stocks, stock options, or other ownership interest excluding diversified mutual funds). C.L. Kannowski Corporate appointments; CLK is an employee of Eli Lilly and Company. Shareholder/stock ownership; CLK owns stock options at Eli Lilly and Company. K. Gavigan: None. Z. Cai: Corporate appointments; ZC is an employee of Eli Lilly and Company. Shareholder/stock ownership; shareholder of Eli Lilly and Company. A. Cardoso: Corporate appointments; AC is an employee of Eli Lilly and Company. Shareholder/stock ownership; AC is a stockholder of Eli Lilly and Company. T. Hunter: Corporate appointments; TH is an employee of Eli Lilly and Company. Shareholder/stock ownership; TH is a shareholder of Eli Lilly and Company. J. Birt: Corporate appointments; JB is an employee of Eli Lilly and Company. Shareholder/stock ownership; JB is a shareholder of Eli Lilly and Company. J. Workman: Corporate appointments; JW is an employee of Eli Lilly and Company. J. Curtis: Consultancies; JC has received Consulting Fees from AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Regeneron, Roche, UCB. Grants/research support; JC has received grants/research support from AbbVie, Amgen, BMS, Corrona, Eli Lilly, Janssen, Myriad, Pfizer, Regeneron, Roche, UCB.

Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States

BACKGROUND

There are limited real-world data on the diagnostic experiences of patients with psoriatic arthritis (PsA), including medical care sought and potential barriers to diagnosis. We aim to describe patient experiences related to receiving a PsA diagnosis.

METHODS

Ours was a mixed-method, 2-phase study. Phase 1 comprised concept elicitation and cognitive interviews with clinical experts and adults diagnosed with PsA to develop a cross sectional, web-based survey. US adults with a self-reported PsA diagnosis were recruited through a patient support community (CreakyJoints), an online patient research registry (ArthritisPower), and social media outreach. In Phase 2, the online survey collected data on sociodemographics, clinical symptoms, disease burden, and diagnosis history of survey respondents with PsA.

RESULTS

Of the 203 respondents included, 172 (84.7%) were female, and the mean (SD) age was 51.6 (10.8) years. The time between seeking medical attention and receiving a diagnosis was < 6 months for 69 respondents, 6 months to 4 years for 68 respondents, and ≥ 5 years for 66 respondents. Most respondents sought care from general practitioners (79.8%) and rheumatologists (66.5%). Common initial symptoms that led respondents to seek medical attention were joint pain (70.0%) and stiffness (53.7%). Among the initial symptoms that led respondents to seek care, joint pain, swollen joints, and sausage-like fingers or toes (indicating dactylitis) were more common among respondents with shorter time to diagnosis, whereas stiffness, fatigue, enthesitis (indicated by foot problems, tendon and ligament pain), and back pain were more common among respondents with longer time to diagnosis. Common misdiagnoses were psychosomatic issues (26.6%) and osteoarthritis (21.7%). Respondents with shorter times to diagnosis had lower frequencies of misdiagnosis.

CONCLUSIONS

Respondents with PsA reported delays in diagnosis and misdiagnoses on their journey to a PsA diagnosis. Symptom differences, such as enthesitis and stiffness, were noted among respondents with shorter vs longer time to diagnosis. Increased understanding of diagnostic barriers may lead to earlier diagnosis and appropriate management to improve outcomes.

Barriers to treatment optimization and achievement of patients' goals: perspectives from people living with rheumatoid arthritis enrolled in the ArthritisPower registry

BACKGROUND

Few studies have investigated patients' own treatment goals in rheumatoid arthritis (RA). The objective of this real-world, cross-sectional study of US patients with RA was to identify factors that patients believed influenced their physician's treatment decisions. Secondary objectives included reasons patients tolerated sub-optimal disease control and their perceived barriers to treatment optimization.

METHODS

Eligible participants were enrolled in the ArthritisPower registry, ≥ 19 years, had physician-diagnosed RA, unchanged treatment within 3 months of baseline, prior/current disease-modifying antirheumatic drug treatment (DMARDs), and computer/smartphone access. In December 2017, participants completed Patient-Reported Outcomes Measurement Information System-Computerized Adaptive Tests (PROMIS-CAT) for pain interference, fatigue, sleep disturbance, and physical function. Routine Assessment of Patient Index Data 3 (RAPID3) provided disease activity scores (0-30). Participants completed an online survey on barriers to treatment optimization, including self-perception of disease compared to RAPID3/PROMIS scores.

