Considering the limited access to healthcare facilities due to the current pandemic, remote patient management has become a topic of particular interest. Remote management of rheumatoid arthritis (RA) provides a feasible alternative for routine outpatient follow-up. This is the main conclusion of a prospective, longitudinal real-world study among RA patients in the UK.
Dr Mwidimi Ndosi (University of the West of England, Bristol, UK) and colleagues investigated to what extent remote management and routine outpatient monitoring decisions are interchangeable. The patients selected for this study (n=72, mean age 57.8, 87% women) continued usual care and clinical assessments, each month, every 3 months, or every 6 months, depending on disease activity. In addition, they performed a monthly self-assessment at home, including patient-reported outcome measures (PROMs) and the self-assessment questionnaires patient global assessment (PGA), Arthritis Self-Efficacy Scale (ASES), pain visual analogue scale, and fatigue visual analogue scale, as well as the self-reported components joint stiffness and flares.
An independent health professional had access to the PROMs, questionnaires, and data covering medical history, ongoing therapy, and adverse events (AEs). Hospital-assessed clinical data was not provided (joint assessment, blood monitoring). Possible remote decisions were the addition or removal of a drug, to bring the patient in for review, or to not change therapy. Remote decisions and usual outpatient follow-up decisions demonstrated fair agreement in the 252 performed assessments.
This result was observed for overall changes to RA therapy (kappa=0.24) and changes to bDMARD therapy (kappa=0.23). The self-assessment questionnaires identified 34 flares and 1 patient had to stop treatment due to an AE. This was recognised by remote and clinic-based evaluation. Dr Ndosi argued that future studies should investigate if the addition of blood test monitoring adds value to remote decision making.
Ndosi M, et al. Remote management of rheumatoid arthritis vs routine outpatient follow-up: a prospective, longitudinal real-world study. OP0155, EULAR 2021 Virtual Congress, 2-5 June.