Background/Purpose: Rheumatoid arthritis (RA) is a chronic, debilitative autoimmune disease. Patients who are treated with disease modifying therapy within 6-12 weeks of symptom onset have better outcomes which leads to a reduced economic burden of disease.¹ Technology that enables near-patient blood testing coupled with digital health applications may increase the proportion of patients treated within this window. This study aimed to assess the perceived unmet need for early treatment amongst clinicians and patients as well as their perceptions of a near-patient blood test and digital health mobile application.

Methods: 74 participants, approximately half from each of Canada (n=18) and the US (n=20) participated in a combination of in-depth interviews and surveys for 40-50 minutes. 38 of the 74 subjects, consisted of 16 rheumatologists, 14 primary care physicians (PCPs) and 8 RA patients. To supplement the patient study-sample, 36 additional patients completed an online survey of quantitative and open-ended questions focused on diagnosis and perspectives of a described near-patient blood test and mobile application. Rheumatologists who were in full-time practice and PCPs who see at least 15 RA patients a month were included. Patients were between 18 and 60 years old, had an RA diagnosis and experience using apps for health management.

Results: Almost all Rheumatologists and PCPs indicated that the time between symptom onset and treatment initiation (currently 6-18 months) could be improved and agreed that difficulty diagnosing is still one of the biggest unmet needs. Referrals to a Rheumatologist range from 6 weeks to 3 months. Patients indicated that it took 8 months to 2 years before treatment initiation. Most Rheumatologists said the longest delay is due to inconclusive PCP clinical exams and blood work, leading to repeated visits before patients are referred. Most clinicians and patients welcomed new tools with 33% of patients willing to pay for the near-patient blood test and mobile application. Clinicians had few concerns about a near-patient blood test and indicated that it should be available in the clinic, not the pharmacy. Patients reported the appeal of an easy to use near-patient blood test that could have meant an earlier diagnosis over a traditional laboratory blood test.

Conclusion: RA is difficult for PCPs to identify for early referral and treatment within 6-12 weeks of symptom onset. The clinicians and patients we surveyed reported positive perspectives regarding near-patient blood tests and mobile applications and welcome their use to assist with earlier referral and treatment. With the emergence of innovative near-patient technologies, opportunities exist to intervene earlier and potentially reduce the social and economic burden of chronic diseases.

Acknowledgement: The authors would like to acknowledge B2 Consulting for their assistance with this project. This project was funded by the National Research Council – Industry Research Assistance Program (NRC-IRAP).

¹Nell VP, Machold KP, Eberl G, et al. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology 2004;43:906–14.10.1093/rheumatology/keh199

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-qualitative-study-evaluating-near-patient-tools-including-a-mobile-application-for-earlier-ra-referral-potential-to-reduce-chronic-disease-burden/