[Nonpharmacological treatment measures, rehabilitation services and membership in patient support groups in axial spondylarthritis (The ATTENTUS axSpA study)]

BACKGROUND

The treatment of axial spondylarthritis (axSpA) includes pharmacological treatment measures (PTM) and nonpharmacological treatment measures (NPTM) as well as supporting resources, such as rehabilitation services (RS) and membership in patient support groups (PSG). Nevertheless, there are significant participation restrictions in patients with axSpA in Germany.

OBJECTIVE

Investigation of functional deficits, participation restrictions and utilization of PTM, NPTM, RS and PSG membership in patients with axSpA.

MATERIAL AND METHODS

Multicentric, observational study of 770 axSpA patients in Germany (ATTENTUS-axSpA).

RESULTS

Substantial functional deficits and participation restrictions were observed in axSpA patients. Of the patients 39% did not receive treatment with biological disease-modifying antirheumatic drugs (bDMARD). In the NPTM 54% received physiotherapy less than once per week and 29% once per week. Physical activities were regularly performed by 86% of patients, mainly in the form of home exercises. Training in a gym (14%) or sports club (7%) was carried out much less frequently. Of the patients 54% received RS, one third had the last rehabilitation more than 5 years ago and 13% of the patients were members in a PSG. A significantly higher utilization of NPTM and rehabilitation was found in this group.

CONCLUSION

Treatment options and resources were often utilized to a small extent and/or in low intensity by axSpA patients, which could be a possible explanation for persisting restrictions of participation. Membership in a PSG was associated with an increased utilization of NPTM and RS.

AB0785 Role of Patient Organizations in Implementation of Recommended Non-pharmacological Treatment Modalities in Spondyloarthritis: Evidence for the Effectiveness of Self-management Strategies

Background

EULAR recommends participation in patient (pt) organizations to improve pt self-management of axial spondyloarthritis (axSpA)1. Non-pharmacological treatment modalities (NPTM)2 are recommended in axSpA treatment guidelines.3

Objectives

To characterize the impact of pt advocacy group membership and its association with NPTM frequency and clinical parameters in axSpA.

Methods

Pts with a confirmed axSpA diagnosis were enrolled in the multicenter, observational ATTENTUS-axSpA survey conducted across Germany (11/2019–07/2020). Demographics, clinical and pt-related data were collected electronically.

Results

Of the 787 enrolled axSpA pts, this analysis was conducted on the working population (n=695)4. Overall, 12.2% (n=85) pts were members of a pt advocacy group and 87.8% (n=610) were not. Pt advocacy group members had higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, increased functional impairment (BASFI, Bath Ankylosing Spondylitis Functional Index) and higher impact of axSpA on health (ASAS-HI, Assessment of SpondyloArthritis International Society-Health Index; Table 1). Despite worse prognostic factors, there was no significant difference in Work Productivity and Activity Impairment (WPAI) score [40.6 (27.0) for pt advocacy group members vs 36.8 (29.9) for non-members; p=0.380]. Membership in a pt advocacy group was associated with increased prescribed, supervised NPTM (57.6% [n=49] vs 34.4% [n=210]). Pts reported to have ever received 2.6 rehabilitation measures, and ≥3.0 different rehabilitation NPTM measures. Cumulatively, 25.0% (N=654) of rehabilitation measures were physiotherapy (Figure 1).

Table 1.

Descriptive characteristics and impact of membership in pt advocacy group

CharacteristicPatient advocacy group member (n=85)Not patient advocacy group member (n=610)Total (n=695)p-valueAge (yrs), mean (SD)50.2 (7.7)44.6 (11.1)45.3 (10.9)<0.001BMI (kg/m2) mean (SD)27.5 (5.0)28.0 (12.7)28.0 (12.0)0.713Male, n (%)45 (52.9)378 (62.0)423 (60.9)0.128Disease duration (yrs) mean (SD)13.7 (10.3)12.5 (11.1)12.6 (11.0)0.303ASAS-HI, 0-177.3 (3.4)6.4 (3.9)6.5 (3.8)0.045BASDAI, 0-104.3 (1.9)3.8 (2.2)3.9 (2.2)0.044BASDAI ≥4, n (%)49 (57.6)275 (45.1)324 (46.6)0.025BASFI, 0-103.9 (2.3)3.2 (2.5)3.3 (2.4)0.015Biologic treatment, n (%)52 (61.2)312 (51.1)364 (52.4)0.072Full time employment, n (%)48 (56.5)410 (67.2)458 (65.9)0.06Absenteeism*, mean (SD)8.4 (21.2)10.9 (26.8)10.6 (26.2)-Presenteeism*, mean (SD)38.4 (24.6)31.8 (25.7)32.6 (25.6)-Overall work impairment score*, mean (SD)40.6 (27.0)36.8 (29.9)37.2 (29.6)0.380Activity impairment, mean (SD)46.7 (21.7)40.5 (26.8)41.3 (26.4)0.058Pts having ever received medicinal rehabilitation measures, mean (SD)67 (78.8)328 (53.8)395 (56.8)<0.001Prescribed supervised group NPTM#, mean (SD)49 (57.6)210 (34.4)259 (37.3)<0.001Regular physical training†, mean (SD)76 (89.4)515 (84.4)591 (85.0)0.231

