Background Mobile devices such as smartphones and tablets have surged in popularity in recent years, generating numerous possibilities for their use in health care as mobile health (mHealth) tools. One advantage of mHealth is that it can be provided asynchronously, signifying that health care providers and patients are not communicating in real time. The integration of asynchronous mHealth into daily clinical practice might therefore help to make health care more efficient for patients with rheumatoid arthritis (RA). The benefits have been reviewed in various medical conditions, such as diabetes and asthma, with promising results. However, to date, it is unclear what evidence exists for the use of asynchronous mHealth in the field of RA. Objective The objective of this study was to map the different asynchronous mHealth interventions tested in clinical trials in patients with RA and to summarize the effects of the interventions. Methods A systematic search of Pubmed, Scopus, Cochrane, and PsycINFO was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were initially screened and later assessed by two independent researchers. Disagreements on inclusion or exclusion of studies were resolved by discussion. Results The literature search yielded 1752 abstracts. After deduplication and screening, 10 controlled intervention studies were included. All studies were assessed to be at risk for bias in at least one domain of the Cochrane risk-of-bias tool. In the 10 selected studies, 4 different types of mHealth interventions were used: SMS reminders (to increase medication adherence or physical activity; n=3), web apps (for disease monitoring and/or to provide medical information; n=5), smartphone apps (for disease monitoring; n=1), and pedometers (to increase and track steps; n=1). Measured outcomes varied widely between studies; improvements were seen in terms of medication compliance (SMS reminders), reaching rapid remission (web app), various domains of physical activity (pedometer, SMS reminders, and web apps), patient-physician interaction (web apps), and self-efficacy (smartphone app). Conclusions SMS reminders, web apps, smartphone apps, and pedometers have been evaluated in intervention studies in patients with RA. These interventions have been used to monitor patients or to support them in their health behavior. The use of asynchronous mHealth led to desirable outcomes in nearly all studies. However, since all studies were at risk of bias and methods used were very heterogeneous, high-quality research is warranted to corroborate these promising results.

BACKGROUND A rising number of people are using mobile devices such as a smartphone or tablet, which results in an increasing number of possibilities to use these devices in healthcare. Healthcare supported by mobile devices is referred to as mHealth. One advantage of mHealth is that it can be provided asynchronously, indicating that healthcare providers and patients are not communicating in real time. This eliminates the need for face-to-face contact, travel costs and travel time (for patients). This form of mHealth has been evaluated in various medical conditions such as diabetes and asthma, with promising results. However, within the field of rheumatoid arthritis (RA), a systematic review of the evidence of the use of asynchronous mHealth in clinical practice has not been performed. OBJECTIVE To provide an overview of the clinical outcomes of asynchronous mHealth interventions tested in clinical trials in patients with rheumatoid arthritis. METHODS A systematic search of Pubmed, Scopus, Cochrane, and PsycINFO was performed following the PRISMA-guidelines. Studies were initially screened, and later assessed, by two independent researchers. Disagreements on inclusion or exclusion were solved through consensus. RESULTS The literature search yielded 1752 abstracts. After deduplication and screening, 10 controlled intervention studies were included. All studies were assessed at risk for bias in at least one domain of the Cochrane risk-of-bias tool. In the 10 selected studies, 4 different mHealth interventions were used: 3 studies used SMS-reminders (to increase medication adherence and physical activity), 5 provided access to a web app for disease monitoring and to provide medical information, 1 with access to a smartphone app for disease monitoring and 1 with an activity tracking through a pedometer. Measured outcomes varied widely between studies; improvements were seen in terms of medication compliance (SMS-reminders), reaching rapid remission (web app), various domains of physical activity (pedometer, SMS-reminders and web apps), patient-physician interaction (web apps) and self-efficacy (smartphone app). CONCLUSIONS There is a limited number of controlled intervention studies on mHealth in RA, but the available studies do show promising results in various domains. mHealth may help to reduce healthcare costs and improve overall patient health in the future. However, to date, actual evidence for implementation for any of its uses in daily clinical practice is limited, which calls for more (high-quality) research.