Potential of digital applications for self-management and other outcomes in inflammatory rheumatic diseases: a systematic literature review

Alina Volkmar¹Cay-Benedict von der Decken^2,3,4,5Stefan Kleinert^6,7Kirsten Karberg^6,8Georg Gauler^6,9Michael Klennert¹⁰Jana Klennert¹⁰Peer Malte Aries^11,6Sonja Froschauer¹²Sarah Wildenhain¹²Theresia Muth¹²Susanna Späthling-Mestekemper^13,6Christoph Kuhn^14,6Wolfgang Vorbrüggen^4,6Martin Welcker^15,6Peter Bartz-Bazzanella^5,6Matthias Englbrecht^16*

• ¹University of Applied Sciences, Faculty of Life Sciences, Hamburg, Germany
• ²RHADAR--RheumaDatenRheport GbR, Erlangen, Germany
• ³Medizinisches Versorgungszentrum, Rheumatologie, Stolberg, Germany
• ⁴Verein zur Förderung der Rheumatologie eV, Würselen, Germany
• ⁵Klinik für Internistische Rheumatologie, Rhein-Maas-Klinikum, Würselen, Germany
• ⁶RHADAR - RheumaDatenRheport GbR, Erlangen, Bavaria, Germany
• ⁷Praxisgemeinschaft Rheumatologie-Nephrologie, Erlangen, Germany
• ⁸Rheumatologisches Versorgungszentrum Steglitz, Berlin, Germany
• ⁹Rheumatology Practice, Osnabrück, Germany
• ¹⁰STAR Healthcare Management GmbH, Köln, Germany
• ¹¹Immunologikum Hamburg, Hamburg, Germany
• ¹²BDRh Service GmbH, Grünwald, Germany
• ¹³Rheumapraxis München, München, Germany
• ¹⁴Praxis für Rheumatologie, Karlsruhe, Baden-Württemberg, Germany
• ¹⁵M.B.W.-Welcker GbR, Planegg, Germany
• ¹⁶Freelance Healthcare Data Scientist, Greven, Germany

Introduction: Inflammatory rheumatic diseases (IRDs) are chronic autoimmune conditions affecting the musculoskeletal system, leading to pain, disability, and reduced quality of life. Despite advances in medical treatments, barriers such as delayed diagnosis, workforce shortages, and low adherence to self-management strategies remain critical challenges. Digital health applications are emerging as promising tools to enhance disease management. The aim of this study was to conduct a systematic literature review (SLR) to evaluate self-care outcomes associated with digital health applications in IRDs.We conducted a systematic literature review according to PRISMA guidelines across four electronic databases (PubMed, Embase, CINAHL, Cochrane) from inception to July 2024. Randomized controlled trials (RCTs) and systematic reviews focusing on digital interventions to promote self-management and self-care in individuals with IRDs were included. Key outcomes were extracted and the quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist.Results: Fifteen RCTs with a total of 1912 participants were analyzed. Primary outcomes, including self-management/self-care, showed mixed results. Some studies demonstrated significant improvements in self-efficacy, pain reduction, depression/anxiety symptoms, and physical function, while others showed no notable changes. Secondary outcomes, including disease activity and medication adherence, revealed heterogeneous findings. Variability in study design, sample size, and intervention duration posed challenges for drawing definitive conclusions about the effectiveness of digital interventions.Discussion: Digital health applications show promise as cost-effective and scalable solutions to complement standard IRD care by empowering patients in their disease management. However, significant heterogeneity and limited generalizability highlight the need for more robust and longterm research to validate the efficacy of specific tools and identify best options for improving outcomes. Tailored digital interventions could bridge the gap in care for IRD patients and support their autonomy.