Background/Purpose:  There are more than 5 million rheumatoid arthritis (RA) patients in China, but only 5,000 rheumatologists. Treat-to-Target (T2T) strategy are critical for the treatment of RA, but the Chinese rheumatologists can hardly provide patients with a complete assessment in the clinic due to limited time. The purpose of this study is to explore the effectiveness of applying SSDM in improvement of disease activity after repeated self-assessment in Chinese RA patients.

Methods:  The SSDM includes interfaces of both physicians’ and patients’ application. After entering the data of lab test records, treatment regiments, and executing DAS28 assessment by patients, all data can be synchronized automatically to the authorized physicians’ mobile tool. The rheumatologist can adjust treatment regiments base on patients’ profile. From August 2014 to June 2016, 126 rheumatologists from 83 hospitals in China participated in the study. Patients were educated to assess DAS28 with SSDM and asked to repeat the self-assessment once a month. Descriptive statistics were performed for patient and disease characteristics. According to DAS28 scores, disease activity was divided into four groups: remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA).

Results:  1,058 RA patients with repeated self-assessment of DAS 28 were recruited, 819 (77.4%) women and 239 (22.6%) men respectively. Mean age was 48.3 ± 13.1 (11 to 83) years. Mean interval of repeat self-assessment was 38.2±38.1 days. Mean self-assessment frequency were 3.39±2.84 (2 to 31) times. Mean DAS28 score was 3.78 ± 1.45 (0.56 to 8.66) at baseline and 3.31 ± 1.35 (0.08 to 9.07) at the last assessment. Proportion of patients in Rem, LDA, MDA and HDA was 22.12%, 16.26%, 43.29% and 18.34% respectively at baseline, and changed into 32.61%, 18.81%, 39.22% and 9.36% at the last assessment. The rate of T2T (DAS28≤3.2) at the last assessment was higher than that of baseline significantly (P<0.01). The rate of HDA patients for last assessment was significantly lower than baseline (P<0.01). To further explore weather tight control of disease activity with SSDM could influence RA patients’ outcome, we stratified the patients who did not achieve clinical remission (DAS>2.6) at baseline into twice assessments group and multiple assessments group with 6 months follow-up. The result showed that 149 patients made only twice assessments of DAS28 within 160.8±94.9 (60-578) days. Their mean DAS28 score was 4.27±1.15 (2.61 to 7.86) at baseline and improvement of DAS28 score was 0.55±1.51 (-4.49 to 4.18) at their last assessment. While another 170 patients made 4 to 10 times of self-assessment during 178.9±139.3 (28 to 648) days follow-up. Their mean DAS28 score was 4.24±1.10 (2.61 to 7.77) at baseline and average improvement of DAS28 score was 1.09±1.37 (-1.86 to 5) at the last assessment, which was significantly better than patients who had only two self-assessments (T=3.331, P=0.001).

Conclusion:  Under repeat self-assessment of DAS28 using SSDM, RA patients can achieve better T2T result. SSDM can assist rheumatologist to rationally adjust treatment for RA patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/significant-improvement-of-rheumatoid-arthritis-ra-outcome-with-repeat-application-of-disease-management-ssdm-mobiles-tools-a-cohort-study-of-ra-patients-in-china/