Improved QOL, Disease Activity Seen in Patients With IA Using Tailored Self-management App

Use of a digital health application (DHA) that provides tailored self-management action advice to patients with inflammatory arthritis (IA) was linked to significant improvements in health-related quality of life (HRQOL) and disease activity, according to a small study published in Rheumatology International.

Recent EULAR recommendations highlighted the importance of encouraging patient self-management strategies and the vital role of digital formats in helping patients do so.

Other research suggests most patients with rheumatic and musculoskeletal diseases regularly use smartphones. Because of this, the study authors claim DHAs are a strong potential format for patients to achieve and maintain disease remission through continuous, on-demand support.

The study focused on the Midaia Software, which was divided into a mobile app for patients (Mida Rheuma App) and a complementary app for the physician (DocBoard Web-App).

The study was small, with only 17 of 19 enrolled patients completing the study and a lack of control group.

Of these 17 patients with IA, 12 had rheumatoid arthritis, 1 had axial spondyloarthritis, and 4 had psoriatic arthritis. Seven patients were male, and the median (SD) age was 40.5 (12.2) years, with participants ranging in age from 19 to 63 years.

Treatments the patients received included nonsteroidal anti-inflammatory drugs, glucocorticoids, hydroxychloroquine, methotrexate, leflunomide, sulfasalazine, apremilast, Janus kinase inhibitors, tumor necrosis factor inhibitors, IL-6 receptor inhibitors, and IL-17 inhibitors. The authors observed no substantial intensification of antirheumatic treatment during the study.

HRQOL was measured by the Short Form-36 (SF-36) Health Survey. The authors assessed SF-36 Total Score, Physical (PCS) and Mental Component Summary (MCS) scores, and 8 scales on physical function, role limitations due to physical function, bodily pain, general health, mental health, role limitations due to emotional health, social functioning, and vitality.

The study demonstrated a significant improvement in patients’ HRQOL assessed by Short Form-36 (SF-36) at day 34, with a 14.4% improvement in Total Score.

Statistically significant improvements were also reflected by a 23.6% increase in the Physical Component Summary (PCS) of SF-36 score (P = .024), a 76.9% increase in the role limitations due to physical health score (P = .022), and a 17.1% increase in the general health score (P = .048).

Clinical significance was based on definitions of 5 points as minimal clinically important difference (MCID) in separate scores and 2.5 in SF-36 Total Score, PCS and MCS scores.

“According to 95% CIs and MCID relation, PCS, ‘role limitations due to physical health,’ and ‘general health’ demonstrated probable clinical significance,” the authors found. “For the SF-36 Total Score, ‘emotional well-being’ and ‘energy/fatigue’ clinical significance was not demonstrated for 95% CI, but it was probable for 90% CI.”

Disease activity also significantly improved, with a 38.4% decrease in Clinical Disease Activity Index and 39.9% decrease in Simple Disease Activity Index.

The Patient Health Questionnaire-9 also demonstrated significant improvements surrounding depression among patients with IA, with a 13.5% improvement.

The Mida Rheuma App also yielded high levels of usability by users.

“This suggests that using a personalized disease management program based on DHA significantly improves several measures of patient-reported outcomes and disease activity in patients with inflammatory arthritis in a timely manner,” the authors said. “These findings highlight the potential of complementary digital therapy in patients with inflammatory arthritis.”

However, the study’s pilot design, small sample size, short study duration of 34 days, and lack of a control group may very likely lead to bias and influence the findings.

“Since the pilot design of our study does not allow for final conclusions, a planned randomized controlled trial is needed to confirm these preliminary positive results,” the authors noted. “Furthermore, rheumatologists and patients need to be educated about the growing number of supportive digital tools available.”

Reference

Fedkov D, Berghofen A, Weiss C, et al. Efficacy and safety of a mobile app intervention in patients with inflammatory arthritis: a prospective pilot study. Rheumatol Int. 2022;1-14. doi:10.1007/s00296-022-05175-4