Automated text message enhanced monitoring versus routine monitoring in early rheumatoid arthritis: a randomized trial
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CitationKuusalo, Laura. Sokka-Isler, Tuulikki. Kautiainen, Hannu. Ekman, Päivi. Kauppi, Markku J. Pirilä, Laura. Rannio, Tuomas. Uutela, Toini. Yli-Kerttula, Timo. Puolakka, Kari. The SandRA Study Group. (2020). Automated text message enhanced monitoring versus routine monitoring in early rheumatoid arthritis: a randomized trial. Arthritis care and research, 72 (3) , 319-325. 10.1002/acr.23846.
Frequent monitoring of patients with early rheumatoid arthritis (RA) is required for achieving good outcomes. This study was undertaken to investigate the influence of text message (SMS)–enhanced monitoring on early RA outcomes.
We randomized 166 patients with early, disease‐modifying antirheumatic drug–naive RA to receive SMS‐enhanced follow‐up or routine care. All patients attended visits at 0, 3, and 6 months, and a follow‐up visit at 12 months. Treatment was at the physicians’ discretion. The intervention included 13 SMSs during weeks 0–24 with questions concerning medication problems (yes/no) and disease activity (patient global assessment [PtGA], scale 0–10). Patients were contacted if response SMSs indicated medication problems or PtGA exceeded predefined thresholds. Primary outcome was 6‐month Boolean remission (no swollen or tender joints and normal C‐reactive protein levels). Quality of life (QoL; measured by the Short Form 36 survey) and Disease Activity Score in 28 joints (DAS28) were assessed.
Six and 12‐month follow‐up data were available for 162 and 157 patients, respectively. In the intervention group, 46% of the patients (38 of 82) reported medication problems and 49% (40 of 82) reported text message PtGAs above the alarm limit. Remission rates at 6 months (P = 0.34) were 51% in the intervention group and 42% in the control group. These rates were 57% and 43% at 12 months (P = 0.17) in the intervention and control groups, respectively. The respective mean ± SD DAS28 scores for the intervention and control groups were 1.92 ± 1.12 and 2.22 ± 1.11 at 6 months (P = 0.09); and 1.79 ± 0.91 and 2.08 ± 1.22 at 12 months (P = 0.28). No differences in QoL were observed.
The study did not meet the primary outcome despite a trend favoring the intervention group. This may be explained by the notably high overall remission rates.