T. Davergne1, R. Tekaya2, C. Deprouw3, A. Tournadre4, S. Mitrovic5, A. Ruyssen-Witrand6, C. Hudry7, S. Dadoun8, J. Avouac9, F. Bruno10, L. Gossec10
1Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, (IPLESP), Paris, France, 2Hôpital Charles Nicolle, Rheumatology Department, University of Tunis El Manar, Tunis, Tunisia, 3Saint-Antoine Hospital, Rheumatology Department, Paris, France, 4Clermont Ferrand Hospital, Rheumatology Department, University of Clermont, Auvergne, France, 5Institut Mutualiste Montsouris, Internal Medicine Department, Paris, France, 6Purpan Hospital, Rheumatology Department, Toulouse, France, 7CeSOA, MGEN, Paris, France, 8Clinique Geoffroy Saint Hilaire, Ramsay, Paris, France, 9Université de Paris, Cochin Hospital, Rheumatology Department, Paris, France, 10Pitié Salpêtrière Hospital, APHP, Rheumatology Department, Paris, France

Background: Adherence to both medications and physical activity (PA) is insufficient in patients with inflammatory arthritis (IA), such as spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA). Recently, 2 clinical guidelines from EULAR bring new information on how to improve PA and how to prescribe medication in patients with IA. Although adherence was stated as a major issue, no recommendation was made on how to target patients with adherence issues. Research agendas encouraged to explore patient profiles accessible to adherence-intervention strategies. Thus, a better knowledge of patterns towards adherence to medication and PA is needed.

Purpose: To assess and compare adherence to medication and levels of physical activity collected through Apps, in patients with IA.

Methods: We performed in 2019-2020 a study to assess and compare adherence to medication and levels of PA collected through Apps, in patients with IA. This was an international, multicentric, cross-sectional study (NCT04426747). Consecutive patients were included if they had definite axSpA, RA or PsA, were aged above 18 and able to walk, with smartphones compatible with Apps measuring steps. Adherence to medication was assessed using the Medication Adherence Report Scale MARS-9 (ranging from 9 to 45 with higher scores indicating higher adherence). PA was measured by steps per day over the past 4 weeks, through the patient’s smartphone app. The link between the MARS-9 score and PA was assessed by Spearman’s correlation, linear and logistic regression (explaining the 2 higher tertiles of the MARS score). Variables included age, gender, disease duration, disease activity, body mass index, working status, bDMARD prescription, comorbidities and functional capacity through the modified Health Assessment Questionnaire (mHAQ). There was no imputation of missing data.

Results: Of 245 patients included, 152 had analyzable data (66 (45%) axSpA, 62 (42%) RA, 18 (12%) PsA). Mean age was 48.0 years (standard deviation 13.4), mean disease duration 11.7 (10.2) years and 47% were women. 70% were receiving a biologic, and disease activity was moderate. Adherence to medication was high: the mean MARS score was 39.4 (6.3) with a median of 41. PA was moderate: the mean steps per day collected through Apps was 5457 (3730), median 4473 with 28% walking over 7000 steps per day. We did not evidence a link between adherence to medications and steps per day (R=-0.06, p=0.20); patients with a lower adherence to medication (lowest MARS tertile scores, i.e., <=40) did not differ in terms of PA: 5611 (3634) versus 5051 (4155) steps per day (p=0.80). In univariate linear regression, patients with lower adherence to medication had longer disease duration and a trend to lower functional capacity. The logistic regression was confirmatory.

Conclusion(s): In conclusion, in this population of patients with long-standing IA, adherence to medication was high whereas PA was insufficient. Patients with IA who were more adherent to treatment were not more physically active than those less adherent.

Implications: Adherence to medication and adherence to lifestyle changes may be linked to different coping mechanisms, which should be further explored to allow implementation of the recent recommendations.

Funding, acknowledgements: This work was supported by Eli Lilly France, Sandoz France and the French society of Physiotherapy through unrestricted grants.

Keywords: Barriers and facilitators, Physical activity, Inflammatory arthritis

Topic: Rheumatology

Did this work require ethics approval? Yes
Institution: ethics committee
Committee: CPP Sud-Est III, France, methodology MR03 for non-interventional study
Ethics number: EudraCT 2019-A01413-54,

All authors, affiliations and abstracts have been published as submitted.

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