Newswise — WASHINGTON – Mobile phone monitoring in people with rheumatoid arthritis increases the likelihood that people with the disease will follow treatment, according to research presented this week at the American College of Rheumatology Annual Meeting in Washington, D.C.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, limitation of motion and loss of function of multiple joints. Though joints are the principal areas affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Early treatment that aims for rapid remission with no signs and symptoms is crucial to prevent fully developed rheumatoid arthritis. Previous studies suggest that repeatedly monitoring RA symptoms and treatments will improve the disease and patient quality of life. However, limited resources that may impact the availability of regular doctor visits may prevent people with RA from receiving close monitoring for the disease. Finnish rheumatologists recently examined whether mobile phones coupled with patient surveys could help in controlling RA.

The research team led by Kari Puolakka, MD, PhD, lead investigator of the study and chief of department of rheumatology at Lappeenranta Central Hospital, Lappeenranta in Finland, developed an automatic cell-phone based monitoring system called Showing any need for Re-Assessment (also called SandRA). Patients with a new diagnosis of RA were registered into the program. After the registration, SandRA sent automatic text messages to participants every two weeks for six months. Participants were advised to answer each question by pushing one button for yes or no, using the phone keypad. The first two questions asked participants about medications. Questions included, “Have you used the prescribed drug treatments?” and “Have you experienced any problems with the drug?”. These questions were repeated between doctor visits to improve adherence to the treatment plan and to identify patients who had any problems with medications.

After six weeks of follow-up, SandRA automatically queried about disease activity with a question, “What is the severity of RA on scale zero to 10, when zero corresponds [with] absence of RA symptoms and 10 as severe RA symptoms as you can imagine?”. Based on data from previous Finnish early RA studies, a treatment target for each patient was initially set at less than or equal to 5/10 which indicates moderate symptoms, and as treatment progressed at less than or equal to 3/10, which indicates mild symptoms, in order to reach a target of less than or equal to 2/10 (almost or totally without symptoms) at six months.

SandRA automatically communicated with each patient throughout six months. In a case of an answer that indicated a problem with medications or too high disease activity, SandRA sent an alarm e-mail to the treating rheumatology clinic, which then contacted the patient and adjusted medication or arranged an earlier visit if needed.

One hundred and thirty seven patients were registered in SandRA with their regular doctor appointments scheduled at three and six months. SandRA was able to identify patients whose disease activity was not at target; these patients were re-assessed before their regular appointments, with adjustments of medications when appropriate. At the end of the study, roughly two-thirds of the patients achieved the treatment target set at less than or equal to two (i.e., patients were almost or totally symptomless).

“These preliminary results suggest that by utilizing a simple technical device, [a] cell-phone, which almost everyone has, communicating automatically with software, helps us identify patients with early RA who have problems with medications. We can also pick out those patients, who are not likely to reach remission, for re-assessment and treat them more effectively,” says Dr. Puolakka.

Funding for this study was provided by the research foundation of Lappeenranta Central Hospital.

The American College of Rheumatology is an international professional medical society that represents more than 9,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit or join the conversation on Twitter by using the official hashtag: #ACR2012.

Learn more about living well with rheumatic disease as well as rheumatologists and the role they play in health care. Also, discover the ACR’s Simple Tasks campaign, which highlights the severity of rheumatic diseases and the importance of early and appropriate referral to a rheumatologist.

Editor’s Notes: Kari Puolakka, MD, and Tuulikki Sokka MD will present this research during the ACR Annual Meeting at the Walter E. Washington Convention Center at 9:00-11:00 AM on Sunday, November 11 in the Poster Hall (Hall B) A. Dr. Sokka will be available for media questions and briefing at 1:30 PM on Monday, November 12 in the on-site press conference room, Room 203 A–B.

Presentation Number: 375

Cell Phone Based Automated Monitoring of Patients with Early Rheumatoid Arthritis

Kari Puolakka (South Karelia Central Hospital, Lappeenranta, Finland) Tuulikki Sokka (Jyvaskyla Central Hospital, Jyvaskyla, Finland)Hannu Kautiainen (Orton Rehabilitation, Helsinki, Finland)

Background/Purpose: Frequent monitoring improves patient compliance and outcomes of RA. Limited resources may hinder adherence to recommendations to frequent assessment. A remote assessment could be a solution with patient's global assessment (PtGA) as a measure. Methods: Frequent monitoring improves patient compliance and outcomes of RA. Limited resources may hinder adherence to recommendations to frequent assessment. A remote assessment could be a solution with patient's global assessment (PtGA) as a measure.

Each incident patient with early RA is being registered in SandRA monitoring – with his or her informed consent. Baseline PtGA is recorded. Every 2 weeks during the following 6 months, SandRA sends automatically an SMS to the patient's cell phone, and patient answers by one push on keyboard. The first 2 SMSs concern medications ("Have you used the prescribed drug treatments?" Y/N) and adverse events ("Have you experienced any problems with the drug?" Y/N). From 6 weeks onwards, PtGAs is inquired: ("What is the severity of RA on scale 0 to 10, when 0 corresponds absence of RA symptoms and 10 as severe RA symptoms as you can imagine?"). Based on data from our previous early RA cohorts, a treatment target was set at 5-3/10 (figure 1).

The patients' answers are recorded in SandRA database and automatically analyzed. If an answer does not indicate problems, patient receives an automatic SMS response of the answer being recorded. If an answer indicates problems, i.e., patient has not used the treatment, has experienced adverse events, or RA has not improved at the pace defined, the patient receives an SMS: "Your nurse will call you within 2 working days". At the same time, the nurse receives an e-mail about the patient's problem. If the problem cannot be solved on the phone, the patient is called for a visit for treatment adjustment.

Results: We analyzed 137 consecutive patients registered in SandRA. The patients' regular doctor appointments were scheduled at 3 and 6 months. Most patients achieved the treatment target, i.e., their PtGAs were under the alarm line (panel A). SandRA picked out 34%, 31%, 29%, and 31% of the patients at 6, 10, 18, and 22 weeks for assessment before regular appointments (panel B).

Conclusion: A novel automated cell phone based monitoring system may provide a feasible method to achieve treatment target in patients with early RA. Disclosure:Kari Puolakka, NoneT. Sokka, NoneH. Kautiainen, None

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