Disease activity in patients with rheumatoid arthritis (RA) fluctuates significantly between outpatient rheumatologist visits, and can be reliably self-monitored by patients between follow-up appointments through the use of a Web-based smartphone application (WebApp), according to the results of a recent prospective, multicenter study by Ulrich A. Walker, MD, Department of Rheumatology, University Hospital Basel, Switzerland, and colleagues (Walker UA, et al. Rheumatology (Oxford). 2017;56:1707-1712).
“One of the biggest challenges in the management of RA is monitoring disease effectively, in order to avoid missing flare-ups,” said Dr Walker and colleagues, adding that the use of patient-reported outcomes to complement disease monitoring is recommended by the European League Against Rheumatism.
“With the development of new technology, PRO [patient-reported outcome] questionnaires are becoming available as Web-based applications (WebApps) for computers and smartphones,” they said.
Dr Walker and colleagues sought to evaluate patient self-assessment of RA disease activity using Routine Assessment of Patient Index Data (RAPID)3 and RAPID4 scores via the WebApp, and to evaluate the correlation between these scores and traditional, physician-assessed Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI) scores. In addition, they aimed to assess the dynamics of RA disease activity between routine clinical visits using RAPID scores.
Between November 2012 and March 2014, Dr Walker and colleagues analyzed the WebApp- and rheumatologist-based scores of 80 adult patients with RA. Rheumatologist examinations were conducted at baseline and after 3 months, whereas WebApp questionnaires were completed by the patients on a weekly basis. Patients were given instructions on how to use the WebApp and had the opportunity to become familiar with the application for 2 weeks before being examined for the first time. The median age and RA duration of patients included in the analysis were 57 years and 4.5 years, respectively, and 59% of them were women.
Dr Walker and colleagues found a moderate-to-strong relationship between RAPID3 and CDAI (0.65), DAS28 (0.63), and SDAI (0.61) scores at baseline, and saw similar or stronger correlations in these measures at the 3-month follow-up (CDAI, 0.71; DAS28, 0.66; and SDAI, 0.61). Comparable relationships were seen between RAPID4 scores and scores gleaned from rheumatologist assessments.
With regard to dynamic changes in RA disease activity between routine clinical visits, Dr Walker and colleagues found that the RAPID3 score changed from baseline to a higher severity category ≥1 times for 47% of patients. In addition, DAS28 scores projected from RAPID3 demonstrated that 11% of patients had an increase of >1 DAS28 units during that 3-month time frame.
They asserted that the correlations between WebApp and physician-assessed scores were not influenced by demographics or by RA therapy, and that the results demonstrated the viability of using the WebApp for disease activity monitoring between rheumatologist visits.
“The results of this study support the feasibility of the continuous patient self-monitoring of RA activity using a WebApp-based approach in order to capture disease flares, even in patients deemed quiescent. WebApp-based RAPID3 data capture may evolve into a means to collect detailed information about the fluctuations of RA activity in between outpatient visits and may in the future optimize RA management,” Dr Walker and colleagues concluded.