Objectives To investigate whether an intensive treatment strategy in early rheumatoid arthritis (ERA), by an internet-based home tailored telemonitoring tight control (TTTC) protocol is more effective than treatment according to usual care in reaching remission and comprehensive disease control (CDC) after 1 year [1, 2]. Additionally we evaluated the patients' satisfaction with the technological device.
Methods Two ERA cohorts were compared. In the TTTC cohort (n=21), a regular evaluation guided by a remote approach of disease activity was applied, according to a CDAI-driven step-up treatment strategy. Patients in the usual-care cohort (n=20) were treated without a CDAI-guided strategy, so treatment decision were made according to the discretion of the rheumatologist. Primary outcome measures were the proportion of patients in remission (CDAI <2.8) and the achievement of comprehensive disease control (CDC). Secondary endpoints were the 1-year area under the curve (AUC) of CDAI minor, moderate and major response cutpoints. Further we reported the results in terms on patients' satisfaction with the technological device.
Results A higher percentage of patients in the TTTC group achieved CDAI remission versus patients in usual care (38.1% vs 25% at year 1, p<0.01). Time to achieve remission (CDAI<2.8) was significantly shorter in the TTTC group than in the usual-care group, with a median of 20 weeks versus a median over 36 weeks (p<0.001). Concordantly, the patients followed for one year in tight control showed a greater improvement (p<0.001) compared with the usual care group in terms of clinical activity (38.1% vs. 25%), functional impairment (71.4% vs. 35%) and radiological damage progression (23.8% vs. 10%), resulting in a greater rate of CDC (19.4% vs. 5%). Moreover was found high satisfaction among the vast majority of respondents.
Conclusions This preliminary study demonstrates that an intensive internet-based home TTTC is more effective in reaching remission and CDC than the usual care. Moreover it is higly accepted by the patients. Larger studies with rigorous designs are needed to get better evidence on the effects of telemedicine interventions on health, satisfaction with care and costs.
Schipper LG, Vermeer M, Kuper HH, et al. A tight control treatment strategy aiming for remission in early rheumatoid arthritis is more effective than usual care treatment in daily clinical practice: a study of two cohorts in the Dutch Rheumatoid Arthritis Monitoring registry. Ann Rheum Dis 2012; 71(6): 845-50.
Emery P, Kavanaugh A, Bao Y, et al. Comprehensive disease control (CDC): wath does achieving CDC mean for patients with rheumatoid arthritis? Ann Rheum Dis 2014; 205302 [Epub ahead of print].
Disclosure of Interest None declared