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Randomized Controlled Trial
. 2023 Apr 3;6(4):e238343.
doi: 10.1001/jamanetworkopen.2023.8343.

Management of Rheumatoid Arthritis With a Digital Health Application: A Multicenter, Pragmatic Randomized Clinical Trial

Chun Li  1 , Jianlin Huang  2 , Huaxiang Wu  3 , Fen Li  4 , Yi Zhao  5 , Zhenchun Zhang  6 , Shengguang Li  7 , Hua Wei  8 , Miaojia Zhang  9 , Hongsheng Sun  10 , Jing Yang  11 , Qin Li  12 , Xiaomei Li  13 , Wufang Qi  14 , Wei Wei  15 , Yasong Li  16 , Zhenbin Li  17 , Yongfu Wang  18 , Fengxiao Zhang  19 , Henglian Wu  20 , Zongwen Shuai  21 , Zhenbiao Wu  22 , Yi Li  23 , Shengsong Jia  24 , Yuhua Jia  24 , Fei Xiao  24 , Rong Mu  25 , Zhanguo Li  1   26   27
Affiliations
Randomized Controlled Trial

Management of Rheumatoid Arthritis With a Digital Health Application: A Multicenter, Pragmatic Randomized Clinical Trial

Chun Li et al. JAMA Netw Open. .

Erratum in

  • Error in Results and Figure 1.
    [No authors listed] [No authors listed] JAMA Netw Open. 2023 May 1;6(5):e2316007. doi: 10.1001/jamanetworkopen.2023.16007. JAMA Netw Open. 2023. PMID: 37204797 Free PMC article. No abstract available.

Abstract

Importance: Digital health applications have been shown to be effective in the management of chronic diseases with simple treatment targets. The potential clinical value of digital health applications in rheumatoid arthritis (RA) has not been well studied.

Objective: To investigate whether assessing patient-reported outcomes using digital health applications could result in disease control for patients with RA.

Design, setting, and participants: This is a multicenter, open-label randomized clinical trial in 22 tertiary hospitals across China. Eligible participants were adult patients with RA. Participants were enrolled from November 1, 2018, to May 28, 2019, with a 12-month follow-up. The statisticians and rheumatologists who assessed disease activity were blinded. Investigators and participants were not blind to group assignment. Analysis was conducted from October 2020 to May 2022.

Interventions: Participants were randomly assigned at a 1:1 ratio (block size of 4) to a smart system of disease management group (SSDM) or a conventional care control group. Upon the completion of the 6-month parallel comparison, patients in the conventional care control group were instructed to use the SSDM application for an extension of 6 months.

Main outcomes and measures: The primary outcome was the rate of patients with disease activity score in 28 joints using the C-reactive protein (DAS28-CRP) of 3.2 or less at month 6.

Results: Of 3374 participants screened, 2204 were randomized, and 2197 patients with RA (mean [SD] age, 50.5 [12.4] years; 1812 [82.5%] female) were enrolled. The study included 1099 participants in the SSDM group and 1098 participants in the control group. At month 6, the rate of patients with DAS28-CRP of 3.2 or less was 71.0% (780 of 1099 patients) in the SSDM group vs 64.5% (708 of 1098 patients) in the control group (difference between groups, 6.6%; 95% CI, 2.7% to 10.4%; P = .001). At month 12, the rate of patients with DAS28-CRP of 3.2 or less in the control group increased to a level (77.7%) that was comparable with that (78,2%) in the SSDM group (difference between groups, -0.2%; 95% CI, -3.9% to 3.4%; P = .90).

Conclusions and relevance: In this randomized clinical trial of RA, the use of a digital health application with patient-reported outcomes was associated with an increase in disease control rate.

Trial registration: ClinicalTrials.gov Identifier: NCT03715595.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Trial Profile
SSDM indicates Smart System of Disease Management.
Figure 2.
Figure 2.. Subgroup Analysis in Per-protocol Analysis
DAS28-CRP indicates disease activity score in 28 joints in C-reactive protein; SSDM, Smart System of Disease Management.
See this image and copyright information in PMC

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