Feasibility and Influential Factors in Performing Self-Evaluation of DAS28 with Smart System of Disease Management (SSDM) By RA Patient in China

Mu Rong¹, Fei Xiao², Chun Li³, Jianlong Guan⁴, Yan Shen⁴, Dongbao Zhao⁵, Xia Xu⁶, Lindi Jiang⁷, Huiyong Chen⁷, Li Su⁸, Yuhua Jia², Li Zhang², Yuan Liu² and Zhan-Guo Li³, ¹Department of Rheumatology and Immunology, People's Hospital, Beijing University Medical School, Beijing, China, ²Gothic Internet Technology Corporation, Shanghai, China, ³Department of Rheumatology & Immunology, People's Hospital, Beijing University Medical School, Beijing, China, ⁴Huadong Hospital Affiliated to Fudan University, Shanghai, China, ⁵ShangHai ChangHai Hospital, ShangHai ChangHai Hospital, ShangHai, China, ⁶Department of Rheumatology and Immunology, Changhai Hospital,Second Military Medical University,, Shanghai, China, ⁷Zhongshan Hospital, Fudan University, Shanghai, China, ⁸Longhua Hospital Shanghai University of TCM, Shanghai, China

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Disease Activity, Education, patient, rheumatoid arthritis (RA) and self-management

Session Information

Date: Sunday, November 8, 2015

Title: ARHP I: Exemplary Abstracts

Session Type: ARHP Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Regular evaluations of rheumatoid arthritis (RA) disease activities with disease activity score in 28 joints (DAS28) are critical steps to reach the goal of “Treat to Target”. However, over-load of RA patients and short supply of rheumatologists in China made these steps impossible in the clinic. An option is to realize self-disease-evaluation by RA patient. Due to the smart phone being widely used in 66% of Chinese people, a user-friend platform of the Smart System of Disease Management (SSDM) is a potential resolution for regular evaluations of RA disease activities. SSDM includes applications of self-evaluation of DAS28, HAQ, and digital records of medication and lab test results. SSDM is developed in IOS, Android and Web format with patient and physician’s interfaces. After patient entries the data, it synchronizes with the interface of authorized doctor in real time mode.

To verify the feasibility and influential factors in performing self-evaluation on DAS28 with SSDM by RA patients.

Methods: From December 14, 2014 to February 2, 2015, two phases of studies were performed and total 103 patients enrolled, with 55 and 48 patients in each phase, respectively. All patients met the 1987 ACR criteria for diagnosis of RA. Ten rheumatologists and two nurses from five hospitals in Beijing and Shanghai participated in the study.

Education courses were held in hospitals. Patients were taught how to do self-evaluations on DAS28 and HAQ with SSDM. After practice and passing the exam, the self-evaluation of DAS28 was performed and data was recorded in SSDM. The same patient was evaluated by doctor or nurse simultaneously.

Statistical analysis was performed using SAS software, version 9.4. Intra-observer reliability of tender joint counts (TJCs) and swollen joint counts (SJCs) were expressed through the intra-class correlation coefficient (ICC).

Results: Among 103 RA patients, Mean age was 55.20 ± 13.26 (23 to 72) years, mean disease duration was 8.91 ± 8.25 (1 to 34) years.

As of December 31, 2014 for phase I, the ICCs of TJCs and DAS28 scores were 0.93 and 0.94, but the ICC of SJCs was 0.68. The analysis showed that the duration of disease was the only associate factor with significant difference (P<0.05). Stratified analysis showed that the result of SJCs matched between patients and health professionals was in the group with disease duration of 6.86 ± 5.78 years, but mismatched group was 14.18 ± 10.26 years in disease duration which group of patients under valuated their SJCs.

In Phase II of 48 patients, the education courses were more emphasized in identification of swollen joints. As a result, the ICCs of SJCs, TJCs and DAS28 were improved to 0.93, 0.93 and 0.92, respectively.

The average time for patients to do self-evaluation on a composite of DAS28 and HAQ with SSDM was 7.11 ± 5.21 (2-30) minutes, median time for 5 minutes; and the corresponding time for health professionals was 6.55 ± 4.26 (1-20) and 2 minutes, respectively.

Conclusion: Through improving education, RA patients in China can master SSDM and perform accurate self-evaluation on DAS28 and HAQ. SSDM may serve as a valuable platform for assisting rheumatologists in rationally managing RA patients in order to reach the goal of “Treat to Target”.

Disclosure: M. Rong, None; F. Xiao, None; C. Li, None; J. Guan, None; Y. Shen, None; D. Zhao, None; X. Xu, None; L. Jiang, None; H. Chen, None; L. Su, None; Y. Jia, None; L. Zhang, None; Y. Liu, None; Z. G. Li, None.

To cite this abstract in AMA style:

Rong M, Xiao F, Li C, Guan J, Shen Y, Zhao D, Xu X, Jiang L, Chen H, Su L, Jia Y, Zhang L, Liu Y, Li ZG. Feasibility and Influential Factors in Performing Self-Evaluation of DAS28 with Smart System of Disease Management (SSDM) By RA Patient in China [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/feasibility-and-influential-factors-in-performing-self-evaluation-of-das28-with-smart-system-of-disease-management-ssdm-by-ra-patient-in-china/. Accessed .

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