*Work-related questions of WPAI-score have been calculated for pts in employment (N=340); †regular physical training in the context of axSpA; #rehabilitation sport and/or functional training. ASAS-HI, Assessment of SpondyloArthritis International Society-Health Index; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BMI, Body Mass Index; n, number of pts; pts, patients; SD, Standard Deviation; WPAI, Work Productivity and Activity Impairment; yrs, years.

Conclusion

Pt advocacy group membership was associated with increased prescribed NPTM in axSpA. Pt organizations may support the implementation of guidelines and improvement of self-management strategies in pts with axSpA, which may influence work participation.

References

[1]Nikiphorou E, et al. Ann Rheum Dis 2021;0:1–8

[2]Rausch Osthoff A-K, et al. Ann Rheum Dis 2018;77:1251–1260

[3]van der Heijde D, et al. Ann Rheum Dis 2017;76:978–991

[4]Kiltz et al. 2021. EULAR eposter; POS0983

Disclosure of Interests

Dirk Meyer-Olson Speakers bureau: Speakers bureau: Abbvie, Amgen,Berlin Chemie, Bristol Myers Squibb, Cellgene, Chugai, Fresenius Kabi, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi and UCB, Consultant of:Abbvie, Amgen, Berlin Chemie, Bristol Myers Squibb, Cellgene, Chugai, Fresenius Kabi, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi and UCB, Kirsten Hoeper Speakers bureau: Speakers bureau: Abbvie, Chugai, Gilead, Lilly, Novartis, Sandoz Hexal and Sanofi., Consultant of: Abbvie, Chugai, Gilead, Lilly, Novartis, Sandoz Hexal and Sanofi., Ludwig Hammel: None declared, Sebastian Lieb Employee of: Employee of Novartis, Andreas Haehle Employee of: Employee of Novartis, Uta Kiltz Speakers bureau: Speakers bureau: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: Abbvie, Amgen, Biogen, Fresenius, GSK, Novartis and Pfizer

Immune signatures underlying post-acute COVID-19 lung sequelae

[Figure: see text].

POS0983 WORK PARTICIPATION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS IN GERMANY: RESULTS FROM A MULTICENTER, OBSERVATIONAL SURVEY (ATTENTUS-axSpA)

Background:

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition often associated with impaired working participation1 not only translating to devastating outcomes for patients (pts) but also increased economic and social burden due to a significant amount of indirect costs. Data on the different work participation domains in axSpA pts with access to biologic therapies are limited.

Objectives:

To characterise the different domains of work participation [presenteeism, absenteeism, sick leave, unemployment, disability pensions] in axSpA pts and their associations with demographic and clinical confounders.

Methods:

Pts with confirmed clinical diagnosis of axSpA were enrolled in a multicenter, observational ATTENTUS survey conducted across Germany (Nov-2019 to Jul-2020). To ensure high data quality, inclusion criteria was verified by external monitoring, followed by evaluation of the domains of impaired work participation, including absenteeism and presenteeism (WPAI). Demographics, clinical parameters and patient related outcomes (PROs) were collected via tablet. This analysis included working age (18–65 years) pts; and excluded students and retired pts. Pts without absenteeism (value=0) and presenteeism ≤20% were defined as no impairment at work.

