Tele-Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial

Annette De Thurah, Kristian Stengaard-Pedersen, Mette Axelsen, Ulrich Fredberg, Liv M V Schougaard, Niels H I Hjollund, Mogens Pfeiffer-Jensen, Trine Bay Laurberg, Ulrik Tarp, Kirsten Lomborg, Thomas Maribo

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Abstract

Objective: To test the effect of patient-reported outcome (PRO)–based tele-health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele-health followup performed by rheumatologists or rheumatology nurses. Methods: A total of 294 patients were randomized (1:1:1) to either PRO-based tele-health followup carried out by a nurse (PRO-TN) or a rheumatologist (PRO-TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self-efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent-to-treat (ITT), and multivariate imputation analysis. Results: Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO-TR versus control were −0.10 (90% confidence interval [90% CI] −0.30, 0.13) and −0.19 (90% CI −0.41, 0.02) between PRO-TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO-TN had mean ± SD 1.72 ± 1.03 visits/year, PRO-TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare. Conclusion: Among RA patients with low disease activity or remission, a PRO-based tele-health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.

Original languageEnglish
JournalArthritis Care & Research
Volume70
Issue number3
Pages (from-to)353–360
ISSN2151-464X
DOIs
Publication statusPublished - Mar 2018

Keywords

  • Aftercare/methods
  • Aged
  • Arthritis, Rheumatoid/diagnosis
  • Denmark
  • Female
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Nurses
  • Patient Reported Outcome Measures
  • Quality of Life
  • Remission Induction
  • Rheumatologists
  • Self Efficacy
  • Severity of Illness Index
  • Telemedicine/methods
  • Time Factors
  • Treatment Outcome

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