Exploring treatment response in people living with rheumatoid arthritis using daily patient-reported symptom data collected through smartphones

Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects the joints, resulting in pain and inflammation. People with RA commonly receive disease modifying anti-rheumatic drugs (DMARDs), but the mechanism of how DMARDs work in RA is not fully understood. This may explain why in one of three cases, people do not or insufficiently respond to their first-line treatment, requiring further periods of trial and error with other DMARDs. Furthermore, an additional 30% of people treated with DMARDs experience severe adverse effects. Currently, rheumatologists assess people's response to a DMARD during routine follow-up appointments 3 to 6 months after treatment initiation. Their decision to continue or discontinue/change DMARD treatment is based on a change in the DAS28 score (a measure of disease activity), complemented with patients' often inaccurate summary of a change in symptoms since baseline. Patient-reported symptoms, collected daily via smartphones in between clinic appointments, may support quicker and better informed treatment adjustments, leading to improved patient outcomes and more efficient use of healthcare resources. However, this potential of patient-reported symptoms remains underinvestigated.

Aims and objectives: this PhD programme aims to better understand treatment response in people living with RA through analysing daily patient-reported symptom data. Ultimately, this will improve RA care and outcomes. Specific objectives are to (1) explore the current state of play of using patient-reported data to understand treatment response and improve treatment decisions in people with RA; (2) for different types of DMARDs, identify and compare responder phenotypes based on trajectories of daily patient-reported symptoms after treatment initiation, and (3) For the identified responder phenotypes, investigate their potential for (a) timelier and (b) better informed treatment adjustments.