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Flares assessed weekly in patients with rheumatoid arthritis or axial spondyloarthritis and relationship with physical activity measured using a connected activity tracker: a 3-month study
  1. Charlotte Jacquemin1,
  2. Anna Molto2,3,
  3. Hervé Servy4,
  4. Jérémie Sellam5,
  5. Violaine Foltz1,
  6. Frédérique Gandjbakhch1,
  7. Christophe Hudry2,
  8. Stéphane Mitrovic1,
  9. Benjamin Granger6,
  10. Bruno Fautrel1 and
  11. Laure Gossec1
  1. 1 Rheumatology Department, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), Pitié Salpêtrière Hospital, APHP, Paris, France
  2. 2 Rheumatology B Department, Cochin Hospital, AP-HP, Paris, France
  3. 3 INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris Descartes University, Paris, France
  4. 4 Sanoïa, e-Health Services, Gardanne, France
  5. 5 Rheumatology Department, INSERM UMRS_938, Sorbonnes University, UPMC University Paris 06, St-Antoine Hospital, DHU i2B, Paris, France
  6. 6 Biostatistics Department, Pitié Salpêtrière Hospital, APHP, Paris, France
  1. Correspondence to Professor Laure Gossec; laure.gossec{at}


Background The evolution of rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) is marked by flares, although their frequency is unclear. Flares may impact physical activity. Activity can be assessed objectively using activity trackers. The objective was to assess longitudinally the frequency of flares and the association between flares and objective physical activity.

Methods This prospective observational study (ActConnect) included patients with definite clinician-confirmed RA or axSpA, owning a smartphone. During 3 months, physical activity was assessed continuously by number of steps/day, using an activity tracker, and disease flares were self-assessed weekly using a specific flare question and, if relevant, the duration of the flare. The relationship between flares and physical activity for each week (time point) was assessed by linear mixed models.

Results In all, 170/178 patients (91 patients with RA and 79 patients with axSpA; 1553 time points) were analysed: mean age was 45.5±12.4 years, mean disease duration was 10.3±8.7 years, 60 (35.3%) were men and 90 (52.9%) received biologics. The disease was well-controlled (mean Disease Activity Score 28: 2.3±1.2; mean Bath Ankylosing Spondylitis Disease Activity Index score: 3.3±2.1). Patients self-reported flares in 28.2%±28.1% of the weekly assessments. Most flares (78.9%±31.4%) lasted ≤3 days. Persistent flares lasting more than 3 days were independently associated with less weekly physical activity (p=0.03), leading to a relative decrease of 12%–21% and an absolute decrease ranging from 836 to 1462 steps/day.

Conclusion Flares were frequent but usually of short duration in these stable patients with RA and axSpA. Persistent flares were related to a moderate decrease in physical activity, confirming objectively the functional impact of patient-reported flares.

  • Physical activity
  • rheumatoid arthritis
  • axial spondyloarthritis
  • disease activity
  • flare
  • patient-reported outcomes

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  • Contributors LG, CJ and HS drafted the study design. CJ and LG drafted the manuscript with contributions from all authors. CJ, LG and BG analysed and interpreted the data. CJ, AM, JS, VF, FG, CH, SM, BF and LG participated in the patient inclusion and data collection. HS participated in the data acquisition. All authors approved the final manuscript.

  • Funding The study was funded by unrestricted academic grants from Lilly France, BMS France and Pfizer France.

  • Competing interests None declared.

  • Patient consent All patients returned an agreement form, written for this specific study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available from CJ at

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