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

类风湿关节炎(RA)是一种慢性自身免疫性疾病，影响关节，导致疼痛和炎症。RA患者通常接受疾病修饰的抗风湿药物(DMARDS)，但DMARD在RA中的作用机制尚不完全清楚。这可能解释了为什么在三个病例中的一个病例中，人们对他们的一线治疗没有或没有足够的反应，需要对其他DMARD进行进一步的试验和错误试验。此外，另外30%接受DMARDS治疗的人会出现严重的不良反应。目前，风湿病专家在治疗开始后3至6个月的常规随访中评估患者对DMARD的反应。他们决定继续或停止/改变DMARD治疗是基于DAS28评分(疾病活动性的衡量标准)的变化，加上患者自基线以来对症状变化的往往不准确的总结。患者报告的症状每天通过智能手机在诊所预约之间收集，可能支持更快、更知情的治疗调整，从而改善患者结果并更有效地利用医疗资源。然而，患者报告症状的这种可能性仍然没有得到充分的研究。目的和目的：这个博士项目旨在通过分析患者报告的日常症状数据，更好地了解类风湿关节炎患者的治疗反应。最终，这将改善RA的护理和预后。具体目标是(1)探索使用患者报告的数据来了解治疗反应并改进RA患者的治疗决策的当前状态；(2)对于不同类型的DMARDS，基于治疗开始后患者报告的每日症状的轨迹，识别和比较应答者表型；(3)对于确定的应答者表型，调查它们在(A)更及时和(B)更知情的治疗调整方面的潜力。

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.