Background: The checklists are rapid methods of evaluating and fulfilling repetitive activities. They are easy to apply and they are used in quality improvement projects to improve health processes. The Group for the Study of Spondyloarthritis of the Spanish Society of Rheumatology (GRESSER) designed a checklist for patients with spondyloarthritis (SpA) in order to homogenize their evaluation, identify factors of radiographic progression and response to treatment, and improve the detection of comorbidities [1]. This checklist has demonstrated a clear and significant improvement in monitoring in SpA patients [2], which may result, in the medium-long term, in better control of disease activity, as well as better control of comorbidities.

Objectives: To analyse whether there is a change in disease activity and comorbidity control in patients with axial SpA following the implementation of an assessment checklist in daily practice.

Methods: A quasi-experimental retrospective pre-post intervention study was carried out evaluating for each subject the improvement in disease activity (BASDAI, CRP) and comorbidity status in 2020-2022, after the development and implementation of the checklist in 2018. An analysis of variance with mixed models was performed; as well as the change in therapeutic level and disease status (low activity, remission), by means of the Mc Nemar asymmetry test. The estimation of the BASDAI50 post-intervention target is also presented.

Results: A total of 7 hospitals participated and 108 axial SpA patients fulfilling the ASAS classification criteria were reviewed before and after the implementation of the checklist. The Mean age was 43.6 (SD 11.7), 43.5% were women (n=47) and the median disease duration was 5.4 years. Dyslipidemia was the most frequent comorbidity (32.4%), followed by depression (23.1%), hypertension (21.3%) and obesity (20.4%). After 24 months of implementation of the checklist, 15% of patients (n=16, 95%CI: 10%-24%) achieved BASDAI50. In terms of disease activity level, a statistically significant change was observed, with 40% (28/70) of subjects moving to low disease activity (p=0.001), as well as 19% (16/85) of subjects moving into remission (p=0.027). In absolute terms, a statistically significant reduction in BASDAI of 0.44 (95%CI: 0.06-0.82, p=0.023) and 3.82 mg/L (95%CI: 1.49-6.14, p=0.001) in CRP was observed. Estimates of the same magnitude are obtained in the models adjusting for age and sex. An increase in uricemia of 0.24 mg/dL was found, while there was no statistically significant change in other comorbidities.

Conclusion: For the first time, we demonstrate that the implementation in daily clinical practice of a checklist leads to a significant improvement in the control of disease activity in patients with axial SpA.

REFERENCES: [1] Almodóvar R, Torre Alonso JC, Batlle E, Castillo C, Collantes-Estevez E, de Miguel E, et al. Development of a checklist for patients with axial spondyloarthritis and psoriatic arthritis in daily practice: ONLY TOOLS project. Reumatología clinica 2018 June 01;14(3):155-159.

[2] Almodóvar R, Joven B, Rodriguez Almaraz E, Melchor S, Rabadan E, Villaverde V, et al. Implementation of an assessment checklist for patients with spondyloarthritis in daily practice. Clinical and experimental Rheumatology 2020 Jan-Feb;38(1):115-121.

Acknowledgements: This Investigator Initiated Study was financially supported by UCB Biopharma SRL.

Disclosure of Interests: RAQUEL ALMODOVAR Abbvie, Lilly, Novartis, Janssen, UCB, Pfizer, MSD, Abbvie, Lilly, Novartis, Janssen, UCB, Pfizer, Elia Pérez-Fernández: None declared, Marta Valero Expósito: None declared, Virginia Villaverde: None declared, Laura González: None declared, Beatriz Joven-Ibáñez Lilly, UCB, Novartis, Lilly, UCB, Novartis, Eva Tomero Muriel: None declared, Alejandro Prada-Ojeda: None declared, Mª Teresa Navio: None declared, Laura Cebrián-Méndez: None declared, Leticia Lojo: None declared, Ramón Mazzucchelli: None declared, Pedro Zarco-Montejo: None declared.