Background/Purpose:

There is evidence that tight control of rheumatoid arthritis improves outcome. In daily practice this aim is constricted by logistic limitations such as a small number of rheumatologists or long distances to specialized centers. By tele-monitoring the disease activity between regular routine controls and individually tailoring control intervals, we might be able to optimize disease management. In this study, we examine the acceptance and usage of an online tele-monitoring tool.

Methods:

The tele-monitoring tool was developed as a patient empowerment platform for an internet community for patients of chronic arthritis. The program includes electronic versions of the DAS28 and the HAQ as well as a form to regularly (e.g., daily) document disease activity (scale 0-10; 0=lowest, 10=highest), pain (0-10) and fatigue (0-10), swollen and tender joints, drugs taken and any noteworthy events such as flares or special occasions in the patient’s life. The monitoring data can be made available to the rheumatologist who can then react appropriately.

Between 2011 and 2015, 2732 users of the internet community signed up for the program, out of which 1233 patients voluntarily provided their age, gender and diagnosis. 616 subjects with RA (n=503) or PsA (n=114) were chosen for further analysis.

Results:

The mean age at registration was 45.0 ± 12.2 years (range 13-82); 467 (76%) subjects are female. 279 patients (45%) used the program less than two weeks. The remaining 337 patients (55%) used the program for 323.8 ± 352.5 days on average, with an average frequency of once every 32.4 ± 57.4 days.

415 patients regularly entered disease activity (totaling n=17691 entries; average of 3.07 ± 2.50), pain (n=19325 entries; average 3.27 ± 2.50), or fatigue (n=18198; average 3.42 ± 2.83). The DAS28 test was performed by 275 patients; the average score after registration was 4.68 ± 1.44 (range 0.42 – 8.91; median 4.71). The average HAQ score (333 patients) was 1.11 ± 0.67 (range 0 – 2.86; median 1.13).

Conclusion:

The tele-monitoring tool is well-received. The majority of patients that signed up continued to use it regularly. Patients seem to prefer simple scores that can be entered quickly over more involved tests such as the DAS28 or the HAQ.

It remains open why some patients discontinued the usage of the tele-monitoring tool. With additional training and support by health care providers such as the primary physician it might be possible to improve the persistency in tele-monitoring as well as the acceptance of lengthier tests such as the DAS28 or HAQ. Here we see chances and challenges for a more broader application of tele-monitoring tools.

The average user of the tele-monitoring tool is rather young, has a high disease activity and reduced functional capacity. This might be an indication that particularly patients with a severe arthritis seek help in additional tools for coping with their disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tele-monitoring-of-disease-activity-in-rheumatoid-arthritis-and-psoriatic-arthritis/