Patients Who Have Rheumatic Disease May Benefit From Telemedicine

Telemedicine may be an effective mode to deliver care for people with rheumatic and musculoskeletal diseases (RMDs), according to a study published in Seminars in Arthritis and Rheumatism.

The COVID-19 pandemic spurred a sudden uptake in telemedicine in rheumatology. Telemedicine may reduce costs and increase accessibility, while providing comparable patient outcomes compared with in-person appointments. However, the researchers of the present study encourage further investigation to determine the best uses of telemedicine for rheumatic conditions.

“This unprecedented and rapid transition to virtual methods of consultation and follow-up within rheumatology in the wake of the COVID-19 pandemic has presented unique challenges in managing patients with RMDs,” wrote the authors.

They analyzed recent literature on telemedicine for the diagnosis and management of inflammatory, noninflammatory, and/or autoimmune rheumatic diseases. A registered systemic search for interventional or observational studies published between August 2015 and January 2022 was performed, and studies were included if they reported outcomes in 10 or more people with rheumatic disease.

Thirty-six reports met inclusion criteria: 27 observational studies, 7 randomized clinical trials, and 2 controlled clinical trials. These studies encompassed 7102 patients with a variety of rheumatic conditions; however, sample sizes were small in a majority of these studies.

These studies focused on general rheumatology, rheumatoid arthritis, gout, osteoarthritis, unspecified inflammatory arthritis, osteoporosis, and systemic lupus erythematosus. The researchers included patients with noninflammatory diseases because they represent a unique population of patients particularly amenable to remote disease monitoring.

The resulting analysis demonstrated that the most commonly reported outcome was patient satisfaction, as the majority of studies demonstrated high levels of satisfaction.

The effect of telemedicine on primary outcomes varied among the interventional studies. Most of these found that telemedicine was as good as usual/in-person care for disease activity control, patient satisfaction, total societal costs, and other patient-reported outcomes. Further, effectiveness and feasibility were found to be high across telemedicine intervention types based on several factors, including disease activity, satisfaction, and cost-effectiveness. The study investigators noted, however, that most demonstrated a high risk of bias.

Data on cost assessment, conducted in 7 of the studies, indicated that telemedicine generally demonstrated cost savings vs in-person visits, with travel-related savings being the greatest.

These findings demonstrate that telemedicine may be an effective mode to deliver care for inflammatory, noninflammatory, and autoimmune rheumatic diseases.

The authors suggest that telemedicine has the potential to mitigate barriers to care and address the rheumatology provider workforce shortage, although they caution that physicians must be aware of disparities in digital literacy when considering telemedicine options for patients.

Although this review highlights unmet needs in rheumatology, the authors encourage further research. Specifically, they recommend randomized clinical trials to determine the best uses of telemedicine for the diagnosis and management of rheumatic conditions and its effect on clinical outcomes.

Most of the studies demonstrated limitations due to their design and the overall high risk of bias. Additionally, many of the observational studies lacked a comparator group.

The authors note that their findings regarding telemedicine's effectiveness should be interpreted with caution given the small sample sizes and inability to blind participants.

However, they assert that even studies demonstrating moderate or high bias may still be meaningful and contribute to the literature on telemedicine and rheumatology.

Reference

Jackson LE, Edgil TA, Hill B, et al. Telemedicine in rheumatology care: a systematic review. Semin Arthritis Rheum. Published online June 15, 2022. doi:10.1016/j.semarthrit.2022.152045