Effect of Lifestyle Counselling via a Mobile Application on Disease Activity Control in Inflammatory Arthritis: A Single-Blinded, Randomized Controlled Study

Abstract

Background: Mobile applications (apps) are a resource for information on lifestyle and nutrition which are associated to improved outcomes in inflammatory arthritis.

Objective: The aim of this study was to explore whether targeted lifestyle counselling via an app improves disease activity in arthritis patients.

Methods: Patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) were randomized to 12 weeks of lifestyle counselling via an app (Mida, Midaia GmbH, Germany) pertaining to a healthy Mediterranean Diet, physical activity, and mental health. Disease activity was measured with specific instruments by a blinded physician and categorized (remission, low, moderate, high). Dietary adherence was assessed by the Mediterranean Diet Adherence Screener (MEDAS). Mixed effects logistic regression adjusted to baseline disease activity, age, and sex were calculated.

Results: Of 158 patients included (73% female, 53.3 ± 11.7 years), 74 were in the active counselling group (ACG). All showed improvement in low disease activity or remission. ACG patients had an odds ratio (OR) of 2.8 (95%-CI 1.1-7.2, p = 0.035), while OR in the control group was not significant OR = 2.1 (0.9-5.0, p = 0.097). The control group was less likely to reach a MEDAS >= 4 (OR = 0.16 (0.03-0.77), p = 0.02), while this was not seen in the ACG (OR = 0.54 (0.06-4.63), p = 0.6). Patients in the ACG showed a tendency towards improved adhesion to a Mediterranean Diet (MEDAS) (β = 0.35 (-0.05-0.74), p = 0.086). This tendency was not observed in the control group (β = 0.09 (-0.29-0.46), p = 0.64).

Conclusions: Individualized lifestyle and dietary counselling via app may help to improve disease control in inflammatory arthritis patients.

Keywords: Mediterranean Diet; axial spondyloarthritis; healthy lifestyle; psoriatic arthritis; rheumatoid arthritis.

Figure 1

Graphical summary of the counselling strategy via app (upper part), and representative screenshots of the app during lifestyle counselling (lower part).

Figure 2

Patient flow chart. RA, rheumatoid arthritis; PsA, psoriatic arthritis; SpA, axial spondyloarthritis.

Figure 3

Outcome parameters at baseline and after 12 weeks of active counselling via app. (A,B) The diagrams show the proportion of patients who changed to a different disease state (A) or dietary adherence state (B) from the start (T0) to the end of the study after 12 weeks (T12). The thickness of the line is proportional to the number of patients changing the respective state. For instance, in the active counseling group, the proportion of patients downgrading the disease activity state is greater than in the control group (A). Disease activity is categorized based on disease-specific instruments (A), and dietary adherence (B) to a healthy diet measured via the Mediterranean Diet Adherence Screener (MEDAS) and categorized into low (0–3), moderate (4–6), good (7–9), or very good (10–12) adherence of 158 patients with inflammatory arthritis. (C). Disease activity was measured via the Disease Activity Score 28 (DAS28) in the subgroup of 43 patients with rheumatoid arthritis at the start and end of the study after 12 weeks.