Pattern Shift and Influential Factors in Promoting Treat-to-Target (T2T) for Follow-up RA Patients with a Rheumatologist-Patient Interactive Smart System of Disease Management (SSDM): A Cohort Study from China

Rong Mu¹, Chun Li², Jing Yang³, Hua Wei⁴, Jianlin Huang⁵, Wenqiang Fan⁶, Yongfu Wang⁷, Hongzhi Wang⁸, Jinmei Zou³, Xiaofei Shi⁹, Xiafei Xin¹⁰, Jianhong Wu¹¹, Fen Li¹², Shouxin Li¹³, Huiqin Yang¹⁴, Anbing Zhang¹⁵, Dongbao Zhao¹⁶, Jinchang He¹⁷, Junli Zhang¹⁸, Luo Li¹⁹, Peng Ji²⁰, Xiaofeng Rong²¹, Feng Jiang²², Ling Wang²³, Yuhua Jia²⁴, Fei Xiao²⁴ and Zhan-Guo Li²⁵, ¹Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China, ²Peking University People's Hospital, Beijing, China, ³Department of rheumatology, Central Hospital of MianYang, Sichuan, Mian Yang, China, ⁴Northern Jiangsu People's Hospital, Yangzhou, China, ⁵Department of rheumatology, The Sixth Hospital Affiliated to Sun yat-sen University, Guangzhou, China, ⁶Department of rheumatology, Central Hospital of XinXiang, Henan, XinXiang, China, ⁷The First Affiliated Hospital of BaoTou Medical College, Baotou, China, ⁸The First Hospital of Jiaxing, Jiaxing, China, ⁹The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China, ¹⁰Ningbo First Hospital, Zhejiang, Ningbo, China, ¹¹Dazhou Central Hospital, Dazhou, China, ¹²The Second Xiangya Hospital of Central South University, Changsha, China, ¹³Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology, wuhan, China, ¹⁴Wuhan No 1 Hospital, wuhan, China, ¹⁵Xiangyang Central Hospital, Xiangyang, China, ¹⁶Changhai Hospital of Shanghai, Shanghai, China, ¹⁷PanZhiHua Central Hospital, Panzhihua, China, ¹⁸Xi 'an no.5 hospital, Xian, China, ¹⁹The First Affiliated Hospital of XinJiang Medical University, Wulumuqi, China, ²⁰[email protected], Wulumuqi, China, ²¹Affiliated hospital of Chongqing medical University, Chongqing, China, ²²Huzhou Third People's Hospital, Huzhou, China, ²³Zao Zhuang Municipal Hospital, zaozhuang, China, ²⁴Shanghai Gothic Internet Technology Co., Ltd., Shanghai, China, ²⁵Rheum/Immunology, Peking University People's Hospital, Beijing, China

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Health Assessment Questionnaire, outcomes and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Treat-to-Target (T2T), achieving a DAS28 score lower than 2.6 (remission, Rem) or below 3.2 (low disease activity, LDA), is the main management strategy recommended by ACR and EULAR. The Smart System of Disease Management (SSDM) is an interactive mobile disease management tool, including the doctors’ and patients’ application system. The patients can perform self-evaluation, including DAS28, morning stiffness duration (MSD) and HAQ, and input medical records (including medication and laboratory test results) through the mobile application. The data synchronizes to the mobiles of authorized rheumatologists through cloud data base and advices could be delivered. The objective of this study is to evaluate the patterns of T2T and related influential factors among RA patients after applying SSDM in real world.

Methods: Patients were registered through downloading the SSDM application, then were trained to master SSDM by health professionals in clinics. The first assessment for DAS28 were performed as baseline. The patients were required to perform repeated assessments once a month after leaving clinic.

Results: From Jun 2014 to May 2018, 2,666 RA patients from 154 hospitals across China were followed up for more than 6 months through SSDM, and the results at baseline and in final follow up were shown in table 1.The rate of T2T achievers were 39% (1,038/2,666) at baseline, and improved significantly to 53% (1,414/2,666) after 6 month follow up, p<0.05. Among T2T achievers at baseline, 70.5% (732/1,038) maintained T2T, 29.5% (306/1038) relapsed. Compared with relapsers, T2T maintainers performed more self-evaluation and data entry (5.47 vs 2.92, p<0.01). Among the pateints who maintained T2T£¬Among patients failed to reach T2T at baseline, 41.9% (682/1,628) achieved T2T after 6 months. Comparing with 6 month failure 58.1%(946/1,628), new T2T achievers got lower HAQ score (1.98 ± 2.15 vs 4.68 ± 3.52, p<0.001) at baseline, performed more times of self-evaluation and data entry (5.43 vs 2.81, p<0. 01). However, even in patients of 6 month failure, the MSD and HAQ score were improved significantly in final follow up comparing with those at baseline (13.93±22.16mins vs 29.16 ± 34.26mins, p<0.001 and 2.18 ± 2.25 vs 4.68 ± 3.52, p<0.001, respectively).

Conclusion: After proactive disease management via SSDM for more than 6 months, the rate of T2T in RA patients increased significantly. The patients who bear better HAQ scores and perform more self-evaluations through SSDM had lower probability of relapse and higher T2T maintaining and achievement. SSDM is a valuable tool for long term RA follow-up through empowering patients. Future RCT of improvingT2T outcome through intervention of above influential factors with SSDM is warranted

Disclosure: R. Mu, None; C. Li, None; J. Yang, None; H. Wei, None; J. Huang, None; W. Fan, None; Y. Wang, None; H. Wang, None; J. Zou, None; X. Shi, None; X. Xin, None; J. Wu, None; F. Li, None; S. Li, None; H. Yang, None; A. Zhang, None; D. Zhao, None; J. He, None; J. Zhang, None; L. Li, None; P. Ji, None; X. Rong, None; F. Jiang, None; L. Wang, None; Y. Jia, None; F. Xiao, None; Z. G. Li, None.

To cite this abstract in AMA style:

Mu R, Li C, Yang J, Wei H, Huang J, Fan W, Wang Y, Wang H, Zou J, Shi X, Xin X, Wu J, Li F, Li S, Yang H, Zhang A, Zhao D, He J, Zhang J, Li L, Ji P, Rong X, Jiang F, Wang L, Jia Y, Xiao F, Li ZG. Pattern Shift and Influential Factors in Promoting Treat-to-Target (T2T) for Follow-up RA Patients with a Rheumatologist-Patient Interactive Smart System of Disease Management (SSDM): A Cohort Study from China [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/pattern-shift-and-influential-factors-in-promoting-treat-to-target-t2t-for-follow-up-ra-patients-with-a-rheumatologist-patient-interactive-smart-system-of-disease-management-ssdm-a-coho/. Accessed .

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