Digital Rheumatology Save

Hello. I'm Jonathan Kaye reporting from EULAR twenty twenty four in Vienna, Austria. I'm gonna talk about two posters that were presented at EULAR. These are posters number O four five one and o six zero seven, both of which come from the University Hospital Lausanne in Switzerland, the group of Thomas Hugler. During the COVID-nineteen pandemic, we faced the challenge of assessing patients with rheumatoid arthritis remote We switched from in person visits to telehealth.

And since rheumatoid arthritis is a disease that is largely assessed based on physical examination, we were challenged in ways to detect joint swelling as well as joint tenderness. Thomas Hugo and Marc Blanchard in his group and others have developed some digital applications for an iPhone, which allow patients to record their hands and give a sense of swelling or loss of motion. The first app is one called Detectra, which is one where the patient captures a real world image of the second through fourth proximal interphalangeal joints. And because with swelling, the folds over the finger joint expand and the ratio of the distance between these folds increases with swelling compared to no swelling, they're able to come up with a reasonably reliable way of detecting finger joint swelling, both worsening and improvement. They trained this model using a convolutional neural network on photographs of seventeen eighty three proximal interphalangeal joints from patients with rheumatoid arthritis and an additional 151 proximal interphalangeal joints to come up with fingerfold number and proximal interphalangeal joint diameters.

They calculated a fingerfold index as the ratio of the joint diameter to the mean pixel length of detected fingerfolds and came up with a reasonable correlation with the DAS28 CRP and swelling and pain on a single joint level. This may be a useful tool to use with remote patient monitoring or with telehealth visits when patients are unable to come into the office, either because of illness, pandemic, or distance. Another challenge is how does one detect function? And they came up with another digital application called Mephisto, which is looking at finger motion. It measures the angle of motion of flexion of the proximal interphalangeal and distal interphalangeal joints.

And they ask patients to make a fist rapidly five times, and it captures, using an algorithm, the angle as well as the rate of motion. And patients who have increased pain and swelling will flex their finger joints more slowly, and those who improve can do it more rapidly. They found that the rate of swelling as well as the I'm sorry, the rate of flexion as well as the maximal flexion of metacarpophalangeal and proximal interphalangeal joints correlated with the HAC DI as well as the DAS28 CRP. So with these two applications, we're reasonably into being able to assess patients remotely using digital rheumatology. This will need to be borne out with further study and additional applications will need to be developed to assess function and other aspects of the physical examination.

But this is both interesting and promising for the future of rheumatology. For more information about this and other presentations at EULAR twenty twenty four in Vienna, go to rheumnow.com. I'm Jonathan Kaye, and look forward to seeing you again soon.