The Axia smartphone app has demonstrated clinically meaningful improvements in disease activity, functional ability and quality of life in patients with axial spondyloarthritis (axSpA) receiving stable pharmacotherapy, as part of a randomised controlled trial.

Exercise therapy and patient education are key components of axSpA care, but long-term adherence remains poor, and access to scalable support is limited.

The CE-marked Axia app integrates personalised exercise programmes, structured patient education and disease self-management tools specifically for axSpA and is supported by gamification features to enhance long-term engagement.

The 12-week, monocentric Bechterew App Trial, conducted by the University Hospital Würzburg, aimed to assess whether the intervention could deliver clinically significant improvements when used alongside pharmacological treatment.

A total of 200 adults who had confirmed axSpA and were receiving stable pharmacotherapy were recruited across Germany and randomised 1:1 to receive either Axia plus standard care or standard care alone. Of these, 186 participants completed the trial (95 in the intervention group and 91 in the control group).

Participants had a mean age of 50.6 years, and 66% were female. Radiographic axSpA was present in 56% of patients, and baseline Bath Ankylosing Spondylitis Disease Activity Index score (BASDAI) was moderate to high (mean score 5.17). Around 58% of participants were receiving biologics or Janus kinase inhibitors.

Axia app and disease activity, function and quality of life

After 12 weeks, the axSpA intervention group showed statistically significant and clinically meaningful improvements across each of the three coprimary endpoints compared with controls.

BASDAI score improved by an adjusted estimated difference of −1.508 (P < 0.001). Functional impairment, assessed by the Bath Ankylosing Functional Index (BASFI), improved by −1.139 (P < 0.001), while Ankylosing Spondylitis Quality of Life (ASQoL) scores improved by −2.297 (P < 0.001). All changes exceeded minimal clinically important difference thresholds.

Responder analyses confirmed these findings. Clinically meaningful improvements were observed in the intervention group compared with controls: 67% vs 18% for BASDAI, 67% vs 22% for BASFI, and 60% vs 28% for ASQoL (all P < 0.001).

Secondary outcomes also favoured the app intervention. Assessment in Spondyloarthritis International Society (ASAS)20 response rates were 51% compared with 9% in the control group (P < 0.001), whereas ASAS40 responses were 23% compared with 3% for controls (P < 0.001).

Improvements were also observed in global pain, patient global assessment, self-efficacy and adherence to exercise therapy, although health literacy did not differ significantly between groups.

Favourable adherence and safety support in axSpA

Adherence to the intervention was high, with participants using the Axia app on average 69 out of 90 days. Notably, 77.9% used the app at least five days per week, and 29.7% engaged daily.

No device-related adverse events were reported, and overall adverse events occurred less frequently in the intervention group than in the control (22% vs 37%), while serious adverse events were rare (1% vs 3%).

However, the authors noted that the lack of blinding and a placebo control introduces potential bias, particularly given the reliance on patient-reported outcomes. In addition, no objective inflammatory markers, such as C-reactive protein, were assessed, limiting insight into biological disease activity.

The remote study design also restricted evaluation of comorbidities, including fibromyalgia, which may influence symptom reporting. Furthermore, the 12-week duration limits conclusions about sustained efficacy, and the app’s multimodal design prevents identification of the specific components driving the observed benefits.

Digital apps may transform axSpA management

The Bechterew App Trial provides the first robust evidence that a disease-specific, app-based intervention can significantly improve outcomes in patients with axSpA receiving stable therapy.

The findings underscore the growing role of digital health tools in improving adherence, supporting long-term disease management and bridging the gap between guideline-recommended exercise and real-world practice.

Aligned with guidance from the European Alliance of Associations for Rheumatology, the researchers concluded that digital apps could serve as a scalable adjunct to standard care in axSpA and may also be adaptable to other inflammatory rheumatic diseases.

Reference
Strunz P-P et al. An app-based nonpharmacological intervention improved patient-reported disease activity, functionality and quality of life in patients with axial spondyloarthritis. Ann Rheum Dis 2026;Mar 12:S0003-4967(36)00098-1.