Turku University Hospital and University of Turku, Turku, Finland.
Jyväskylä Central Hospital, Jyväskylä, Finland.
Arthritis Care Res (Hoboken). 2020 Mar;72(3):319-325. doi: 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.
频繁监测早期类风湿关节炎（RA）患者以实现良好的治疗效果。本研究旨在探究短信（SMS）增强监测对早期 RA 结局的影响。
我们将 166 例早期、未接受疾病修饰抗风湿药物治疗的 RA 患者随机分为接受 SMS 增强随访或常规护理的两组。所有患者在 0、3 和 6 个月时就诊，并在 12 个月时进行随访。治疗由医生决定。干预措施包括在 0-24 周内发送 13 条短信，询问药物问题（是/否）和疾病活动度（患者总体评估[PtGA]，0-10 分）。如果回复短信提示药物问题或 PtGA 超过预设阈值，则联系患者。主要结局为 6 个月时的布尔缓解（无肿胀或触痛关节且 C 反应蛋白水平正常）。评估生活质量（SF-36 量表）和 28 个关节疾病活动度评分（DAS28）。
分别有 162 例和 157 例患者在 6 个月和 12 个月时获得了随访数据。在干预组中，46%（82 例中的 38 例）患者报告了药物问题，49%（82 例中的 40 例）报告了短信 PtGA 超过警报阈值。干预组和对照组在 6 个月时的缓解率分别为 51%（82 例中的 41 例）和 42%（82 例中的 33 例）（P=0.34）。在干预组和对照组中，12 个月时的缓解率分别为 57%（82 例中的 43 例）和 43%（82 例中的 34 例）（P=0.17）。干预组和对照组的 DAS28 评分均值±SD 在 6 个月时分别为 1.92±1.12 和 2.22±1.11（P=0.09）；在 12 个月时分别为 1.79±0.91 和 2.08±1.22（P=0.28）。生活质量无显著差异。
尽管干预组有趋势更优，但本研究未达到主要结局。这可能是由于整体缓解率较高。
