Mobile App Improves Disease Control in Patients with Rheumatic Diseases

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A targeted lifestyle counseling app was shown to improve disease activity among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA), according to a study published in Nutrients.¹

Previous research has proven common autoimmune inflammatory rheumatic diseases are impacted by nutritional patterns, exercise, and mental health. The Mediterranean Diet has been recommended for these patients due to its anti-inflammatory effects and the European League against Rheumatism (EULAR) has even published guidance on lifestyle modifications for inflammatory rheumatological conditions.²

“Lifestyle changes are notoriously hard to induce in patients,” wrote a team of German investigators. “There are several potential obstacles to efficient lifestyle counseling, including time restrictions and insufficient reimbursement modalities or even a lack thereof, depending on the local health policy.”

Investigators recruited a cohort of patients with RA, SpA, and PsA from St. Elisabeth-Hospital Meerbusch-Lank and Krankenhaus Porz am Rhein in Cologne, Germany. Patients were randomized to receive 12 weeks of individualized lifestyle counseling via an app or were placed in a control group that only reported patient-reported outcomes (PROs). The app included information on physical activity, mental health, and the Mediterranean Diet. Disease activity was measured and categorized as remission, low, moderate, and high. The Mediterranean Diet Adherence Screener (MEDAS) was used to determine dietary adherence.

The primary outcome was to determine the effect of the app on disease activity as assessed by the number of patients who were able to achieve low disease activity or remission. Secondary endpoints were diet adherence, health-related quality of life as measured using the Short Form 36 Health Survey (SF36), physical activity level, and depression and anxiety levels measured using the Patient Health Questionnaire (PHQ 4).

A total of 158 patients were included in the single-blinded, randomized, controlled trial, of which 73% were female and the median age was 53.3 ± 11.7 years. Among this group, 74 were placed in the active counseling group (ACG). All patients showed improvement in either low disease activity or remission, although patients in the ACG group reported better success (odds ratio [OR] = 2.8 [95% confidence interval (CI) 1.1 – 7.2, P = .035] vs OR = 2.1 [.9 – 5.0, P = .097], respectively).

Additionally, controls were less likely to achieve a MEDAS ≥ 4, which investigators believe is reasonable cut-off for determining a healthy vs unhealthy diet (OR = .16 [.03 – .77], P = .02). Patients receiving active counseling were more likely to reach this goal (OR = .54 [.06 – 4.63], P = .6). Additionally, patients in the ACG exhibited improved adherence to the Mediterranean Diet (β = .35 [−.05 – .74], P = .086) compared with controls (β = .09 [−.29 – .46], P = .64).

No changes were observed in terms of depression, physical function, weight, and weekly time spent being physically active.

Although previous studies have reported mental health and physical activity were improved by apps, investigators did not implement instruments that were able to detect more subtle changes in these domains. Therefore, they were unable to determine if clinically significant effects went unnoticed in the ACG cohort due to the detection method coupled with the small sample size. Further, investigators noted they did not address the possibility of smart phone addiction in the study, although previous data did not show an increased risk.

“In follow-up studies, the inclusion of a more detailed dietary assessment is likely to provide further insight and help to even better define healthy nutrients for rheumatic diseases beyond broad categories such as that of a ‘healthy Mediterranean Diet,’” investigators concluded.

References

1. ^{Kurt T, Vossen D, Schumacher F, et al. Effect of Lifestyle Counselling via a Mobile Application on Disease Activity Control in Inflammatory Arthritis: A Single-Blinded, Randomized Controlled Study. Nutrients. 2024;16(10):1488. Published 2024 May 14. doi:10.3390/nu16101488}
2. ^{Gwinnutt, J.M.; Wieczorek, M.; Balanescu, A.; Bischoff-Ferrari, H.A.; Boonen, A.; Cavalli, G.; de Souza, S.; de Thurah, A.; Dorner, T.E.; Moe, R.H.; et al. 2021 EULAR Recommendations Regarding Lifestyle Behaviours and Work Participation to Prevent Progression of Rheumatic and Musculoskeletal Diseases. Ann. Rheum. Dis. 2022, 82, 48–56.}