Adopting Right-Sized Patient Care in Rheumatology

In this week’s news roundup from Rheumatology Network, we led the week with three stories on COVID-19 and rheumatic disease that were based on new reports published in The Lancet Rheumatology.

The first was an observational study that found elevated levels of inflammatory markers---C-reactive protein and ferritin----may suggest which patients will experience a more severe case of COVID-19.

In the second, which was a small study from China, researchers suggested that patients with autoimmune rheumatic disease might be more susceptible to COVID-19 infections. A larger analysis would be needed to support those findings, they wrote.

In the third Lancet study we featured, researchers reported that the long-term use of hydroxychloroquine may increase mortality risk, but the risk doesn’t apply to patients who use the drug for a short period of time.

And, in non-COVID-19 news, we featured a study about gout. In this case, researchers published a review and meta-analysis in the Journal of Human Nutrition and Dietetics that finds consuming sugar-sweetened beverages is significantly associated with gout flares.

We also featured two studies on osteoporosis. In one, atypical bone fractures appear to be more common in patients who use bisphosphonates long-term. Otherwise, the risk is typically very low. In the second study, researchers reported that bisphosphonates lower fracture risk, but not mortality risk which rises after a serious fracture.

And, finally, in today’s one-on-one interview, we talk with Dr. Jeffrey Curtis, he is a rheumatologist and epidemiologist and the associate director of the University of Alabama Center for Education and Research on Therapeutics of Musculoskeletal Diseases.

This week, he and I spoke about the use of activity trackers as a tool to record and track arthritic flare-ups. The device has been found to be useful in improving patient care or as Dr. Curtis says, “we need to right size care” by giving patients the right care at the right time.”

The goal of the project, Dr. Curtis says, was to understand whether activity trackers could be useful in following patients with inflammatory arthritis in between office visits.

"Most rheumatologists see patients with gout or rheumatoid arthritis or psoriatic arthritis, three to six times at most (in a year). But I want to know what is going on the other 360 days of the year because I'm their doctor every day of the year. Rheumatologists lack ways to really know how patients are doing between the times they may come see us. The notion that I might have a way to know how you are doing between the time you come to see me in clinic is incredibly powerful [but] tracking a flare of arthritis is difficult to do in a trial setting. People are not always going to come in when they have a flare and flares will not always coincide with a clinical study visit. But maybe, and more importantly, as a practicing clinician I am excited about having the ability to know how patients are doing between visits. That's the power here and it's really the opportunity that's provided by the app," he said.

An activity tracker is beneficial for a number of reasons, but above all, it can eliminate the possibility of errors occurred through recall bias. Unless flare events are recorded daily, it would be impossible to recall with accuracy the severity and frequency of arthritis flares. The activity tracker eliminates the guesswork, Dr. Curtis said.

"The end goal is to enable rheumatologists to take better care of patients. There is a workforce shortage which essentially means that we can't keep doing the same things the same way because we're used to it. We can't say follow-up in three or four months because that's what we've always done. We need to right-size care which is the idea behind precision medicine or personalized medicine. It means that I need to give you the right care at the right time, but it doesn't mean that everybody gets everything exactly the same way---that's not personalized care. That's an algorithm or a cookbook. The notion that we can help monitor how you're doing out of the office is incredibly powerful," he said.

For more information about ArthritisPower, click her to download the mobile app. It's free.

In this interview, he explains how an activity tracker can make such a huge difference in the care patients receive.