Background/Purpose: The demand on outpatient rheumatology clinics is high due to protocolised visits of rheumatoid arthritis (RA) patients, including those in low disease activity or remission. We developed a mobile phone app for patients with RA, which allows them to self-monitor their disease activity in between clinic visits by answering a weekly routine assessment of patient index data (RAPID-3). The objective of this study is to assess efficacy and safety of self-initiated care assisted by a smartphone app in patients with RA.

Methods: A randomised controlled trial was performed with a study duration of one year. Inclusion criteria were: 1) diagnosed with RA by a rheumatologist, 2) disease duration of at least two years and 3) a Disease Activity Score 28 (DAS28) below 3.2 at the start of the study. Patients were excluded if they had initiated or discontinued conventional DMARDs or a biological in the previous 6 months. Patients were randomised to either app supported self-initiated care with only one scheduled follow-up consultation after a year (app-group) or to usual care. The app warned patients that they could be flaring when RAPID-3 scores increased more than 2 points and the overall score was over 4. The co-primary outcome was mean number of consultations with a rheumatologist and non-inferiority in terms of difference in DAS28 at 12 months. The non-inferiority limit was set at 0.5 difference in DAS28 between the groups. Secondary outcomes included consultations with nurses, satisfaction with healthcare and app usage.

Results: In total, 103 patients were randomised to usual care (n=53) or to the app group (n=50). Baseline characteristics were similar in both groups (table 1). At 12 months, the mean number (±SD) of outpatient or telephone consultations with the rheumatologist was significantly lower in the app group compared with usual care (1.7±1.8 vs 3.0±1.4, p< 0.001). The same applied to the nurse outpatient or telephone consultations (0.4±1.0 vs 0.9±1.1, p=0.03; table 2). Non-inferiority was established as the 95% confidence interval of the mean difference in DAS28 between the groups was within the non-inferiority limit: -0.04 in favour of the intervention group ([95% CI], -0,39, 0.30). Satisfaction with healthcare received was high (8.6 out of 10 ±1.3) in both groups and not statistically different. On average patients completed 56% (29/52, SD13.3) of the weekly questionnaires.

Conclusion: The results of this study show that self-initiated care supported with weekly RAPID3 self-monitoring via a smartphone app reduces the number of outpatient visits and telephone consultations and is non-inferior to usual care in terms of the DAS28. We propose the implementation of this approach to optimise rheumatologic care for RA patients in low disease activity.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/smartphone-assisted-patient-initiated-care-safely-reduces-outpatient-clinic-visits-in-patients-with-rheumatoid-arthritis-results-from-a-randomized-controlled-trial/