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To determine demographic and clinical predictors of 12-week adherence to a rheumatology-specific mobile health application in patients with IA. We retrospectively analyzed 2,036 adult users of the CE-certified Mida Rheuma App (2022\u20132024). Adherence was defined as self-reported body weight entry at week 12. Candidate predictors included age, gender, time since diagnosis, baseline body weight, and two patient-reported outcomes (PROs): Patient\u2019s Global Assessment of Disease Activity (PGADA) and Patient\u2019s Global Assessment of Pain Intensity (PPAIN). A Random Forest classifier (six predictors) was evaluated with repeated stratified 5\u2009\u00d7\u20092 cross-validation; performance was summarized by receiver-operating characteristic area under the curve (ROC AUC). Of 2,036 patients, 526 (25.8%) met the adherence criterion. Adherence increased with age (peak\u2009\u2248\u200947.4% at 63\u201369 years) and showed a threshold with disease duration (peak\u2009\u2248\u200945.2% at 3,001\u20133,500 days, &gt;\u20093,000-day inflection). PROs exhibited non-linear (\u201cinverted-U\u201d) patterns, with higher adherence at moderate-to-high symptoms (e.g., PGADA 35\u201340\u2009\u2248\u200939.3%; PPAIN 10\u201315\u2009\u2248\u200939.3%) and lower adherence at minimal or extreme values. Baseline body weight contributed modest predictive information, while the gender effect was minimal. The model achieved an ROC AUC of 0.627 (95% CI, 0.600\u20130.654), indicating modest but informative discrimination. In this large real-world IA cohort, 12-week adherence was highest among older patients, those with longer disease durations (&gt;\u20093,000 days), and those reporting moderate-to-high symptom burdens. These results support the use of stratified onboarding and tailored support, particularly for younger or newly diagnosed patients and those at symptom extremes, and motivate the development of multidimensional adherence metrics in prospective studies.<\/jats:p>","DOI":"10.1007\/s00296-025-06017-9","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T11:24:20Z","timestamp":1765797860000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predictors of adherence to a digital health application in patients with inflammatory arthritis: retrospective analysis"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7965-9438","authenticated-orcid":false,"given":"Dmytro","family":"Fedkov","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6500-7180","authenticated-orcid":false,"given":"Christine","family":"Peine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6102-2674","authenticated-orcid":false,"given":"Felix","family":"Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9969-5462","authenticated-orcid":false,"given":"Abdullah","family":"Khalil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9695-0657","authenticated-orcid":false,"given":"Johannes","family":"Knitza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9684-9700","authenticated-orcid":false,"given":"Jan","family":"Leipe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"issue":"12","key":"6017_CR1","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1038\/s41584-024-01177-7","volume":"20","author":"J Knitza","year":"2024","unstructured":"Knitza J, Gupta L, H\u00fcgle T (2024) Rheumatology in the digital health era: status quo and quo vadis? 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Now, it has been updated.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"DF, FL, AK, and CP are employees and have an equity interest in Midaia GmbH and have no other disclosures to make. Midaia GmbH developed a mobile application used in this study, but did not finance it. JK received financial support from ABATON GmbH, developer of software for rheumatic diseases. JL declares that he has no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was conducted following the ethical principles of the Declaration of Helsinki and Good Clinical Practice guidelines and was approved by the appropriate institutional review boards (Local Ethic Committee of Medical Center Medical Clinic Blagomed LLC), protocol #107\/5, dated 13 Aug 2022). 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