Comparison of Remotely Applied and Face-to-Face Disease Activity Scores in Saudi Arabian Patients With Rheumatoid Arthritis: A Prospective Cohort Study

Abstract

Objectives: This study aimed to assess the disease activity indices (DAI) of rheumatoid arthritis (RA) by telephone-based tele-visits compared to face-to-face clinic encounters.

Methods: Patients with RA attending outpatient clinics between December 2021 and May 2022 were prospectively recruited. Disease activity assessments were initially performed in the clinic using the disease activity score 28-C-reactive protein (DAS28-CRP) and disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR). Within two weeks of the clinic visit, a telephone-based assessment gathered information on demographics, Routine Assessment of Patient Index Data 3 (RAPID3) score, and satisfaction. Disease activity scores were dichotomized into remission or low disease activity and moderate to high disease activity.

Results: A total of 78 patients completed the two-point interview. Of those, 62 (79.49%) were women, with a mean age of 54.73±13.71 years. Seropositivity for rheumatoid factor and/or anti-citrullinated peptide was observed in 51 (83.61%) participants. Twenty-seven percent of the patients were classified as in remission or low disease activity by RAPID3. This was 71% for DAS28-CRP and 33% for DAS28-ESR. Based on the dichotomized disease activity classification, the agreement percentage between RAPID3 and DAS28-ESR was 78.08%, while it was 47.22% between RAPID3 and DAS28-CRP, which resulted in kappa statistic values of 0.48 (moderate agreement) and 0.14 (low agreement), respectively. Satisfaction rates were low.

Conclusion: Telephone-based RAPID3 showed a low-moderate agreeability compared to DAS28 and had low satisfaction rates. This suggests that tele-rheumatology care by this means was not feasible for following up with patients with RA and warrants further development.

Keywords: covid-19; disease activity in rheumatoid arthritis; patients satisfaction; saudi arabia; telemedicine.

Figure 1. RAPID3, DAS28-CRP, and DAS28-ESR percentages of different categories of DAI

DAI, disease activity indices; DAS28-CRP, disease activity score 28-C-reactive protein; DAS28-ESR, disease activity score 28-erythrocyte sedimentation rate; RAPID3, Routine Assessment of Patient Index Data 3

Figure 2. Bland-Altman plot of RAPID3 and rescaled DAS28-ESR (A) and DAS28-CRP (B)

A) Horizontal lines are shown to indicate the mean difference and 95% limit of agreement (mean difference ± 1.96 × standard deviation). Good agreement is represented by a small mean difference (nearer to zero) and low dispersion around the mean difference (i.e., most points are within the dotted lines). B) Bland-Altman plot of RAPID3 and rescaled DAS28-CRP. Horizontal lines are shown to indicate the mean difference and 95% limit of agreement (mean difference ± 1.96 × standard deviation). Good agreement is represented by a small mean difference (nearer to zero) and low dispersion around the mean difference (i.e., most points are within the dotted lines).