Bottom Line
Based on available evidence, it’s reasonable to argue that by identifying the right subset of patients (e.g., those with low disease activity who could reliably report symptoms based on self-assessment and manage some form of communication on a digital platform [SMS, text]), telerheumatology could succeed as an adjunct tool to help triage established patients.
More rigorous studies are needed to examine the potential impact on the healthcare system, particularly in regard to cost effectiveness. It’s also not clear, in terms of disease subsets, which patients would benefit, because most studies included patients with RA or an unspecified form of inflammatory arthritis. Another contentious question is how to adequately train the presenters (who are not rheumatologists) to present a complex history and verbally convey articular exam findings accurately.
As a rheumatologist, I like to think we are irreplaceable. But it’s also clear we are in need of innovative assistance to meet demands. Perhaps telerheumatology is one solution.
Elizabeth Park, MD, is a second-year rheumatology fellow at Columbia University Irving Medical Center, New York. Her interest in telemedicine stems from working with the Mobile Health Informatics Program, Botswana-UPenn Partnership as a medical student. She is pursuing a career in clinical research studying cardiovascular outcomes in rheumatoid arthritis patients.
Table 1: FLARE-RA Questionnaire7
The patient is asked to indicate whether the following statements are absolutely true, true, fairly true, not really true, untrue or completely untrue.
- You noticed the appearance or worsening of morning stiffness in joints over several consecutive days.
- You noticed the appearance or worsening of pain in one or several joints over several consecutive days.
- You noticed the appearance or worsening of swelling in one or several joints over several consecutive days.
- You noticed the worsening of your sleep because of arthritis pain over several consecutive nights.
- You noticed a marked worsening in your arthritis lasting several consecutive days.
- You increased your doses of pain killers or anti-inflammatory medication over several consecutive days (if you are not taking any pain killer, select ‘completely untrue).
- You increased your daily dose of prednisone for several consecutive days (if you are not taking prednisone, select ‘completely untrue).
- You felt particularly tired for several consecutive days because of your rheumatic disorder.
- You were so restricted that you have decreased your daily activity over several consecutive days.
- You felt more irritable than usual over several consecutive days because of your rheumatic disorder.
- You felt depressed over several consecutive days because of your rheumatic disorder.
- You felt you wanted to withdraw and be alone over several consecutive days because of your rheumatic disorder.
- You felt an increased need for help over several consecutive days because of your rheumatic disorder.
References
- Charting outcomes in the match. Specialties Matching Service, Appointment Year 2018. National Resident Matching Program.
- Deal C, Bolster MB, Hausmann JS, et al. 2015 ACR/ARHP workforce Study (WFS): Adult rheumatology specialists in the United States: Effect of gender and generation [abstract]. Arthritis Rheumatol. 2016;68(suppl 10).
- American College of Rheumatology Committee on Rheumatology Training and Workforce Issues, FitzGerald JD, Battistone M, et al. Regional distribution of adult rheumatologists. Arthritis Rheum. 2013 Dec;65(12):3017–3025.
- Tuckson RV, Edmunds M, Michael L. Hodgkins ML. Telehealth. N Engl J Med. 2017 Oct 19;377(16):1585–1592.
- McDougall JA, Ferucci ED, Glover J, Fraenkel L. Telerheumatology: A systematic review. Arthritis Care Res (Hoboken). 2017 Oct;69(10):1546–1557.
- De Thurah A, et al. Tele‐health followup strategy for tight control of disease activity in rheumatoid arthritis: Results of a randomized controlled trial. Arthritis Care Res (Hoboken). 2018 Mar;70(3):353–360.
- Berthelot J-M, De Bandt M, Morel J, et al. A tool to identify recent or present rheumatoid arthritis flare from both patient and physician perspectives: The ‘FLARE’ instrument. Ann Rheum Dis. 2012 Jul;71(7):1110–1116.
- Kuusalo L, Sokka-Isler T, Kautiainen H, et al. Automated text message-enhanced monitoring versus routine monitoring in early rheumatoid arthritis: A randomized trial. Arthritis Care Res (Hoboken). 2020 Mar;72(3):319–325.
- Felson DT, Smolen JS, Wells G, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011 Mar;63:573–586.
- Ferucci ED, Holck P, Day GM, et al. Factors associated with use of telemedicine for follow‐up of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2019 Aug 17. [online ahead of print]
Editor’s note: See the ACR’s suggestions for using telemedicine during the pandemic here.
