Project ID NS-MH2024_46


Co Supervisor 1A Institute of Psychiatry, Psychology & Neuroscience, School of Mental Health & Psychological Sciences, Department of PsychologyWebsite

Co Supervisor 1B Faculty of Life Sciences & Medicine, School of Immunology & Microbial Sciences, Department of Inflammation BiologyWebsite

Additional Supervisor Dr James Galloway

Remote assessment of disease flares in rheumatoid arthritis

There has been an increasing interest in the potential of remote assessment technologies in healthcare settings (e.g., electronic patient reported outcomes [ePROs]) to allow additional information disease experience and mental health to inform decision making. The pandemic led to a step change in care delivery with fewer in-person appointments and a shift towards patient-initiated (e.g., due to disease flare) rather than routine appointments. As a result, remote assessment is increasingly important and now often embedded within routine care, typically as ePROs completed every few months with increased monitoring around key points in the disease course (e.g. treatment initiation, disease flare). A key issue is the ability to monitor somatic and psychological symptoms and distinguish disease flares from short term illnesses/events, such as inflections or periods of high psychological stress, which can also be monitored using similar approaches (e.g. Zoe COVID Study, the world’s largest study of COVID-19).

This project will examine the use of daily ePROs and wearables during disease flare in immune mediated inflammatory diseases, such as rheumatoid arthritis and psoriasis/psoriatic arthritis. Specifically, the project will evaluate the ability of remote assessment technologies to identify and distinguish disease flares from short-term illnesses and infections, characterise flare types (inflammatory vs non-inflammatory), and evaluate the precipitating clinical and psychosocial factors related to flare onset and duration.

This studentship will consist of three studies:
1. Systematic review of remote assessment technologies for monitoring disease flare in immune mediated inflammatory diseases (0-9months)
2. Analysis of existing ePRO data and potentially Zoe COVID Study data to identify the frequency and course of disease flare versus short-term illnesses (3-12months)
3. Measurement burst study with ~120 high-risk patients completing weekly assessments for 6 months, with daily assessments for up to 10 days during flare (12-36months)

Representative Publications

Tung, H. Y., Galloway, J., Matcham, F., Hotopf, M., & Norton, S. (2021). High-frequency follow-up studies in musculoskeletal disorders: a scoping review. Rheumatology, 60(1), 48-59.;

Arumalla, N., Chan, C. K., Gibson, M., Man, Y. L., Adas, M. A., Norton, S., … & Garrood, T. (2023). The clinical impact of electronic patient?reported outcome measures in the remote monitoring of inflammatory arthritis: a systematic review and meta?analysis. Arthritis & Rheumatology.;

White, K. M., Ivan, A., Williams, R., Galloway, J. B., Norton, S., & Matcham, F. (2021). Remote measurement in rheumatoid arthritis: qualitative analysis of patient perspectives. JMIR Formative Research, 5(3), e22473.

Bechman, K., Sin, F. E., Ibrahim, F., Norton, S., Matcham, F., Scott, D. L., Cope, A., & Galloway, J. (2018). Mental health, fatigue and function are associated with increased risk of disease flare following TNF inhibitor tapering in patients with rheumatoid arthritis: an exploratory analysis of data from the Optimizing TNF Tapering in RA (OPTTIRA) trial. RMD open, 4(1), e000676.;

Bechman, K., Halai, K., Yates, M., Norton, S., Cope, A. P., British Society for Rheumatology Biologics Register for Rheumatoid Arthritis Contributors Group, … & Klimiuk, P. (2021). Nonserious infections in patients with rheumatoid arthritis: results from the British Society for rheumatology biologics register for rheumatoid arthritis. Arthritis & Rheumatology, 73(10), 1800-1809.