Evidence-based follow-up in axial spondyloarthritis: how much is (not) enough?

Purpose of review: Present follow-up strategies for axial spondyloarthritis (axSpA) entail frequent preplanned in-person outpatient visits. Capacity constraints make this approach increasingly difficult, and it is plausible that regular follow-up in axSpA is not necessary for all patients. The purpose of this review is to discuss emerging alternative follow-up strategies to improve care efficiency in axSpA, and the challenges of applying these solutions in clinical practice.

Recent findings: Patient-initiated follow-up (PIFU) and remote monitoring have been investigated in axSpA in two recent trials. These strategies demonstrated meaningful reductions in the number of outpatient visits and associated healthcare costs in patients with stable (ax)SpA, without negatively affecting health outcomes. Qualitative studies have additionally shown widespread acceptability of PIFU and remote monitoring from the perspective of both patients and healthcare providers, and their ability to enhance self-efficacy of patients. Loss to follow-up, delayed care, and logistical limitations are associated concerns requiring further consideration.

Summary: PIFU and remote monitoring hold potential as effective, efficient, and safe strategies for the follow-up of patients with axSpA. For successful implementation in practice, their inherent challenges must be addressed, including the careful selection and training of patients, and ensuring the necessary infrastructure.