s35_ab5

Internet-based monitoring of patients with rheumatoid arthritis

S.J. Lee, L. Lenert, A. Kavanaugh

Center for Innovative Therapy, UCSD, Division of Rheumatology, Allergy and Immunology, La Jolla, California, USA.

ABSTRACT
Patient-derived measures have been increasingly recognized as a valuable means for monitoirng patients with rheumatoid arthritis. One advantage of this data is that it can be collected remotely. This would allow more frequent and more rapid assessments, which could optimize therapeutic intervention and patient outcome.

Case vignette: October 28, 2006
Mrs. Ann Dawson is a 46-year-old woman who presents to her primary care physician (PCP) with pain in her joints that has been present for about 6 weeks. She self-medicated with an over-the-counter NSAID, and comes in due to worsening pain and an inability to continue working at her job.
On initial presentation, the patient has bilateral swelling of all of her MCP joints and several PIP and DIP joints, as well as both wrists and knees. The PCP prescribes a tapering course of prednisone and a different NSAID, and orders laboratory tests as well as radiographs of her hands and knees. Results are completed early in the next week, and show an ESR of 86, a positive rheumatoid factor of 325 IU/dL and a high titer of anti-CCP antibodies. X-rays show only soft-tissue swelling about the involved joints.
Despite a typical 8-month wait for a new patient referral appointment, a local rheumatologist agrees to see the patient the next week after the PCP presents the details of the case. On evaluation, the rheumatologist confirms the joint involvement noted by the PCP, and additionally finds synovitis of the elbows and ankles. An ultrasound examination shows greater involvement with synovitis in the PIP joints than was suspected clinically and also reveals small periarticular erosions at several MCP joints.
Knowing that the patient has not only active disease, but also multiple risk factors for severe disease and a poor outcome, the rheumatologist wishes to embark on an aggressive course of treatment. Methotrexate is begun at an initial dose of 12.5 mg per week, along with folic acid. However, due to a shortage of rheumatologists as well as constraints imposed by her payer, the soonest the patient can be seen in followup by the rheumatologist is 12 weeks later. How can this patient be started on an effective regimen in the shortest possible time ?

Key words
Patient monitoring, rheumatoid arthritis, Internet, computer.

Please address correspondence to: Arthur Kavanaugh, MD, Professor of Medicine, Center for Innovative Therapy, UCSD, Division of Rheumatology, Allergy and Immunology, 9500 Gilman Drive, La Jolla, CA 92093-0943, USA.