RESULTS

A total of 249 participants met inclusion criteria and completed the survey. Mean age (SD) was 52 (11) years, and the majority were female (92%) with high RAPID3 disease activity (175/249 [70%]; median score 18). The main reason participants did not change treatment was their physician's recommendation (66%; n = 32). Of participants with high RAPID3 disease activity, 66 (38%) were offered a treatment change; 19 (29%) of whom declined the change. Most participants who intensified treatment did so because their symptoms had remained severe or worsened (51%; n = 65); only 16 (25%) participants intensified because they had not reached a specified treatment goal. Among participants who self-reported their disease activity as "none/low" or "medium" (n = 202; 81% of cohort), most still had RAPID3 high disease activity (137/202 [68%]; score > 12). Most PROMIS scores showed moderate agreement with participants' self-assessment of health status, in contrast to RAPID3 (weighted kappa: 0.05 [95% CI - 0.01, 0.11]).

CONCLUSIONS

Most participants trusted their rheumatologist's treatment decisions and prioritized their physician's treatment goals over their own. Patients should be encouraged to share their treatment goals/expectations with their rheumatologist, in line with the treat-to-target approach. RAPID3 may be inappropriate for setting patient-centric treatment goals given the poor agreement with self-reported disease activity; most PROMIS scores showed better alignment with patients' own assessments.

Digital Tracking of Rheumatoid Arthritis Longitudinally (DIGITAL) Using Biosensor and Patient-Reported Outcome Data: Protocol for a Real-World Study

Background

Rheumatoid arthritis (RA) is a condition with symptoms that vary over time. The typical 3- to 6-month interval between physician visits may lead to patients failing to recall or underreporting symptoms experienced during the interim. Wearable digital technology enables the regular passive collection of patients’ biometric and activity data. If it is shown to be strongly related to data captured by patient-reported outcome (PRO) measures, information collected passively from wearable digital technology could serve as an objective proxy or be complementary to patients’ subjective experience of RA symptoms.

Objective

The goal of this study is to characterize the extent to which digital measures collected from a consumer-grade smartwatch agree with measures of RA disease activity and other PROs collected via a smartphone app.

Methods

This observational study will last 6 months for each participant. We aim to recruit 250 members of the ArthritisPower registry with an RA diagnosis who will receive a smartwatch to wear for the period of the study. From the ArthritisPower mobile app on their own smartphone device, participants will be prompted to answer daily and weekly electronic PRO (ePRO) measures for the first 3 months.

Results

The study was launched in December 2018 and will require up to 18 months to complete. Study results are expected to be published by the end of 2021.

Conclusions

The completion of this study will provide important data regarding the following: (1) the relationship between passively collected digital measures related to activity, heart rate, and sleep collected from a smartwatch with ePROs related to pain, fatigue, physical function, and RA flare entered via smartphone app; (2) determine predictors of adherence with smartwatch and smartphone app technology; and (3) assess the effect of study-specific reminders on adherence with the smartwatch.

International Registered Report Identifier (IRRID)

DERR1-10.2196/14665

Real-World Patient Experience on the Path to Diagnosis of Ankylosing Spondylitis

Introduction

We describe the journey to diagnosis of ankylosing spondylitis (AS) from the patient perspective and examine differences in this journey by sex.

Methods

US adults aged ≥ 18 years with a self-reported AS diagnosis were recruited online through CreakyJoints, a patient support community, and ArthritisPower, a patient research registry. Respondents completed a web-based survey on sociodemographics, disease burden, and diagnosis history. Results were stratified by sex and time to diagnosis using two-sample t tests and χ² tests, respectively, to observe differences across the groups; P < 0.05 was considered statistically significant.

Results

Among 235 respondents, 174 (74.0%) were female. Mean (SD) ages of female and male respondents were 48.6 (10.6) and 53.1 (10.3) years, respectively. From the time respondents began seeking medical attention, 87 were diagnosed within ≤ 1 year, 71 in 2–9 years, and 77 after ≥ 10 years. Symptoms that led respondents to seek treatment were back pain (73.2%) and joint pain (63.8%); fatigue and difficulty sleeping were more common among respondents with longer times to diagnosis. During the diagnosis process, men with AS tended to receive quicker AS diagnosis compared with women. Overall, commonly reported initial diagnoses among respondents with longer time to AS diagnosis included back problems and psychosomatic disorders. Significantly more women reported misdiagnoses of fibromyalgia (20.7 vs. 6.6%) and psychosomatic disorders (40.8 vs. 23.0%) compared with men.

Conclusions

Diagnosis delays and misdiagnoses were common among respondents with AS. Increasing awareness about AS among referring providers may minimize diagnosis delay.

Funding

Novartis Pharmaceuticals Corporation.

Plain Language Summary

Plain language summary available for this article.

Electronic Supplementary Material

The online version of this article (10.1007/s40744-019-0153-7) contains supplementary material, which is available to authorized users.