Legislation is changing, and doctors and psychotherapists are increasingly likely to prescribe medical smartphone applications. Indeed, Forbes recently stated that the COVID-19 pandemic was boosting digital therapeutics. That´s all well and good—but questions nevertheless remain about what digital therapeutics really are and what they really offer to our patients. Below, we list seven reasons why digital therapeutics and app-managed treatments are a good thing, although there are also some areas of uncertainty:

1.) Information

That´s the most obvious point. Providing reliable information plays a major role in treating patients. Merely taking a pill is rarely a sustainable therapy and compliance often becomes an issue. Patients need to know what is really wrong with them and what they can do about it. Good smartphone applications can provide this information, ideally in a personalised way. In the past, nurse-led care has undoubtedly proven its efficacy e.g. by promoting patients’ self-management skills, self-efficacy ect. Unfortunately, there is a worldwide shortage of nurses, but digital support could help to meet this shortfall…

2.) Monitoring

We know that monitoring, e.g. for treat-to-target strategies is a good thing, for example, in patients with rheumatoid arthritis or gout. It seems obvious that patients can monitor their disease more precisely and autonomously with digital support.

3.) Coordinating

Rheumatic diseases, anxiety, depression, muscular deconditioning, fibromyalgia occur regularly in the same patients , all requiring special care. All their different treatment modalities require coordination. Apps can coordinate symptoms systematically or hierarchically and adapt different therapeutic modalities such as physical activity, sleep improvement for a better and more holistic treatment of our patients.

4.) Connecting

Chronic diseases such as arthritis or fibromyalgia fluctuate in intensity, and sharing with peers is a relief. Group therapies for patients with chronic pain have been proven effective and, in a smaller setting, this might work via apps which offer this feature to connect with similar patients. Some apps can operate as a personal assistant and are capable of making an appointment with the doctor.

5.) Reporting

Patients usually have 20 minutes or less to consult with their doctor; that´s not much time. Summarising several weeks of symptoms in just 20 minutes is not an easy task for everybody. It’s much better to be able to show charts with disease activity, mobility and medications taken. This saves time for the rheumatologist too.

6.) Visualising

Instead of trying to understand your patient’s description of what their joint looked like six weeks ago, why not scroll through a time-line of their photographs assigned to each particular symptom?

7.) Artificial intelligence

Why shouldn’t rheumatologists and patients learn directly from every patient’s (shared) data? Deep learning and other AI tools can automatically provide the app user with explanations and context about their disease. What makes my case special? Why does the treatment not work on me but work on others? What should I be doing? Neural networks can also provide individual disease forecasts and image recognition.

There remain numerous areas of uncertainty. Appropriate studies are needed to show the efficacy of digital therapies. What about the user interface and the user experience (UI/UX)? Is there an (ap)placebo effect? What of data safety, privacy standards and connections to electronic medical records? What if AI goes wrong? What roles do the pharmaceutical industry or Google play in this? How will digital therapeutics be reimbursed by medical insurance schemes?

Digitalisation changes patient care. Patients and doctors will have to adapt. Rheumatologists will adapt.

by Thomas Hügle