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

风湿性关节炎（RA）是一种慢性自身免疫性疾病，影响关节，导致疼痛和炎症。类风湿关节炎患者通常接受疾病缓解抗风湿药物（DMARDs），但DMARDs在类风湿关节炎中的作用机制尚不完全清楚。这可能解释了为什么在三种情况下，人们对一线治疗没有反应或反应不足，需要对其他DMARD进行进一步的试验和错误。此外，另外30%的接受DMARD治疗的人会出现严重的不良反应。目前，风湿病学家在治疗开始后3至6个月的常规随访中评估人们对DMARD的反应。他们决定继续或停止/改变DMARD治疗是基于DAS 28评分（疾病活动性的衡量标准）的变化，并辅以患者对自基线以来症状变化的通常不准确的总结。每天通过智能手机在诊所预约之间收集的患者报告的症状可以支持更快和更好地了解治疗调整，从而改善患者的治疗效果并更有效地利用医疗资源。然而，这种潜在的患者报告的症状仍然underinvestigated.Aims和目标：这个博士课程的目的是通过分析每日患者报告的症状数据，以更好地了解治疗反应的人与RA生活。最终，这将改善RA护理和结果。具体目标是（1）探索使用患者报告数据了解治疗反应和改善RA患者治疗决策的现状;（2）对于不同类型的DMARD，基于治疗开始后每日患者报告的症状的轨迹来鉴定和比较应答者表型，和（3）对于鉴定的应答者表型，调查他们（a）更及时和（B）更知情的治疗调整的潜力。

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.