Background There are more than 5 million RA patients in China, but only 4,000 rheumatologists. T2T strategy are critical for the treatment of RA, but the Chinese doctors can hardly provide patients with a complete assessment in the clinic due to limited time. We have confirmed in a validation study that Chinese RA patients can master the use of SSDM for accurate DAS28 self-assessments after training1.
Objectives To explore the effectiveness of applying SSDM in improvement of disease activity after repeated self-assessment in Chinese RA patients.
Methods The SSDM includes both doctors' and patients' application. After entry of lab test, treatment regiments, and executing DAS28 assessment by patients, all data can be synchronized to the authorized doctor' mobile tool. They can adjust treatment regiments base on these data. Since Aug. 2014 to Jan. 2016, 31 rheumatologists from 25 hospitals participated in the study. Patients were educated to measure DAS28 with SSDM on the baseline, and were asked to repeat the assessment once a month.
Results 636 RA patients with repeated self-assessment of DAS 28 were recruited, 448 (70.4%) women and 188 (29.6%) men. Mean age was 45.26±13.17 (18 to 83) years, median duration of disease was 2.92 (0.08 to 50.42) years. Mean duration of self-assessment was 67.00±66.50 (2 to 371) days. Mean assessment times were 4.38±3.36 (2–20). Mean DAS28 score was 3.96±1.46 (0.62 to 8.29) at baseline and 3.58±1.45 (0.60 to 9.07) at the last assessment. Proportion of patients in remission, low, moderate and severe disease activity (Rem, LDA, MDA and SDA) was 19.03%, 13.36%, 45.28% and 22.33% respectively at baseline, and changed into 26.57%, 13.68%, 45.28% and 14.47% at the last assessment. The rate of T2T (DAS28≤3.2) at the last assessment was higher than that of baseline significantly (P<0.01). The rate of SDA patients for last assessment was also significantly lower than baseline (P<0.01). To explore whether the frequency of self-assessment could influence disease activity, we stratified the times of DAS28 assessment among those who did not achieve clinical remission (DAS>2.6). 65 patients made only two assessments within 151.41±86.72 (48–372) days, whose mean DAS28 was 4.20±1.28 (2.64–7.39) at baseline and improvement of that was 0.49±1.46 (-4.31–4.25) at their last assessment. There were 61 patients making more than 5 times of self-assessment during 159.98±88.10 (28–343) days. Their mean DAS28 score was 4.27±1.13 (2.61–7.19) at baseline and improvement of that was 1.12±1.34 (-1.86–4.51) at the last assessment, which was significantly better than patients who had only two self-assessments (T=2.52, P=0.013).
Conclusions Under regular self-assessment of DAS28 using SSDM, RA patients achieved better T2T result. SSDM can assist rheumatologists to rationally adjust treatment for RA patients.
Mu Rong. Feasibility and Influential Factors in Performing Self-Evaluation of DAS28 with SSDM By RA Patient in China. Arthritis Rheumatol. 2015; 67 (suppl 10). Abstract Number: 997
Disclosure of Interest None declared