Automated Text Message–Enhanced Monitoring Versus Routine Monitoring in Early Rheumatoid Arthritis: A Randomized Trial

Abstract

Objective Frequent monitoring of patients with early rheumatoid arthritis (RA) is required for achieving good outcomes. This study was undertaken to investigate the influence of text message (SMS)–enhanced monitoring on early RA outcomes. Methods We randomized 166 patients with early, disease‐modifying antirheumatic drug–naive RA to receive SMS‐enhanced follow‐up or routine care. All patients attended visits at 0, 3, and 6 months, and a follow‐up visit at 12 months. Treatment was at the physicians’ discretion. The intervention included 13 SMSs during weeks 0–24 with questions concerning medication problems (yes/no) and disease activity (patient global assessment [PtGA], scale 0–10). Patients were contacted if response SMSs indicated medication problems or PtGA exceeded predefined thresholds. Primary outcome was 6‐month Boolean remission (no swollen or tender joints and normal C‐reactive protein levels). Quality of life (QoL; measured by the Short Form 36 survey) and Disease Activity Score in 28 joints (DAS28) were assessed. Results Six and 12‐month follow‐up data were available for 162 and 157 patients, respectively. In the intervention group, 46% of the patients (38 of 82) reported medication problems and 49% (40 of 82) reported text message PtGAs above the alarm limit. Remission rates at 6 months (P = 0.34) were 51% in the intervention group and 42% in the control group. These rates were 57% and 43% at 12 months (P = 0.17) in the intervention and control groups, respectively. The respective mean ± SD DAS28 scores for the intervention and control groups were 1.92 ± 1.12 and 2.22 ± 1.11 at 6 months (P = 0.09); and 1.79 ± 0.91 and 2.08 ± 1.22 at 12 months (P = 0.28). No differences in QoL were observed. Conclusion The study did not meet the primary outcome despite a trend favoring the intervention group. This may be explained by the notably high overall remission rates.

Tele-health interventions to support self-management in adults with rheumatoid arthritis: a systematic review

“…Three studies looked at telephone based self-management education sessions as an intervention following hospital discharge compared to usual care [21][22][23]. One study used a mobile phone text messaging (SMS) application to improve self-management by supporting medication adherence and self-monitoring of symptoms [24]. A wide range of outcomes to measure the effectiveness of interventions were included in the RCTs.…”

“…Results for the Cochrane Risk of Bias tool [17] for the included RCTs are reported in Table 2. Despite using random sequence generation participants were being selected from a group already identified to have access to either Internet or a mobile phone in several studies indicating a high risk of selection bias [18,20,24]. The risk of detection bias was unclear across all studies as it was not certain whether blinded outcome assessment had been performed.…”

“…The risk of detection bias was unclear across all studies as it was not certain whether blinded outcome assessment had been performed. One study was assessed to have high risk of attrition bias as the data was incomplete [24]. All studies were unclear or at high risk of bias in most domains, common issues included small numbers of participants and a lack of blinding [20][21][22][23].…”

Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study (Preprint)

“…This work adds to the growing body of telerheumatology knowledge [11][12][13][14][15][16][17] by providing detailed user preferences, needs, and barriers. Hence, we believe that the results of this study may help in the development of telemedicine solutions that can be integrated into the clinical routine of patients with rheumatic diseases.…”

“…The use of telemedicine in the provision of rheumatology care (telerheumatology) could ease constraints on health care access and the timeliness of care, bridge the workforce gap, and improve access to care for underserved communities [10,11]. The effectiveness of telerheumatology could be equal or higher than a standard face-to-face approach [12][13][14][15][16]. However, evidence is lacking, and further studies are needed to determine the best use of telerheumatology [16,17].…”