Self-management recommended for people with inflammatory arthritis

EULAR—The European Alliance of Associations for Rheumatology—recommends patient self-management for people with inflammatory arthritis. The intention is to empower people to acquire a good understanding of their disease and build their ability to deal effectively with the practical, physical, and psychological impacts.

Disease activity, structural damage, and progression all impact the lives of people with rheumatoid arthritis (RA), and can cause psychosocial distress. While inhibition of inflammation and structural changes have improved significantly following advances in pharmacological treatment in recent dates, the observed impact of these disease-modifying antirheumatic drugs (DMARD) on key psychosocial outcomes is limited.

An important feature within the EULAR recommendations on self-management in people with inflammatory arthritis is that digital health care is tagged as being essential in supporting and optimizing self-management. Thus, health care professionals need to be aware of available resources in order to direct patients to the most appropriate websites and apps.

RECLARIT is an internet-based digital health app designed for people with RA. The app provides methods and exercises—often relying on cognitive-behavioral therapy—and follows a holistic approach in order to support people to enhance their mental quality of life. But there is a need to show that such resources are effective.

To address this, a two-armed randomized controlled trial was conducted in Germany, with 354 adult RA patients assigned to use RECLARIT in addition to standard of care, or standard of care alone.

The primary endpoint was the change in health-related quality of life (HRQoL) from baseline to month 3, as measured by the SF-36 mental component summary (MCS) score. Secondary endpoints included depression, anxiety, fatigue, social work-related functioning, pain, physical function, and safety.

The results—presented at the 2024 EULAR congress by Frank Behrens—showed that at 3 months HRQoL was significantly higher in those using RECLARIT versus standard of care alone, and this effect was maintained at 6 months. Secondary endpoints related to psychosocial HRQoL also showed significant improvement in those using RECLARIT, although there were no significant differences seen in pain or physical function.

These findings suggest that using the digital health app significantly improved people's psychological HRQoL, with stable effects maintained up to 6 months. This aligns with the EULAR position that including self-management advice and resources in routine management, and aiming to empower and support patients with a more holistic approach to care could result in improved patient experience of care and outcomes.