In patients with rheumatoid arthritis (RA) who received teleconsults during the initial wave of COVID-19, the reliability of clinician intervention regarding identification of individuals who required in-person visits and therapeutic adjustments was evaluated, in a study published in The Journal of Rheumatology.
The researchers sought to characterize which variables were most often used by rheumatologists to monitor RA in teleconsultations during the first wave of the COVID-19 pandemic, as well as to identify the variables that were more frequently associated with a change in disease management.
A retrospective, monocentric, routine-care, cross-sectional study was conducted among patients with RA who had received teleconsults between March 2020 and September 2020 in the Department of Rheumatology at Hôpital Cochin, Paris, France. All teleconsultations were conducted by telephone or video at the discretion of the physician.
Data were obtained from a review of electronic medical records (EMRs). Information regarding demographic data, disease characteristics (duration of RA, antibody status, presence or absence of erosive disease), ongoing RA therapy, and all variables for evaluation of disease status were collected.
Clinical intervention was defined by “treatment escalation and/or the need for a rapid face-to-face consultation or day hospitalization.”
A total of 143 individuals (81% women) with established RA were included in the study. The mean participant age was 58±16 years; the mean duration of disease was 14±11 years. Of 139 participants, positive rheumatoid factor was reported in 100 individuals (72%) and anticyclic citrullinated peptide (anti-CCP) antibodies were reported in 104 individuals (75%). Erosions were reported in 75 of 140 patients (54%).
Of the 143 participants, teleconsultation was conducted by telephone in
106 individuals (74%) and by video in 37 individuals (26%). A trend toward a higher rate of teleconsultations being performed by telephone vs by video was observed in patients with a low socioeconomic status (25% vs 13%; P =.11).
The presence or absence of patient-reported RA flares was noted, followed by the presence and/or number of tender joints (76%), duration of morning stiffness (66%), number of pain-related nocturnal awakenings (66%), and C-reactive protein (CRP) levels (54%).
Teleconsultation was associated with a clinician intervention in 15% of participants, which represented 51% (n=22/43) of individuals with self-reported flares. In addition, therapeutic escalation was needed in 13 participants and/or a face-to-face consultation or day hospitalization in 10 individuals.
According to multivariable analysis, RA flares (odds ratio [OR], 15.60; 95% CI, 3.37-68.28; P =.01) and CRP levels greater than 10 mg/L (OR, 3.32; 95% CI, 1.12-13.27; P =.03) were identified as the variables that were independently associated with clinician intervention.
Several limitations of the current study should be noted, most of which are inherent to its retrospective design. In spite of the suggestion that patient-reported outcomes (PROs) entered into the EMR might be highly relevant in teleconsultations, PROs are rarely used in daily practice in the rheumatology department in which the current study was conducted. Further, patient and clinician satisfaction was not evaluated. In addition, no validated questionnaire was used to collect the number of tender and swollen joints.
The authors concluded that the results of the current study, which “identified patient-reported RA flares and increased CRP values as 2 red flags, . . . may help clinicians’ decision making in teleconsultation and need to be confirmed in independent cohorts.”
Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Avouac J, Molto A, Frantz C, et al. Evaluation of patients with rheumatoid arthritis in teleconsultation during the first wave of the COVID-19 pandemic. J Rheumatol. Published online June 15, 2022. doi:10.3899/jrheum.220073