Abstract
BackgroundThe advent of Internet and World Wide Web has created new perspectives toward interaction between patients and healthcare professionals. Telemonitoring patients with rheumatoid arthritis (RA) is an emerging concept to guide the collaborative management treatment and improve outcomes in patients. The objective of this study was to investigate whether an intensive treatment strategy, according to a telemonitoring protocol, is more effective than conventional management strategy in reaching remission and comprehensive disease control (CDC) after 1 year in early rheumatoid arthritis (ERA) patients.MethodsForty-four ERA patients were randomly allocated into two groups: the telemonitoring intensive strategy (TIS) group (group 1) or the conventional strategy (CS) group (group 2). Three patients refused to participate. In group 1 (n = 21), a remote monitoring system of disease activity, in combination with protocolised treatment adjustments aiming for remission was applied. In group 2 (n = 20), patients were treated according to daily clinical practice, with regular evaluation of disease activity, but without protocolised treatment adjustments. A telemedical care called “REmote TElemonitoring for MAnaging Rheumatologic Condition and HEaltcare programmes” (RETE-MARCHE), was developed to perform the remote monitoring.ResultsA higher percentage of patients in the TIS group achieved CDAI remission vs patients in the CS group (38.1 % vs 25 % at year 1, p <0.01). Time to achieve remission was significantly shorter in the group 1 than in the group 2, with a median of 20 weeks vs a median over 36-weeks (p <0.001). Concordantly, the patients in group 1 showed a greater improvement (p <0.001), compared with group 2 in terms of 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 %).ConclusionsAccording to our results, an intensive treatment strategy by telemonitoring leads to more effective disease remission and more rapid CDC than treatment according to conventional management strategy in ERA.Trial registrationTrial registration number: ISRCTN13142685Date of registration: March, 17th 2016
Highlights
The advent of Internet and World Wide Web has created new perspectives toward interaction between patients and healthcare professionals
The T2T concept is currently highly accepted by the rheumatoid arthritis (RA) community [7] it still represents a challenge in daily clinical practice due to some aspects such as: (a) a proportion of RA patients is treated by rheumatologists who have no confidence with the T2T, (b) not all rheumatologists adopt the T2T strategy in their routine care, (c) the correct T2T approach requires repetitive patient clinical assessments and regular application of disease activity measurements that are not always available in the busy daily practice [7]
We addressed this study to investigate whether an intensive treatment strategy, according to a specific protocol by a telemonitoring solution is more effective than a treatment according to conventional management approach in reaching remission and comprehensive disease control (CDC) [22] after 1 year of follow-up in early RA (ERA) patients
Summary
The advent of Internet and World Wide Web has created new perspectives toward interaction between patients and healthcare professionals. Rheumatoid arthritis (RA) is the most frequent chronic inflammatory joint disease, affecting 0.4–1 % of the population [1] It is characterised by a progressive inflammation leading to irreversible joint damage that reduces the function, increases the disability and may determine a poor prognosis, influencing health care resources and budgets. A tight control of the disease, including a “treat-to-target” (T2T) approach, has demonstrated positive advantages [4]. This strategy, aimed for low disease activity (LDA) or remission seems even more important than specific therapies adopted [4,5,6]. The T2T concept is currently highly accepted by the RA community [7] it still represents a challenge in daily clinical practice due to some aspects such as: (a) a proportion of RA patients is treated by rheumatologists who have no confidence with the T2T, (b) not all rheumatologists adopt the T2T strategy in their routine care, (c) the correct T2T approach requires repetitive patient clinical assessments and regular application of disease activity measurements that are not always available in the busy daily practice [7]
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