Mobile Health Apps for Systemic Lupus Erythematosus and Lupus Nephritis

A Critical Appraisal

Akshara Ramasamy; Poojitha Dugyala; Chandra Mohan

Disclosures

Arthritis Res Ther. 2022;24(110) 

In This Article

Background

Systemic lupus erythematosus (SLE) is a chronic disorder in which the body's immune system attacks its own tissues, causing widespread inflammation. SLE affects at least 1.5 million individuals in the USA, with 16,000 new cases recorded each year.[1] Lupus nephritis (LN) is a complication of SLE with manifestations such as kidney inflammation and eventual renal failure.[2] Approximately 40% of adults and 50–80% of adolescents with systemic lupus erythematosus will develop lupus nephritis, as early as a year within diagnosis.[2–4] Conventional treatment for LN includes high-dose corticosteroids and immunosuppressive agents.[5,6] While pharmacologic treatments have increased patient survival overall, drug therapies are associated with a wide range of adverse effects, and corticosteroids have caused significant treatment-associated toxicity.[5,6] In recent years, both patient progress and immunosuppressive treatment for LN have stagnated. At 12 months, short-term complete renal response rates are 10–40%, long-term outcomes have not adequately improved, and end-stage kidney disease may develop in 10–30% of individuals with LN.[5,6] In addition, one of the most common causes of treatment failure is non-adherence to pharmaceutical therapy.[7]

SLE and consequently LN have a significant impact on a patient's quality of life, which is heavily influenced by the psychosocial components of the disease.[8] Though pharmacologic treatments address the clinical manifestations of LN, alternative therapies are needed to address the psychological symptoms such as cognitive difficulties, depression, and fatigue. Over the past decade, there has also been a growing interest in non-pharmacologic therapies as supplementary treatment options for LN patients. Psychological interventions such as psychotherapies have shown to be beneficial as adjuncts to traditional medical treatment in LN patients for improvement in fatigue, depression, pain, and quality of life.[9]

With the advent of non-pharmacological treatment options, there has also been a rise of health information technology (HIT) such as disease-specific apps for mobile devices. In recent years, HIT has become increasingly important in rheumatic illnesses, particularly the care of patients with SLE and LN, for diagnostic, therapeutic, and prognostic purposes, as well as disease management.[8] Mobile phones and wireless technologies utilized in healthcare (mHealth) help bridge the gap between the patient and the healthcare practitioner by providing physicians with a realistic summary of the patient's health state in between consultations. The more easily symptoms and changes can be captured in real time and communicated to a healthcare practitioner, the better the condition may be controlled. As SLE/LN symptoms vary greatly on a daily basis and are unique to the individual, mHealth holds promise in the management of autoimmune diseases. For example, a clinical trial by Mymee Inc., a digital health company dedicated to autoimmune disease research, demonstrated that the Mymee Digital Health Program resulted in statistically significant improvements in health-related quality of life (HRQoL) in lupus patients when combined with standard therapy.[10]

In the USA, approximately 85% of Americans own smartphones.[11] This percentage increases within the young adult population, with 95% of American teenagers having access to a smartphone.[12] Due to the widespread use of smartphones, mHealth technologies play an increasingly significant role in SLE/LN management, particularly among young adults, who have more severe symptoms.[1] Understanding the quality and functionality of the available mobile health apps for lupus patients is crucial to decreasing the communication gap between the physician and patient and increasing the patient's overall quality of life. This systematic review and critical appraisal aim to study the functionality and quality of the available mHealth apps for SLE and LN patients, using well-accepted tools and metrics. Understanding the role mHealth apps play in disease management is critical for clinicians to build patient-centered treatment plans and for the overall well-being of individuals with SLE and LN.

processing....