Review: Remote disease monitoring in rheumatoid arthritis

Rheumatoid arthritis (RA), the archetypal inflammatory arthritis, remains a complex and challenging disease to manage in spite of the abundance of new therapies in the last 20 years. The unpredictable relapsing/remitting nature of RA is at odds with the current prevailing system of scheduled follow-ups, leaving patients with RA to manage pain, flares, and medications between appointments, which may be of little value if occurring during a period of disease control. The rapid progress in the field of mobile health (mHealth) in the last 10 years has led to a proliferation of smartphone applications (apps) targeted at people with RA. Harnessing the power of smartphones to deliver remote monitoring for patients with RA has gone from an exciting possibility to an urgent necessity due to the COVID-19 pandemic. Apps developed solely by commercial providers have been found to be of limited utility in disease monitoring. However, multiple global institutions have developed mHealth technology to support remote monitoring of RA patients, utilizing asynchronous technology for patients to submit indicators of their disease activity, ranging from validated electronic patient-reported outcome measures, to innovative monitoring utilizing smartphone biosensors. This review discusses the current published evidence for mobile applications designed to facilitate remote monitoring of RA, the common barriers faced in implementing mhealth monitoring and strategies to overcome these, and potential areas for future research.