How are RA patients doing using telemedicine/virtual care? Save

Rheumatologists switched their practices overnight from primarily in person to nearly all virtual care as COVID-19 pandemic geared up in March 2020 and then to a blend of in person and virtual care. Many rheumatologists had never done virtual care (including myself) so the learning curve was steep. 

At the ACR2020 meeting, Caroline Benson et al (#0483) studied patient reported disease activity using the patient clinical disease activity index (PT-CDAI) and the usual CDAI. Patients from the early RA incident cohorts from Canada (CATCH) and the US (CATCH-US). A total of 460 patients were studied. In the Canadian CATCH cohort, the mean SJC was 4.7 (out of 28) for the MD and patient reported measures but the TJC was a bit higher for patients (5.3 vs 7.5) and the CDAI was 17 vs PT-CDAI of 19. Data from the CATCH-US were similar where CDAI was 12.6 vs. PT-CDAI of 13.4. Not surprisingly, MD assessments were lower for tender joints (as has been shown in other studies) with more agreement at the lower CDAI values. Overall, agreement was good with kappa of 0.67 to 0.72 comparing the MD to the patient for CDAI scores.

So, I can continue to feel comfortable that if my patients with RA say that they are doing well and that their RA is under very good control, it is highly likely to be true. Whereas, if a RA patient says they are flaring when having a virtual (phone) visit, they may or may not be. What I do is I look in the past visits and see if my MD and patient global assessments are concordant. If they are, I bring the patient into clinic for an in person visit or prescribe a short course of prednisone if this is a recent onset flare. If the patient usually says they have very active disease and I usually rate the disease activity as low, then I look for other causes of pain. For patients, I think ‘flare’ means an increase in MSK pain for any reason. If I am uncertain, I always default to seeing the patient in person. These data help confirm that we can effectively do telemedicine for RA patients (at least some of the time).

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Editor's note: This news article was originally published November 6, 2020, during the 2020 ACR Convergence meeting, and is being shared again with readers post-event.