Background/Purpose: Remission targeted treatment of early RA requires frequent monitoring. However, in clinical practice monitoring frequency is not always optimal due to factors like limited resources. Therefore, to ensure successful initiation of anti-rheumatic therapy and adherence to treatment during the crucial 6 months after the diagnosis, we have developed an automated text message (SMS) based monitoring system for early RA called SandRA. Here we present the results of a randomized study comparing SMS-based follow-up to routine care.

Methods: We randomized 166 patients with early, untreated RA fulfilling the EULAR 2010 classification criteria to intensive SandRA-based follow-up (visits at 0, 3, and 6 months and 13 SMSs at 1–2 week intervals) and to routine follow-up (visits at 0, 3, and 6 months) in 2014–2015. The SandRA software sent questions about medication use, adverse effects, and disease activity (patient global assessment [scale 0–10]). Treatment was administered at the physician’s discretion. The SandRA follow-up aimed to improve medication adherence and to identify early the patients responding poorly to treatment. If responses suggested medication problems or insufficient reduction in disease activity, the system alarmed and the patient was contacted. The primary outcome was a strict Boolean remission at 6 months, defined as no tender or swollen joints (46 joint count), and normal CRP.

Results: Follow-up data at 6 months were available for 162 patients. The randomization groups were nearly identical at baseline (Table 1).  All patients started intensive therapy; 96% started MTX, and 89% started a combination of 2–3 conventional DMARDs. At 6 months, 62% of patients in the intervention, and 53% in the control group were in remission (p=0.34). DAS28 levels decreased similarly, 2.18 in the intervention group, and 2.21 in the control group (p=0.18). Alarms from SandRA increased the number of nurses telephone contacts in the intervention group (p=0.027 for scheduled calls; p<0.001 for non-scheduled calls). No differences were observed for other visit types. Of the patients in the intervention group, 94% found the monitoring messages easy to answer, >80% felt secure and were satisfied with their treatment, and 100% would recommend SandRA monitoring for other RA patients.

Conclusion: The vast majority of RA patients were satisfied with the SMS-based monitoring system. The remission rate was higher in the SandRA group than in the control group but the difference did not reach statistical significance. Overall, remission rates were remarkably high in both groups, possibly due to successful efforts to optimize the rheumatology service (1). Despite our study failing the primary outcome, SMS-based monitoring may be beneficial in less resourced settings, and may facilitate medication adherence. Reference: Vare P, et al. SAGE Open Medicine 2016; 6: 1–7.