Management of Rheumatoid Arthritis With a Digital Health Application

Abstract

IMPORTANCEDigital health applications have been shown to be effective in the management of chronic diseases with simple treatment targets. The potential clinical value of digital health applications in rheumatoid arthritis (RA) has not been well studied.OBJECTIVETo investigate whether assessing patient-reported outcomes using digital health applications could result in disease control for patients with RA.DESIGN, SETTING, AND PARTICIPANTSThis is a multicenter, open-label randomized clinical trial in 22 tertiary hospitals across China. Eligible participants were adult patients with RA. Participants were enrolled from November 1, 2018, to May 28, 2019, with a 12-month follow-up. The statisticians and rheumatologists who assessed disease activity were blinded. Investigators and participants were not blind to group assignment. Analysis was conducted from October 2020 to May 2022.INTERVENTIONSParticipants were randomly assigned at a 1:1 ratio (block size of 4) to a smart system of disease management group (SSDM) or a conventional care control group. Upon the completion of the 6-month parallel comparison, patients in the conventional care control group were instructed to use the SSDM application for an extension of 6 months.MAIN OUTCOMES AND MEASURESThe primary outcome was the rate of patients with disease activity score in 28 joints using the C-reactive protein (DAS28-CRP) of 3.2 or less at month 6.RESULTSOf 3374 participants screened, 2204 were randomized, and 2197 patients with RA (mean [SD] age, 50.5 [12.4] years; 1812 [82.5%] female) were enrolled. The study included 1099 participants in the SSDM group and 1098 participants in the control group. At month 6, the rate of patients with DAS28-CRP of 3.2 or less was 71.0% (780 of 1099 patients) in the SSDM group vs 64.5% (708 of 1098 patients) in the control group (difference between groups, 6.6%; 95% CI, 2.7% to 10.4%; P = .001). At month 12, the rate of patients with DAS28-CRP of 3.2 or less in the control group increased to a level (77.7%) that was comparable with that (78,2%) in the SSDM group (difference between groups, −0.2%; 95% CI, −3.9% to 3.4%; P = .90).CONCLUSIONS AND RELEVANCEIn this randomized clinical trial of RA, the use of a digital health application with patient-reported outcomes was associated with an increase in disease control rate.TRIAL REGISTRATIONClinicalTrials.gov Identifier: NCT03715595

DreamBooth3D: Subject-Driven Text-to-3D Generation

“…Recently, denoising diffusion models [17] have been proposed for image synthesis, which can generate high-quality images by iteratively denoising a noise image toward a clean image [10,36,37,39]. Diffusion models can also be conditioned on various inputs such as depth-map [48], sketch [43], semantic segmentation [1,37], text [30,36,37,39] and others [18,22,48]. For text conditioning, these models take advantage of pre-trained large language models (LLMs) [34,35] in order to generate images that are aligned with a natural language text prompt given by the user.…”

“…It's worth noting that these methods do not generate 3D assets or 3D coherent images. There have also been developments in guiding image generation with grounding inputs [22], editing instructions [3], and task-specific conditions such as edges, depth, and surface normals [48]. However, these techniques do not provide personalization to specific subjects, and do not generate 3D assets.…”

A Mobile Health Application Integrated in the Electronic Health Record for Rheumatoid Arthritis Patient–Reported Outcomes: A Controlled Interrupted Time‐Series Analysis of Impact on Visit Efficiency

“…[7][8][9] One tested in China demonstrated improved patient outcomes. 10 Simultaneous with the advent of PRO applications, the rheumatic disease workforce is under stress. The most recent workforce reports from the American College of Rheumatology predict a substantial shortfall in person-power within the next decade.…”

“…Several other similar PRO applications have been developed for RA, with strong adherence and positive patient experiences 7–9 . One tested in China demonstrated improved patient outcomes 10 …”

Application of digital health technology in autoimmune diseases: Opportunity and challenge

“…The utilization of mobile health applications allows the continuous monitoring of patients' disease activity, triggering timely alerts. This, in turn, guides patients to seek medical attention and enhances the achievement rate of treatment goals, especially in rheumatoid arthritis patients 12 . Wearable devices, smart sensors, and mobile health applications collectively enable remote monitoring of patients' physiological parameters, symptoms, and treatment feedback.…”