Currently accepted at: JMIR Formative Research
Date Submitted: Apr 19, 2026
Date Accepted: Oct 28, 2026
Date Submitted to PubMed: Nov 3, 2026
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/98774
The final accepted version (not copyedited yet) is in this tab.
An "ahead-of-print" version has been submitted to Pubmed, see PMID: 42973436
Mixed Reality-Based Telemedicine for Rheumatoid Arthritis in a Remote Island Setting: A Pilot Feasibility Study (Nagasaki University Rheumatoid Arthritis Remote Medicine System, NURAS)
ABSTRACT
Background:
Rheumatoid arthritis (RA) requires regular monitoring by specialists; however, access to rheumatologists is severely limited in remote island setting. Conventional two-dimensional video-based telemedicine has shown limitations in conducting detailed joint assessments remotely.
Objective:
This study aimed to evaluate the feasibility of the Nagasaki University Rheumatoid Arthritis Remote Medicine System (NURAS), a novel telemedicine platform utilizing mixed reality (MR) technology to enable remote three-dimensional joint assessment by rheumatologists and deliver specialist care to underserved populations on remote islands.
Methods:
NURAS is a system that enables remote rheumatologists to perform joint assessments using three-dimensional holographic visualization based on MR technology beyond conventional two-dimensional video telemedicine. Six patients with RA at Goto Chuoh Hospital, located on a remote island, were enrolled in a 12-month pilot feasibility study. The primary endpoint was to evaluate the feasibility of establishing a foundational framework for remote RA rheumatologist consultations using MR technology. Secondary endpoints included changes in clinical disease activity (DAS28-CRP and CDAI) and patient-reported outcomes (PROs) (HAQ-DI, RAID, FACIT-F, VAS, and K6) at 6 and 12 months.
Results:
All 6 patients completed the 12-month follow-up. NURAS enabled a collaborative joint assessment between the on-site physician and the remote rheumatologist, with joint findings determined through a consensus discussion. Exploratory analyses showed improvement in clinical disease activity over time, including a decrease in mean DAS28-CRP from 2.89 at baseline to 1.74 at 12 months (P =0.03), while PROs demonstrated favorable exploratory trends in this small feasibility cohort.
Conclusions:
NURAS demonstrated technical and clinical feasibility in delivering specialist-led telemedicine to patients on remote islands. The observed improvements in disease activity should be interpreted as preliminary signals that require validation in larger controlled studies. Clinical Trial: This study was a noninterventional observational study and was therefore not prospectively registered. This study was approved by the Nagasaki University Hospital Clinical Research Ethics Committee (approval number: 21081605).
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