Results:

A total of 787 axSpA pts were enrolled in the survey. Seven students, 68 retired pts and 17 pts not fulfilling the inclusion criteria were excluded from this analysis, leaving 695 pts with complete data sets. Baseline data are outlined in Table 1. 50 pts received disability pensions, 29 pts received unemployment benefits, 590 (84.9%) pts reported paid work [part-time: n=132 (22.4%); full-time: n=458 (65.9%)], with 242 (41.0%) pts having no impairments at work. 379 (64.2%) employed pts took sick leave within the previous 12 months (mo) (<3 mo: n=351; 3–6 mo: n=17; >6 mo: n=11). Absenteeism and presenteeism occurred in 140 (23.7%) and 496 (84.1%) pts, respectively. Pts without impairments were mostly of young age, male sex, well-educated, with low disease activity, less fatigue and shorter duration of morning stiffness, and preserved global and physical functioning. No apparent differences between pts with and without impairment of work participation were observed in terms of biologic treatment, disease duration and BMI.

Table 1.

Descriptive characteristics of the study population

Mean (SD), unless specifiedImpaired WP (n=453)Full WP(n=242)p-valueTotal(n=695)Age (yrs)46.7 (11.1)42.8 (10.1)<0.00145.3 (10.9)BMI28.5 (14.0)27.0 (6.8)0.14628.0 (12.0)Male, n(%)246 (54)177 (73)<0.001423 (61)Disease duration (yrs)12.7 (11.3)12.4 (10.2)0.81312.6 (11.0)University-Education, n(%)104 (23.0)82 (33.9)0.001186 (26.8)In a committed relation, n(%)310 (68.4)159 (65.7)0.464469 (6.6)ASAS-HI8.0 (3.3)3.7 (3.0)<0.0016.5 (3.8)BASDAI4.8 (1.9)2.1 (1.6)<0.0013.9 (2.2)BASDAI > 4, n(%)286 (63.1)28 (11.6)<0.001314 (45.2)Fatigue [BASDAI #1]5.8 (2.1)2.8 (2.1)<0.0014.7 (2.5)Duration morning stiffness [BASDAI #6]3.5 (2.4)1.6 (1.8)<0.0012.8 (2.4)BASFI4.2 (2.3)1.5 (1.5)<0.0013.3 (2.4)Biologic treatment, n(%)230 (50.8)134 (55.4)0.390364 (52.4)Full time employment, n(%)256 (56.5)202 (83.5)<0.001458 (65.9)Absenteeism17.9 (32.1)0-10.6 (26.2)Presenteeism48.6 (21.00)9.6 (8.3)-32.6 (25.6)

ASAS-HI, Assessment of SpondyloArthritis International Society-Health Index; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BMI, basal metabolic index; n, number of pts; SD, standard deviation; WP, work productivity; years, yrs

Conclusion:

There was a substantial impact on work participation for axSpA pts, despite numerous available therapeutic options. Pts with impaired work participation compared to pts with no impairment, reported increased fatigue, longer duration of morning stiffness, decreased functional capacity, female sex and a lower level of education.

References:

[1]Ramoda R et al. Arthritis Res Ther. 2016;78

Disclosure of Interests:

Uta Kiltz Speakers bureau: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: AbbVie, Biocad, Chugai, Eli Lilly, Grünenthal, Janssen, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: Abbvie, Amgen, Biogen, Fresenius, GSK, Novartis and Pfizer, Kirsten Hoeper Speakers bureau: Abbvie, Chugai, Gilead, Lilly, Novartis, Sandoz Hexal and Sanofi. Consultant of: Abbvie, Chugai, Gilead, Lilly, Novartis, Sandoz Hexal and Sanofi. Ludwig Hammel: None declared, Sebastian Lieb Employee of: Employee of Novartis, Andreas Haehle Employee of: Employee of Novartis, Dirk Meyer-Olson Speakers bureau: Abbvie, Amgen, Berlin Chemie, Bristol Myers Squibb, Cellgene, Chugai, Fresenius Kabi, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi and UCB, Consultant of: Abbvie, Amgen, Berlin Chemie, Bristol Myers Squibb, Cellgene, Chugai, Fresenius Kabi, GSK, Jansen Cilag, Lilly, Medac, Merck Sharp & Dome, Mylan, Novartis, Pfizer, Sandoz Hexal, Sanofi and UCB.

[Flexible programs and advanced training for rheumatological patient education]

In two research projects, rheumatological patient education programmes were updated. The first step was to develop an expert consented framework for all rheumatological patient education programmes. From this, curricula and working materials for rheumatoid arthritis (RA) and axial spondyloarthritis (AS) were derived and two exemplary patient education manuals developed. A randomized controlled trail was designed for the five-hour RA basic education program. Finally, existing train-the-trainer training courses were adapted for these patient education programmes.