Background Despite the increased prevalence of rheumatoid arthritis (RA) in recent years, no studies have yet investigated the effect of monitoring disease activity through a standardized tele-health strategy in patients with RA (1).
Objectives To test the effect of patient-reported outcome (PRO) based tele-health follow-up for tight control of disease activity in patients with RA, and the differences between tele-health follow-up performed by rheumatologists or rheumatology nurses.
Methods A total of 294 patients were randomized (1:1:1) to either PRO-based tele-health follow-up carried out by a nurse (PRO-TN) or a rheumatologist (PRO-TR), or conventional out-patient follow-up by physicians. The Flare-RA (2) was used as decision aid for assessing disease activity.
The primary outcome was change in DAS28 after week 52. Secondary outcomes were: physical function, quality of life and self-efficacy. The non-inferiority margin was a DAS28 change of 0.6. Mean differences were estimated following per-protocol, intention to treat (ITT) and imputation (IMP).
Results Overall patients had low disease activity at baseline and end follow-up. Demographics and baseline characteristics were similar between groups. Non-inferiority was established for DAS28. In the ITT analysis mean difference in DAS28 between PRO-TR vs. control were -0.10 (90% CI -0.30; 0.13) and -0.19 (-0.41; 0.02) between PRO-TN vs. control. When including one yearly visit to the outpatient clinic, patients in PRO-TN had a total of 1.72 (SD 1.03) visit/year, PRO-TR 1.75 (SD 1.03) vist/year and control 4.15 (SD 1.0) visits/year. This included extra visits due to inflammatory flare.
Overall more than 80% of the patients in all three groups answered that they were “very satisfied” with the consultation form they received and no differences were found between the three groups.
Conclusions Among RA patients with low disease activity or remission a PRO-based tele-health follow-up for tight control of disease activity in RA can achieve similar disease control as conventional outpatient follow-up. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.
Ward IM, Schmidt TW, Lappan C, Battafarano DF. How critical is tele-medicine to the rheumatology workforce? Arthritis Care Res (Hoboken). 2016 Feb 11.
Berthelot JM, De Bandt M, Morel J, Benatig F, Constantin A, Gaudin P, et al. A tool to identify recent or present rheumatoid arthritis flare from both patient and physician perspectives: The 'FLARE' instrument. Ann Rheum Dis. 2012 Jul;71(7):1110–6.
ClinicalTrails.gov identifier: NCT02155894.
Disclosure of Interest None declared