title: Effectiveness of a telemonitoring intensive strategy in early rheumatoid arthritis: comparison with the conventional management approach.
abstract: BACKGROUND
  The advent of Internet and World Wide Web has created new perspectives toward interaction between patients and healthcare professionals. Telemonitoring patients with rheumatoid arthritis (RA) is an emerging concept to guide the collaborative management treatment and improve outcomes in patients. The objective of this study was to investigate whether an intensive treatment strategy, according to a telemonitoring protocol, is more effective than conventional management strategy in reaching remission and comprehensive disease control (CDC) after 1 year in early rheumatoid arthritis (ERA) patients.
  
  
  METHODS
  Forty-four ERA patients were randomly allocated into two groups: the telemonitoring intensive strategy (TIS) group (group 1) or the conventional strategy (CS) group (group 2). Three patients refused to participate. In group 1 (n = 21), a remote monitoring system of disease activity, in combination with protocolised treatment adjustments aiming for remission was applied. In group 2 (n = 20), patients were treated according to daily clinical practice, with regular evaluation of disease activity, but without protocolised treatment adjustments. A telemedical care called "REmote TElemonitoring for MAnaging Rheumatologic Condition and HEaltcare programmes" (RETE-MARCHE), was developed to perform the remote monitoring.
  
  
  RESULTS
  A higher percentage of patients in the TIS group achieved CDAI remission vs patients in the CS group (38.1 % vs 25 % at year 1, p <0.01). Time to achieve remission was significantly shorter in the group 1 than in the group 2, with a median of 20 weeks vs a median over 36-weeks (p <0.001). Concordantly, the patients in group 1 showed a greater improvement (p <0.001), compared with group 2 in terms of functional impairment (71.4 % vs 35 %) and radiological damage progression (23.8 % vs 10 %), resulting in a greater rate of CDC (19.4 % vs 5 %).
  
  
  CONCLUSIONS
  According to our results, an intensive treatment strategy by telemonitoring leads to more effective disease remission and more rapid CDC than treatment according to conventional management strategy in ERA.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  ISRCTN13142685 Date of registration: March, 17(th) 2016.
authors.affiliation: Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy. fausto.salaffi@gmail.com.|Clinica Reumatologica, Università Politecnica delle Marche, c/o Ospedale "Carlo Urbani", Via Aldo Moro, 25, 60035, Jesi, AN, Italy. fausto.salaffi@gmail.com.
authors.forename: Fausto
authors.initials: F
authors.lastname: Salaffi
authors.affiliation: Radiology Department, Polytechnic University of the Marche, Ancona, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Carotti
authors.affiliation: Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy.|Rheumatology Department, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, Wales.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ciapetti
authors.affiliation: Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Carlo
authors.affiliation: Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Gasparini
authors.affiliation: DII, Department of Information Engineering, Politechnic University of Marche, Ancona, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Farah
authors.affiliation: Rheumatology Department, Polytechnic University of the Marche, Jesi, Ancona, Italy.|Musculoskeletal Department, National Rehabilitation Institute, Mexico City, Mexico.
authors.forename: Marwin
authors.initials: M
authors.lastname: Gutierrez
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D002985:Clinical Protocols; D003695:Delivery of Health Care; D018450:Disease Progression; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D012074:Remission Induction; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: Disease activity; Healthcare; Rheumatoid arthritis; Telemonitoring