The American College of Rheumatology (ACR) convened an expert panel from prior rheumatoid arthritis (RA) disease activity and functional status measures in order to provide strategies for the modification and use of these measures in telehealth settings.

One of the challenges associated with the rapid increase of telehealth visits during the COVID-19 pandemic relates to the importance of regular assessment of RA disease activity and functional status. An expert panel was convened by the ACR in order to provide recommendations on the use of RA disease activity and functional status measures for telehealth settings.

The recommended disease activity and functional status measures according to the 2019 ACR guidelines include both patient-reported measures  and measures requiring clinical assessments.

Patient-reported measures, including Patient Activity Scale-II and Routine Assessment of Patients Index Data 3 for RA disease activity do not require any modification for use in telehealth settings.


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On the other hand, measures that require clinician assessments for tender and swollen joint counts and/or physician global scores, including Clinical Disease Activity Index, 28-joint Disease Activity Score with ESR/CRP, and Simplified Disease Activity Index are not feasible in telehealth settings. Furthermore, the latter 2 measures require obtaining laboratory testing in conjunction with telehealth, which may be problematic.

When available, patient portals may be used to electronically collect patient reported measures directly from the patient. Otherwise, survey administered by providers or clinic staff during the telehealth visit may be used. Mailed paper forms can be prefilled by the patient and recorded during the telehealth visit or mailed back to the provider.

The ACR Clinical Practice Guidelines and Criteria App can aid in scoring of RA disease activity and functional status. The ACR website (https://www.rheumatology.org/Practice-Quality/Clinical-Support/Quality-Measurement/Disease-Activity-Functional-Status-Assessments) can also be used, when necessary.

The researches acknowledged that the lack of a new literature search on telehealth tools for the collection of disease activity or functional status measures is a limitation of this work.

“To support high-quality telehealth care for patients with RA in this new environment, we have described strategies for the modification and use of RA disease activity and functional status measures,” concluded the researchers.

Reference

England BR, Barber CEH, Bergman M, Ranganath VK, Suter LG, Michaud K. Brief report: Adaptation of American College of Rheumatology rheumatoid arthritis disease activity and functional status measures for telehealth visits. Arthritis Care Res (Hoboken). Published online Aug 19, 2020. doi:10.1002/acr.24429