Identification of Major Clinical Characteristics and Linear Correlations Among DAS28, HAQ and Morning Stiffness Time Using Smart System of Disease Management (SSDM)

Jianlin Huang¹, Hongzhi Wang², Jing Yang³, Wenqiang Fan⁴, Hua Wei⁵, Rong Mu⁶, Xinwang Duan⁷, Xiangyuan Liu⁸, Fang He⁹, Zhenchun Zhang¹⁰, Fei Xiao¹¹, Hui Xiao¹¹, Yuhua Jia¹¹, Yuan Liu¹¹, Li Zhang¹¹, Bing Wu¹¹ and Xiaofeng Li¹², ¹Department of rheumatology, The Sixth Hospital Affiliated to Sun yat-sen University, Guangzhou, China, ²The First Hospital of Jiaxing, Jiaxing, China, ³Department of rheumatology, Central Hospital of MianYang, Sichuan, Mian Yang, China, ⁴Department of rheumatology, Central Hospital of XinXiang, Henan, XinXiang, China, ⁵No 98,Nantong West Rd,Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, China, ⁶Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China, ⁷Department of rheumatology, The Second Affiliated Hospital of Nanchang University, Nanchang, China, ⁸Department of Rheumatology and Immunology, Peking University Third hospital, Bei jing, China, ⁹Central Hospital of Sui Ning, Sichuan, Suining, China, ¹⁰People's Hospital of Linyi, Shandong, Linyi, China, ¹¹Gothic Internet Technology Corporation, Shanghai, China, ¹²The Second Affiliated Hospital of Shanxi Medical College, Taiyuan, China

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Disease Activity, Health Assessment Questionnaire, management and rheumatoid arthritis (RA)

Session Information

Date: Monday, November 14, 2016

Title: ARHP IV: Clinical Practice, Patient Care and Health Services

Session Type: ARHP Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: There are more than 5 million rheumatoid arthritis (RA) patients in China, but only 5,000 rheumatologists. Treat-to-target (T2T) is a widely accepted cretria as management strategy for rheumatoid arthritis (RA) to achieve defined outcomes (remission or low disease activity), but the Chinese rheumatologists can hardly provide patients with a complete assessment in the clinic due to limited time. Our previous study shows that patients in China can master the application of Smart System of Disease Management (SSDM) for accurately evaluating disease activity score in 28 joints (DAS28) and health assessment questionnaire (HAQ)after training. The purpose of this study is to describe major clinical characteristics of Chinese RA patients using SSDM and analyze the potential association among DAS28, HAQ and morning stiffness time in real world.

Methods: SSDM includes physicians’ and patients’ application system. The patient application system includes self-assessment (DAS28, HAQ), morning stiffness time and medication management. After data entry, patients can synchronize data to the mobile terminal of authorized rheumatologist. All patients fulfilling the 1987 ACR criteria for RA were recruited. The mean of each variable was analyzed using t-test, assuming normality for DAS28 distribution and the level of disease activity was analyzed using Pearson’s statistics. One-way analysis of variance was employed to explore for difference between sub-groups.

Results: From August 2014 to May 2016, data were extracted online from the mobile terminals of 741 rheumatologists in 295 rheumatology centers across China. A total of 5,756 RA patients participated in the study. The mean age was 46.37 ±13.32 (18 to 99) years and the median disease duration was 2.58 (0 to 51.83) years. All patients performed self-assessment of DAS28, HAQ and morning stiffness time for 8,533 times. At baseline, the mean DAS28, HAQ scores and morning stiffness time were 3.75 ± 2.52 (0.21 to 9.71), 2.75 ± 4.30 (0 to 24) and 19.02 ± 30.01 (0 to 240) minutes respectively. DAS28 was positively correlated with HAQ and stiffness time independently. Both HAQ and morning stiffness time showed linear regression association with DAS28 score, the regression equation as “DAS28 = 3.40 + 0.019*morning stiffness time” and ““DAS28 = 3.41 + 0.0145*HAQ” respectively, p<0.01. According to the T2T criteria, 19.29% of patients achieved remission (Rem), 12.78% with low disease activity (LDA), 42.50% with moderate disease activity (MDA) and 25.43% with high disease activity (HDA). The most commonly used medication were small molecule DMARDs (92.7%) include leflunomide (65.33%), methotrexate (45.99%) and hdroxychloroquine (44.19%). Etanercept (2.40%) was the most common being used biological DMARDs (6.07%). The number of DMARDs being taken by patients who reach target was significantly less than who fail to reach target (2.78 ± 1.64 vs 3.05 ± 1.74), p = 0.019.

Conclusion: SSDM is an effective mobile interface to serve for RA patients performing self-management as well as to supply physicians with valuable data. DAS28 was positively correlated with HAQ and morning stiffness time independently. HAQ and morning stiffness time could surrogate reflect disease activity.

Disclosure: J. Huang, None; H. Wang, None; J. Yang, None; W. Fan, None; H. Wei, None; R. Mu, None; X. Duan, None; X. Liu, None; F. He, None; Z. Zhang, None; F. Xiao, None; H. Xiao, None; Y. Jia, None; Y. Liu, None; L. Zhang, None; B. Wu, None; X. Li, None.

To cite this abstract in AMA style:

Huang J, Wang H, Yang J, Fan W, Wei H, Mu R, Duan X, Liu X, He F, Zhang Z, Xiao F, Xiao H, Jia Y, Liu Y, Zhang L, Wu B, Li X. Identification of Major Clinical Characteristics and Linear Correlations Among DAS28, HAQ and Morning Stiffness Time Using Smart System of Disease Management (SSDM) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/identification-of-major-clinical-characteristics-and-linear-correlations-among-das28-haq-and-morning-stiffness-time-using-smart-system-of-disease-management-ssdm/. Accessed .

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