Digital health application using patient input improves rheumatoid arthritis outcomes
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Key takeaways:
- Patients with rheumatoid arthritis who used a digital health app demonstrated improved disease control rates at 6 months.
- At 12 months, results between the control and test groups were similar.
Patients with rheumatoid arthritis who use a digital health application to assess their patient-reported outcomes are more likely to report controlled disease activity, according to data published in JAMA Network Open.
“For chronic diseases with clearly defined, simple treatment targets that can be monitored using biosensors, such as hypertension, digital health applications are particularly useful,” Chun Li, MD, of the department of rheumatology and immunology at Peking University People’s Hospital, in Beijing, China, and colleagues wrote. “In contrast, the use of digital health applications in diseases with more complex treatment targets, such as rheumatoid arthritis (RA), has not been proven.”
To investigate the impact of using a digital application to measure patient-reported outcomes on disease activity in patients with RA, Li and colleagues conducted a multicenter, open-label, randomized trial. Patients were eligible to participate in the trial if they were aged 18 years or older and met the 2010 American College of Rheumatology/EULAR criteria for RA. Between Nov. 1, 2018, and May 28, 2019, patients were randomized 1:1 to enter a conventional care group or a smart system of disease management (SSDM) group. Patients were followed for 12 months after randomization.
Patients in the SSDM group were instructed to use the program to assess their own disease activity on a monthly basis. Patients in the conventional care group, meanwhile, continued routine medical visits for 6 months, before completing a 6-month and 12-month visit. To ensure proper use of the program, patients in the SSDM group were assisted during their first self-assessment, which included entering the name of the patient, their sex, date of birth, date of diagnosis, comorbidities, level of attained education, family income, regular annual medical expenses and DAS28 score.
After 4 months, the program alerted patients for certain conditions, including a worsening of symptoms. The primary outcome was the rate of patients with a DAS28-CRP score of three or less at 6 months. Secondary outcomes included the rate of patients with a moderate-to-good EULAR response rate, the ACR/EULAR Boolean remission percentage of patients, changes in the clinical disease activity index and the changes in tender and swollen joint counts.
The trial included a total of 2,197 patients, of whom 1,099 were randomized to the SSDM group, while 1,098 were randomized to the control group. After 6 months, patients achieved DAS28-CRP scores of 3.2 or less more frequently in the SSDM group (71%), compared with the control group (64.5%), with a difference of 6.6% (95% CI, 2.7% to 10.4%). After 12 months, the control group increased to 77.7%, similar to the SSDM group at 78.2% (difference = –0.2%; 95% CI, -3.9 to 3.4).
“In this randomized clinical trial of patients with RA, the use of digital health applications to assess patient-reported outcomes increased the rate of patients with a DAS28-CRP score of 3.2 or less at month 6,” Li and colleagues wrote. “This study provides modest clinical value that application-based patient-reported outcomes and intervention could be an effective way to treat patients with RA and may provide evidence for diseases with complex treatment targets.”
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