Investigation of changes in ankylosing spondylitis disease activity through 2021 COVID-19 wave in Taiwan by using electronic medical record management system

ethics statement

The Institutional Review Board (I) of Taichung Veterans General Hospital approved this study (TCVGH-IRB No.: CE22171A), all data were anonymized prior to analysis, and all experiments were subject to relevant guidelines and regulations. Informed consent was waived because it was done in accordance with

research design

This was a single-center retrospective cohort study.

data source

EMRMS was established in November 2016 to assist rheumatologists in conducting ASDAS and BASDAI assessments and comprehensively assessing clinical outcomes for all AS patients on TCVGH. The EMRMS database contains information on AS-related biological characteristics (CRP level and his ESR), patient comorbidities, patient medical history, family history, etc.Data are verified for reliability and validity13AS patients were consecutively enrolled in the TCVGH-AS cohort after being diagnosed with AS by a TCVGH rheumatologist according to the 1984 modified New York criteria.14CRP and ESR data were automatically uploaded to TCVGH’s medical information system, reducing human error. Information collected by trained nurses included clinical characteristics, age of onset, comorbidities (hypertension, diabetes mellitus, hyperlipidemia, hepatitis B, hepatitis C, renal failure, gout, coronary artery disease, included information on stroke, periodontal disease, osteoporosis, and tuberculosis). ), periarticular extraspinal conditions (synovitis, enthesitis, and dactylitis) and non-articular manifestations (psoriasis, uveitis, and IBD), family history of autoimmune disease, and patient history of arthrosis . These data were obtained through standardized questionnaires and worksheets to ensure reproducibility according to good laboratory practices. The attending rheumatologist then reviewed the patient’s clinical characteristics, and the nurse assisted the patient in completing a self-assessment questionnaire for disease assessment. Questionnaires were completed on her TCVGH app during the 3-month outpatient visit or on the day of the blood test.

research group

From February 7, 2021 to October 16, 2021, 342 AS patients were monitored using EMRMS. 252 patients have been evaluated to date for pre-COVID-19 stages (BASDAI, ASDAS-ESR, or ASDAS-CRP). One hundred and twenty-six patients were assessed for at least one of her disease activities during each study period. This was done irrespective of whether the assessment was performed during the consultation, telemedicine, or using the EMRMS web application. A patient with TCVGH began using her EMRMS app in November 2016 to monitor disease activity and medication compliance every 3 months.

Duration of disease activity assessment

The weekly number of new SARS-CoV-2 infections in Taiwan in 2021 is shown in Figure 1.

Figure 1

Weekly new SARS-CoV-2 infections registered in Taiwan. Pre-COVID-19 wave phase: Weeks 6-17 of 2021 (7 February – 1 May 2021). COVID-19-wave phase: Weeks 18-29 of 2021 (02 May – 24 July 2021) *Weekly calculations are based on the WHO week-to-year table, each week has 7 days All are inclusive, and the first week of each year does not necessarily include January.

The number of SARS-CoV2 infection cases over time is shown in (1) the stage before the COVID-19 wave (February 7 to May 1, 2021), (2) the COVID-19 wave stage (May 2, 2021). and (3) the post-COVID-19 wave phase (25 July to 16 October 2021).

Disease activity assessment

Various versions of the ASDAS were combined with patient-oriented scales (disease activity, back pain, duration of morning stiffness, global assessment of peripheral pain or swelling; all parameters were numerical rating scales). ). [NRS] 0-10) Laboratory measurement of inflammation (CRP or ESR levels)15The BASDAI was based solely on patient-oriented measures (degree of fatigue/fatigue experienced; AS-related pain in the neck, back, or hip; pain or swelling in other joints; discomfort in the area of ​​induced tenderness); All parameters were assessed using an NRS of 0–10 by tactile sensation, post-wake pressure and discomfort, and duration of morning stiffness after waking). Patient-reported outcomes (PROs) provide key assessments of function and ability to perform daily activities. PRO helps assess response to treatment through physician-assessed clinical measurements16,17.

statistical analysis

Continuous variables are reported as mean ± standard deviation (SD) and categorical variables are reported as percentages. Differences in continuous variables were assessed for the same patient at two time points using pairs. t test. The Kolmogorov-Smirnov test was used for normality testing, and nonparametric data were compared using the Wilcoxon signed-rank test for pairwise data. ASDAS ratings were used to measure four disease activity states: inactive, moderate, high, and very high. Disease activity was assessed according to three cutoff values ​​of 1.3, 2.1, and 3.5 units for ASDAS-CRP and ASDAS-ESR, with optimal BASDAI values ​​of 2.1, 3.1, and 3.7 units corresponding to ASDAS-CRP. bottom.2.0, 2.6, and 4.8 units corresponding to the ASDAS-ESR of the Taiwanese population18The following cutoff values ​​were chosen to demonstrate improvement. A change of 1.1 units or more indicated significant clinical improvement, and a change of 2.0 units or more indicated major improvement.19The results of the cross-validation analysis strongly supported the chosen cutoff values. Data were analyzed using SAS software (SAS Institute, Cary, NC, USA).

ethical standards

Ethics approval was obtained according to the policies of the Taichung Veterans General Hospital Ethics Committee (TCVGH-IRB No.: CE21149B).

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