P040 The clinical impact of electronic patient-reported outcome measures in remotely monitoring inflammatory arthritis: a systematic review
Authors: Arumalla Nikita , Adas Maryam , Chan Chun K D , Gibson Mark , Man Yik L , Norton Sam , Galloway James , Garrood Toby 
Published: April 2023

Abstract

Background/Aims
The inflammatory arthritides make up a majority of conditions requiring follow-up in rheumatology clinics; a treat-to-target management approach is advocated in patients with inflammatory arthritis (IA), requiring regular monitoring. With rising patient numbers and increasing demand on clinics, integration of digital healthcare has been advocated as a means to improving this, potentially allowing for fewer outpatient visits. The objective of this review is to evaluate the clinical effectiveness of electronic patient-reported outcome measures (ePROMs) as a digital remote monitoring intervention on disease activity and treatment decisions in patients with inflammatory arthritis.

Methods
Five databases including MEDLINE, Embase, PubMed, Cochrane Library and Web of Science were searched from inception to 29 August 2022. Randomised controlled trials (RCT) and (non-randomised) controlled clinical trials considering remote monitoring with ePROMS in IA samples that assessed disease activity scores, disease flare, treatment escalation and healthcare use were included, with meta-analysis and forest plots conducted for each outcome. Data regarding between-group differences in outcomes were extracted and a risk of bias assessment was completed by two assessors on all included studies using Cochrane Risk of Bias (RoB)-2 tool for RCTs and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) for non-randomised cohorts.

Results
The literature search identified 4230 abstracts, of which 8 relevant studies were included in the analysis after de-duplication and screening. Seven studies assessed patients with rheumatoid arthritis and one involved patients with axial spondyloarthritis. Most included studies were at high risk of bias. Compared with control, the disease activity in the ePROM group was lower (standardised mean difference (SMD) -0.15; 95% CI -0.27 to -0.03). A second analysis using a stricter definition of ePROM use limiting to studies without other combined interventions (eg. disease education) showed the same direction of effect but was not significant (SMD -0.13; 95% CI -0.31 to 0.04). There were no significant differences between groups in terms of disease flare (OR 2.32; 95% CI 0.21 to 25.28), escalation of immunosuppression (OR 1.12; 95% CI 0.70 to 1.80) or face-to-face clinic visits (OR -0.93; 95% CI -2.14 to 0.28).

Conclusion
This review suggests there is an advantage in using ePROMs to remotely monitor patients with IA in terms of disease outcomes. Importantly there was no detrimental impact in terms of clinic attendance frequency with ePROMs. There are limitations including heterogeneity in study design and substantial risk of bias in the studies included. ePROMs are likely here to stay, but we need better quality data to fully understand their role in clinical practice.
Disclosure
N. Arumalla: None. M. Adas: None. C.K.D. Chan: None. M. Gibson: None. Y.L. Man: None. S. Norton: None. J. Galloway: Honoraria; from AbbVie, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Pfizer, Roche and UCB. T. Garrood: None.