Understanding the impact of patient empowerment and remote management on rheumatoid arthritis


The World Health Organization describes empowerment as a process in which people can take control and make informed decisions about their lives and health. Empowerment is important for people with RA, as most of the care is provided by the patients themselves.

Andersson and colleagues studied levels of and associated variables in people with RA, and investigated longitudinal clinical data in those with low and high levels of empowerment. The study involved 2837 people with RA from the BARFOT (Better Anti-Rheumatic PharmacO Therapy) cohort. Everyone was evaluated according to a structured protocol at inclusion and after 3, 6, 12, 24, 60, 96, and 180 months. At each follow-up, disease activity, function, and pain were assessed. In 2017, a postal survey was sent with questions about disease characteristics, lifestyle habits, and the Swedish rheumatic disease empowerment scale (SWE-RES-23). The 844 patients who responded to SWE-RES-23 formed the study cohort. Differences in empowerment between groups were analyzed.

In terms of lifestyle habits, there were no differences between groups in smoking habits, diet or drinking. Moderate for a minimum of 150 minutes per week 27% were reported in the lowest empowerment group versus 41% in the highest empowerment group, and vigorous physical activity of at least 60 minutes per week was reported. reported at 22% versus 37%, respectively.

A la , several factors were associated with low empowerment: 1) being a woman; 2) pain-related factors, such as a more tender joint count; 3) worse overall patient assessment fatigue; 4) function, and 5) quality of life. Over time, the group with low empowerment reported worse pain and function at all time points, worse at two and eight years, and worse inflammation at 15 years of follow-up compared with the high-potency group.

An important component in effective self-management can be the use of remote management technologies. Remote management of RA through disease self-assessment and patient-reported outcomes has the potential to inform timely clinical decisions about disease management, reduce the burden of busy rheumatology services, and promote effective self-management. In a second presentation of the 2021 EULAR congress, Ndosi and colleagues report on a study to determine the agreement between remote treatment decisions based on self-assessment questionnaires blindly evaluated by a health professional and the treatment decisions based on routine outpatient appointments.

Enrolled patients continued with regular care and clinical monitoring. In addition, they completed self-assessment questionnaires at home at monthly intervals, which include: two self-reported components that are collected as part of routine clinical practice (joint stiffness and flare-up), visual analog scales for pain, overall health, and fatigue; and scales of function and self-efficacy. An independent healthcare professional made decisions about remote treatment, based on the patient’s self-assessment questionnaires and the information gathered in the study. In this analysis, the blind independent physician did not have the same information as the usual hospital visiting physician (evaluation of blood and joint outcomes).

Remote decisions were combined with hospital visit decisions (within 2 weeks) and the measure of agreement between the two evaluators was evaluated.

A total of 72 patients with RA were recruited, and there were 57 matching decisions between the independent healthcare professional and the outpatient. The outpatient made 7 changes in biological therapy and 18 in non-biological therapy, while the remote healthcare professional made a change in biological and 17 in a non-biological DMARD, including the review. Self-assessment questionnaires reported 34 outbreaks of RA, of which 21 had resolved. In the matching decisions, there was only one adverse event that required discontinuation of treatment, identified by both remote treatment and outpatient.

The authors conclude that remote monitoring of RA through patient self-assessment and outcome measures is feasible with fair agreement on treatment decisions. Additional work is required to understand the importance of adding remote blood test control manufacturing.

HRQoL-related empowerment in young adolescent CA survivors

More information:
Andersson M, et al. Empowerment and association with disease activity and pain in patients with
Rheumatoid arthritis. Presented at EULAR 2021; summary OP0322-HPR.

Provided by the European Alliance of Associations for Rheumatology

Citation: Understanding the Impact of Patient Empowerment and Remote Management on Rheumatoid Arthritis (2021, June 14) Retrieved June 14, 2021 at https://medicalxpress.com/news/2021-06 -impact-patient-empowerment-remote-rheumatoid.html

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