Background/Purpose: The burden of chronic musculoskeletal disease is increasing worldwide, with a high demand for innovative approaches to deliver effective, feasible and cost-effective access to care. With specific regard to rheumatoid arthritis (RA),  self-reported data from patients collected remotely (ePROs= electronic patient reported outcomes) have the potential to improve healthcare services. Indeed, according to EULAR/ACR,  PROs could act as a valid surrogate for disease activity measures and enable effective tight control in patients with RA, allowing early identification of disease flares, prioritization of patients who require early treatment review, and reducing appointment frequency for those in stable remission/low disease activity.

Methods: 150 patients over 18 year of age, with a diagnosis of RA according to the 1987 or 2010 classification criteria, undergoing synthetic DMARD therapy and with low/ moderate disease activity according to DAS28, have been encouraged to upload  ePROS on a dedicated online platform on a monthly basis for 12 months, after receiving adequate training. The information collected on the online platform was available to the clinical team for regular monitoring.  Each patient was allocated a follow-up appointment after 6 months of telemonitoring. Among the ePROs, RADAI (Rheumatoid Activity Disease Activity Index) is a self-administered questionnaire that correlates with validated composite measures of disese activity such as DAS28. RADAI asks patients to rate pain in eight joint areas (total score range 0-48; 0-2.8=remission: 2.9-10 low disease activity; 10.1-22 moderate; > 22 high disease activity). Patients in remission/low disease activity within 2 months prior the scheduled visit at 6 months were offered to have their appointment postponed to 12 months. A satisfaction questionnaire was collected at the end of the 12 months.

Results: Mean age 61 ( ± 11 SD , min age 22 max age 85). Female 106 (70%)

We considered 4 different outcomes:
Outcome 1 = 47 (31.3%) the visit planned at 6 months was postponed to 12 months

Outcome 2 = 27 (18%) the visit at 6 months was not postponed due to active disease

Outcome 3 = 55 (36.7%) ePROs were not uploaded due to lack of compliance

Outcome 4= 21 (14%) ePROs were not uploaded due to technical issues/lack of confidence with the electronic system on the patients’ side

A significant difference among the 4 groups by age has been observed (p value 0.02, Kruskal -Wallis test). Post -hoc test (using the Holm correction to adjust p) showed that the only significant difference between groups when compared one to one was between goup 1 and group 4 (mean age in group 1 being the lowest and in group 4 being the highest) .

128 patients answered the satisfaction questionnaire: 55% were very satisfied, 75% stated  telemonitoring would be an important asset for heathcare in future.

Conclusion: Telemonitoring enabled the postponement of pre-scheduled visits for patients in remission/low disease activity, avoiding unecessary journeys to the hospital for these patients and freeing slots/cutting waiting lists for patients in need to be seen. Our project shows a relevant age divide, with younger patients being more confident with the use of ePROs and more likely to benefit from telemedicine.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/virtual-rheumatology-in-the-real-world-use-of-telemonitoring-to-optimize-the-management-of-patients-with-rheumatoid-arthritis/