POS1371 TELEMEDICINE IN INFLAMMATORY ARTHRITIS: A STANDARDIZED MODEL AND THE ROLE OF ePROs IN THE ASSESSMENT OF DISEASE ACTIVITY

Background: Over the past years and during pandemic telemedicine has been increasingly used in the management of patients with rheumatic musculoskeletal diseases and many data suggest that it could offer advantages to patients as well as to health care systems1,2. According with the EULAR points to consider a possible model for telemedicine could be to alternate one virtual and one face to face (F2F) visit. Objectives: (i)To apply the mixed telemedicine model as proposed in the EULAR points to consider, using a dedicated platform and to evaluate the clinical and organizational impact of this approach. (ii)To evaluate the electronic patient-reported outcomes (ePROs) ability to predict the six-month target line. Methods: This is a retrospective analysis from a RA, PsA and AS patient database, obtained remotely using the digital telemedicine platform iAR Plus, from 2021 to 2023. iAR-Plus is a telemonitoring platform dedicated to inflammatory arthritis; between follow-up visits, the patient has the option to independently compile electronic patient-reported outcomes (ePROs). The platform is fully GDPR compliant, with separation of the registry from the clinical database. The following ePROs were collected to assess disease activity at each televisit: Visual analogue scale pain (VAS), FACIT, HAQ and disease-specific questionnaires (RAID for RA, PSAID for Psa and ASAS-HI for AS). The F2F visit was anticipated if the patient was reporting a worsening of the ePROs score and if the virtual visit was suggestive of a disease flare. The presence of a disease flare was diagnosed based on a change in treatment at the F2F visit. To analyze ePROs chi square test and Student t-test for independent sample were applied. Factors resulted significant to the univariate tests were assessed by binary logistic regression as multivariate analysis. Results: 138 patients were included in the study (characteristics of the population at baseline, Table 1). All the patients were adherent to the monitoring during follow up. 29 patients (AR, SPA, PSA) needed to anticipate F2F visit due to a possible flare of disease activity based on a worsening of ePROs associated with a virtual visit. Interestingly in all three diseases a correlation was observed between the ePROs and the clinical assessment at the F2F visit. In particular, the RAID correlated with the DAS-28-CRP (Cohen's kappa =0.82); the PSAID with the DAPSA (Cohen's kappa =0.8), the ASAS-HI with the ASDAS (Cohen's kappa =0.75). Regarding RA, multivariate analysis showed correlation between RAID and change in treatment (as shown in Table 2). In the PsA group the relationship between PSAID and change therapy was demonstrated (Cohen's kappa = 0.72). In the group of AS patients, disease flare was correlated to the ASAS-HI (Cohen's kappa =0.79) Conclusion: Our study applies a combining model of telehealth follow-up, showing it is possible to alternate telemedicine and outpatient visits in a scheduled manner, and the importance of standardizing the use of ePROs to evaluate disease activity. In addition, it highlights how remote RAID, PSAID and ASAS-HI are reliable as ePROS, correlating with disease activity and immunosuppressive therapy change. Therefore, through ePROs it is possible to discriminate the subgroup of patients who need F2F visit, while for other patients the alternation at 6 months can be maintained. REFERENCES: 1 De Thurah A, et al. Ann Rheum Dis 2022;81:1065–1071. 2 Avouac J, et al. Teleconsultation in rheumatology: A literature review and opinion paper. Semin Arthritis Rheum. 2023 Dec;63:152271. doi: 10.1016/j.semarthrit.2023.152271. Acknowledgements: NIL. Disclosure of Interests: None declared.