Evaluation of Patients With Rheumatoid Arthritis in Teleconsultation During the First Wave of the COVID-19 Pandemic.

Abstract

To describe which variables were collected by rheumatologists to monitor patients with rheumatoid arthritis (RA) during teleconsultation and identify which ones have more impact on clinician intervention. Retrospective monocentric, routine care cross-sectional study including patients with RA seen in teleconsultation between March and September 2020. Available variables assessing disease status were collected in teleconsultation files. Clinician intervention was defined by treatment escalation and/or the need for a rapid face-to-face consultation or day hospitalization. One hundred forty-three patients with RA were included (116 females, mean age of 58 [SD 16] yrs, mean disease duration of 14 [SD 11] yrs). The presence or absence of patient self-reported RA flares was mentioned in all medical files, followed by the presence and/or the number of tender joints (76%), the duration of morning stiffness (66%), the number of pain-related nocturnal awakenings (66%) and the C-reactive protein (CRP) value (54%). Teleconsultation led to a clinician intervention in 22/143 patients (15%), representing 51% of patients with self-reported flares (22/43 patients). Therapeutic escalation was necessary in 13 patients and/or face-to-face consultation or day hospitalization were organized for 10 patients. Multivariate analysis identified RA flares (odds ratio [OR] 15.6, 95% CI 3.37-68.28) and CRP values > 10 mg/L (OR 3.32, 95% CI % 1.12-13.27) as the variables independently associated with clinician intervention. Our study identified patient-reported RA flares and increased CRP values as 2 red flags in teleconsultation, independently associated with therapeutic modification and/or the need for a rapid face-to-face consultation. These indicators may help clinicians' decision making in teleconsultation.