Intervention
RA
ADVERSE REACTIONS, DISEASE
Patients randomized to the SSDM group were asked to conduct self-assessment and report the results once every month by themselves. Patients randomized to the control group received conventional care and maintained their routine medical visits during the first 6 months and were asked to come back for a visit at month 6 and month 12.Upon the first use of the system, a research staff was onsite to assist the patients with the following information: full name, sex, date of birth, date of initial diagnosis, comorbidities, education level, occupation, family income, annual medical expenses, and DAS28-CRP at each research site. Other information included: (1) laboratory results (eg, routine blood test, liver and kidney function, and CRP), submitted as photographs and automatically processed to extract key information via Optical Character Recognition technology; (2) medications, for RA as well as comorbid conditions; and (3) perceived adverse reactions (a total of 33 types of symptoms). The DAS28-CRP score, as assessed by patients, together with key laboratory reports if available, were uploaded and synchronized to a rheumatologist’s interface, and the assigned rheumatologists could monitor the patient’s condition online, as well as instruct the patients to come back for outpatient visits or refill or make new prescriptions.The alert function of the SSDM was performed at 4 months after the trial started. A red flag was raised for 1 or more of the following conditions: (1) disease activity exacerbation—the DAS28-CRP score increased to and remained MDA for 3 months or increased to HDA in patients with REM or LDA at baseline; (2) sustained MDA or worsening HDA—the DAS28-CRP score remained at 3.2 to 5.1 for 3 months or increased to more than 5.1 in patients with MDA at baseline; (3) HDA status—the DAS28-CRP score remained higher than 5.1 for 3 months, decreased to between 3.2 and 5.1 but had subsequent exacerbation (ie, DAS28-CRP increased to >5.1) at any time point, or no further reduction by at least 1.2 within 3 months in patients with HDA at baseline. The alert was also triggered upon elevated alanine aminotransferase or aspartate aminotransferase levels above 2 times the upper normal limit or a white blood cell count of less than 2000 or greater than 10 000 per mL.Patients in the SSDM group watched a 15-minute video that described the key features of the SSDM to allow them to correctly use of the application. The use of SSDM and self-assessment of DAS28-CRP by patients were confirmed by physicians.