The role of timely rheumatoid arthritis treatment effectiveness control

Background. Regular assessment of rheumatoid arthritis (RA) activity is a key factor in therapy effectiveness improving. Aim. To prove that timely RA treatment control recommended by modern guidelines improves outcomes and reduce disability in real clinical practice. Materials and methods. Fourty patients with RA hospitalized at the University Clinical Hospital from January 2021 to January 2023 were included into a retrospective single-center study and divided into 2 groups. In the first group, RA activity was monitored after 3, 6, and 12 months, with therapy adjusted if necessary. In the second group, monitoring of RA activity was carried out after 12 months. The patients underwent clinical, laboratory and instrumental examinations (Tender Joint Count (TJC) and Swollen Joint Count (SJC), common blood test with differential white blood cell count, ESR, biochemical blood test, CRP, RF, ACCP, hands, feet and chest X-ray, ECG). RA activity was assessed using DAS28, CDAI, SDAI indices in both groups. Results. RA activity control after 12 months in patients of the first group regularly observed by a rheumatologist was better than in patients of the second group, who visited rheumatologist again only in 12 months. DAS28 decreased significantly, from 4.71±0.80 to 3.08±0.70 in the group with regular monitoring during the observation period. Remission or low activity was achieved by 75% of patients (5% remission and 70% low activity). Less dynamics was registered in patients of the second group: the initial DAS28 was 4.50±0.74, DAS28 after 12 months was 4.36±0.64, which corresponds to moderate activity. Low activity was achieved in 15% of patients, remission was not achieved in any patient. Conclusion. Strict adherence to the recommended terms for disease activity monitoring is necessary for successful RA treatment in real clinical practice

A chat-bot in rheumatoid arthritis treatment control

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune rheumatic disease with joint damage and systemic manifestations, which worsens the quality of life and life expectancy, leading to disability in the absence of effective therapy at a young age. The goal of RA treatment is to achieve remission/low disease activity. Frequent monitoring of the disease is needed (every 13 months until the goal is reached, then every 36 months), which is not always possible due to remoteness of residence, financial capabilities of patients, and epidemic situation. Remote monitoring appears to be a possible solution to the problem; however, the effectiveness of telemedical technologies in the treatment of patients with RA is not sufficiently studied. AIM: To investigate the effectiveness of remote-control treatment of patients with RA of high and moderate activity using a chat-bot. METHODS: An algorithm for remote monitoring and communication with RA patients was developed. The chat-bot performs a survey every month and out-of-schedule when the patients condition worsens and provides the data to the doctor in a convenient form. Regular assessments of RA activity, functional impairment, and quality of life and correction of recommendations if necessary are made. All participants are coded, with only the doctor having access to personal data. In remote (60 patients) and traditional (30 patients) control groups, the time to remission/low disease activity will be compared. Adherence to the chat-bot and cost-effectiveness analysis will be studied. RESULTS: Twenty patients were trained on how to use the chat-bot and have been using the program for 2 months. The condition is monitored and online counseling is provided if necessary. Nineteen patients had no difficulties when working with the chat-bot. One patient needed a second consultation on how to use the chat-bot. Half of the patients were over 60 years old. Most patients prefer remote counseling to a face-to-face appointment. Patients report an improved understanding of the disease, treatment principles, and methods of self-assessment of the joint condition. Remote monitoring is planned to achieve stable control of RA activity by timely detection of exacerbations and therapy correction and assessment of the need for hospitalization, which will help to reduce the period of remission/low RA activity. The economic cost of treating RA is expected to be reduced. CONCLUSIONS: Remote monitoring using a chat-bot to improve the effectiveness of RA treatment is an important aspect of current rheumatology and a potential method for increasing the availability of medical care. The results may serve as a basis for further research on telemedical technologies and the development and application of personalized algorithms for monitoring, prevention, and treatment of patients with rheumatic diseases