title: Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is a chronic inflammatory arthritis requiring long-term treatment with regular monitoring by a rheumatologist to achieve good health outcomes. Since people with RA may wish to monitor their own disease activity with a smartphone app, it is important to understand the functions and quality of apps for this purpose.
  
  
  OBJECTIVE
  The aim of our study was to assess the features and quality of apps to assist people to monitor their RA disease activity by (1) summarizing the available apps, particularly the instruments used for measurement of RA disease activity; (2) comparing the app features with American College of Rheumatology and European League against Rheumatism (ACR and EULAR) guidelines for monitoring of RA disease activity; and (3) rating app quality with the Mobile App Rating Scale (MARS).
  
  
  METHODS
  Systematic searches of the New Zealand iTunes and Google Play app stores were used to identify all apps for monitoring of RA disease activity that could be used by people with RA. The apps were described by both key metadata and app functionality. App adherence with recommendations for monitoring of RA disease activity in clinical practice was evaluated by identifying whether apps included calculation of a validated composite disease activity measure and recorded results for future retrieval. App quality was assessed by 2 independent reviewers using the MARS.
  
  
  RESULTS
  The search identified 721 apps in the Google Play store and 216 in the iTunes store, of which 19 unique apps met criteria for inclusion (8 from both app stores, 8 iTunes, and 3 Google Play). In total, 14 apps included at least one validated instrument measuring RA disease activity; 7 of 11 apps that allowed users to enter a joint count used the standard 28 swollen and tender joint count; 8 apps included at least one ACR and EULAR-recommended RA composite disease activity (CDA) measure; and 10 apps included data storage and retrieval. Only 1 app, Arthritis Power, included both an RA CDA measure and tracked data, but this app did not include the standard 28 tender and swollen joint count. The median overall MARS score for apps was 3.41/5. Of the 6 apps that scored ≥4/5 on the overall MARS rating, only 1 included a CDA score endorsed by ACR and EULAR; however, this app did not have a data tracking function.
  
  
  CONCLUSIONS
  This review found a lack of high-quality apps for longitudinal assessment of RA disease activity. Current apps fall into two categories: simple calculators primarily for rheumatologists and data tracking tools for people with RA. The latter do not uniformly collect data using validated instruments or composite disease activity measures. There is a need for appropriate, high-quality apps for use by rheumatologists and patients together in co-management of RA.
authors.affiliation: Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, Wellington, New Zealand.|Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand.
authors.forename: Rebecca
authors.identifier: http://orcid.org/0000-0001-9201-8678
authors.initials: R
authors.lastname: Grainger
authors.affiliation: Department of Medicine, University of Otago Wellington, Wellington, New Zealand.
authors.forename: Hermaleigh
authors.identifier: http://orcid.org/0000-0002-2517-722X
authors.initials: H
authors.lastname: Townsley
authors.affiliation: Department of Medicine, University of Otago Wellington, Wellington, New Zealand.
authors.forename: Bonnie
authors.identifier: http://orcid.org/0000-0002-3382-778X
authors.initials: B
authors.lastname: White
authors.affiliation: Department of Information Science, University of Otago, Dunedin, New Zealand.
authors.forename: Tobias
authors.identifier: http://orcid.org/0000-0003-1275-2026
authors.initials: T
authors.lastname: Langlotz
authors.affiliation: Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago Wellington, Wellington, New Zealand.|Hutt Hospital, Hutt Valley District Health Board, Lower Hutt, New Zealand.
authors.forename: William J
authors.identifier: http://orcid.org/0000-0001-6075-8479
authors.initials: WJ
authors.lastname: Taylor
keywords: mHealth; mobile applications; rheumatoid arthritis; self-management; telemedicine