Background/Purpose:  The disease activity score in 28 joints (DAS28)  and health assessment questionnaire (HAQ) serve as guides for the treatment of rheumatoid arthritis (RA). Smart System of Disease Management (SSDM) is a series of mobile phone applications for chronic diseases management, which includes interfaces of both physicians’ and patients’ applications. After entry the results of DAS28 and HAQ self-assessed by patients, all data can be synchronized automatically to the authorized rheumatologist’ mobile terminals. We have confirmed in a validation study that Chinese RA patients can master the use of SSDM for accurate DAS28 self-assessments after training. The purpose of this study is to evaluate the susceptible joints and the recovery sequence of swollen joint counts (SJCs) and tender joint counts (TJCs) based on DAS28 which self-assessed by Chinese RA patients with SSDM, and to describe the association between DAS28 and HAQ.

Methods: From August 2014 to May 2016, 5,756 RA patients did self-management and synchronized their data with the responsible physicians. The data were extracted online from the mobile terminals of 741 rheumatologists in 295 rheumatology centers across China. Patients were trained to self-assess DAS28 and HAQ with SSDM at baseline, and were asked to repeat the assessment once a month during the treatment. Descriptive statistics were performed for patient and disease characteristics. The mean of each variable was analyzed using t-test assuming.

Results: Among 5,756 RA patients, 4,299 (74.7%) women and 1,457 (25.3%) men. 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. Total 8,533 times self-assessment of DAS28 and HAQ were performed. There were 37,501 joints tender and 22,029 joints swollen in the entire cohort. 807 RA patients did repeat self-assessment at least 28 days apart for 1,361 times. At baseline, 3,363 joints were swollen and 5,176 joints were tender. The top three swollen joints were right wrist (25.28%), right middle proximal interphalangeal (PIP) (25.15%) and left wrist (22.92%), and the top three tender joints were right wrist (43.25%), left wrist (42.63%) and right knee (40.40%). After treatment, the recovery rate of TJCs (25.54%) was significantly better than that of SJCs (21.80%), p < 0.01. Hand joints recovered more quickly than other joints. In the last assessment, the three worst recovery swollen joints were left shoulder (-15.50%), right shoulder (-1.79%) and right knee (0.00%). At baseline, HAQ score showed that the top two most difficult physical activities were “bending down to pick up clothing from the floor (reaching)” and “washing and dry entire body (hygiene)”. At the last assessment, the total HAQ score was significantly improved than the baseline in the entire group, p < 0.01. The top two difficult physical activities changed as “getting in and out of a car” and “reaching”, which match with joints swollen conditions.

Conclusion: In this study, most involved joints in tender and swelling are hand and wrist joints. After treatment, hand joints recovered quickly but shoulders and knees recovered slowlier, which matched with HAQ assessment results. The results will prompt future rehabilitation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analysis-of-joints-susceptible-to-rheumatoid-arthritis-ra-and-their-recovery-sequence-based-on-das28-and-physical-function-based-on-haq-with-smart-system-of-disease-management-ssdm-in-china/