Digital home monitoring in patients with juvenile idiopathic arthritis to increase intervals of hospital visits

OBJECTIVES: Juvenile Idiopathic Arthritis (JIA) patients attend routine hospital check-ups, even when disease activity is low. These visits are time-consuming and costly. Replacing visits with home monitoring may reduce costs but should not affect safety and (perceived) quality of care. This non-inferiority study tested whether patients with inactive JIA could safely prolong visit-intervals by home monitoring disease activity using EuroQol EQ-5D-Y-5L and Juvenile Arthritis Multidimensional Assessment Report (JAMAR) questionnaires. METHODS: One regular three-monthly visit was replaced by home monitoring. Healthcare professionals evaluated responses to determine whether patients could safely prolong their visit-interval or needed a doctor's consultation. Flare percentages over the total study period and six months after baseline were compared with a historical flare percentage and with matched JIA patients using relative risks (RR) and a non-inferiority margin of 15%. Secondary outcomes were number of reminders, number of patients not completing home monitoring, and patient satisfaction. RESULTS: 84 patients aged between 6 and 20 years participated in the study. Eighteen patients had a visit before or after evaluation of the questionnaires. 63 had a prolonged interval, of whom seven experienced a flare. The study-wide flare percentage was 18.5%, the historical flare percentage was 18.4% (including non-inferiority margin). The RR for study-wide flares was 0.50 (95%CI: 0.29-0.86), showing non-inferiority. The study was underpowered for comparing flares after prolonged visit-intervals (RR: 0.77, 0.30-1.93). 92% showed interest in home monitoring more often. CONCLUSION: No clear evidence was found that increased visit-intervals with home monitoring poses a risk for missing disease flares. Reminders were necessary and patient satisfaction was high. TRIAL REGISTRATION: Clinicaltrials.gov.uk; NCT05603286.