DiBiRA

The challenge

Monitoring disease activity in rheumatoid arthritis (RA) relies on episodic clinical visits, laboratory tests, and imaging, which can miss rapid changes such as flares and place a significant burden on patients. The interval between clinic appointments, typically several weeks or months, creates blind spots in understanding disease progression. During this period, patients may experience symptom fluctuations that go undetected until the next scheduled visit, potentially delaying treatment adjustments. Whilst patients may struggle to recall symptom patterns accurately during consultations, objective measures like inflammatory markers require blood draws and do not capture the full spectrum of disease impact on daily functioning. Imaging provides valuable structural information but is expensive, time-consuming, and not suitable for frequent monitoring. Continuous, non-invasive monitoring could enable earlier detection of changes in disease activity and support more personalised treatment decisions, ultimately improving outcomes and quality of life for patients living with this chronic, progressive condition.

The project: DiBiRA

DiBiRA is a prospective, longitudinal observational study of adults with active rheumatoid arthritis receiving a triamcinolone acetonide injection. The study design captures the dynamic nature of RA disease activity through continuous monitoring in patients' daily lives, moving beyond the limitations of clinic-based assessments.

Participants wear medical-grade devices continuously, collecting physiological data including heart rate variability, skin temperature, respiratory rate and electrocardiogram parameters, alongside activity patterns, sleep metrics, and detailed gait characteristics. These objective measurements are complemented by digital questionnaires completed via a smartphone app that capture patient-reported symptoms, pain levels, duration of stiffness, and functional status. This multimodal approach provides a comprehensive picture of treatment response that extends far beyond what traditional episodic assessments can achieve, revealing patterns that might otherwise remain hidden.

TNO leads the development and validation of digital biomarkers, applying advanced statistical modelling and machine learning to identify meaningful patterns in large datasets. The focus is on identifying digital signatures that distinguish high from low disease activity, for example, specific patterns in nocturnal heart rate variability or gait asymmetry that correlate with inflammatory burden. Beyond simply reflecting the current state, the project explores whether these biomarkers can predict treatment response before clinical changes become apparent, enabling proactive rather than reactive care.

The project aims to identify digital biomarkers that not only reflect current disease activity but also predict future treatment outcomes. Alongside biomarker development, DiBiRA evaluates the feasibility of continuous monitoring in this patient population and assesses patient experience through questionnaires, ensuring that any future implementation is both technically sound and acceptable to users.

Looking to the future

Validated digital biomarkers from DiBiRA will enable clinicians to monitor disease activity remotely and detect flares earlier, facilitating timely treatment adjustments and potentially preventing irreversible joint damage. The next phase will focus on validating these biomarkers in larger, multicentre studies and exploring their utility in guiding treatment tapering decisions, a particularly important application given the risks associated with long-term immunosuppressive therapy. Collaboration with rheumatology departments, pharmaceutical companies developing targeted therapies, and patient advocacy groups will be crucial to translate these findings into clinical practice, ultimately enabling more personalised and effective management of rheumatoid arthritis.